Sinonasal Inflammatory Burden on Computed Tomography in Adults With Obstructive Eustachian Tube Dysfunction: A...

Chronic rhinosinusitis (CRS) and Eustachian tube dysfunction (ETD) frequently coexist, yet objective data quantifying their relationship remain scarce. Because both conditions can reflect shared mucosal inflammation, we investigated whether adults with objectively verified ETD harbor a larger paranasal sinus inflammatory burden on computed tomography (CT) than controls, and whether this burden varies by drainage pathway or ear laterality.

This single-center, retrospective CT case-control study compared 140 adults who underwent balloon tuboplasty for obstructive ETD (January 2017-April 2025) with 312 vestibular schwannoma controls without inflammatory middle-ear disease. Sinonasal opacification was graded using the Lund-Mackay (LM) scoring system with an LM score ≥ 5 used as a CRS-related radiologic threshold. Anterior and posterior compartment scores were analyzed separately. Ear-level analysis distinguished ipsilateral and contralateral sinonasal cavities. Group differences were assessed using the Mann-Whitney U test and Fisher's exact test.

The total LM score was more than twice as high in the obstructive ETD group as in controls (1.77 ± 2.94 vs. 0.80 ± 1.51; p = 0.002; d = 0.47). The proportion of patients with an LM score ≥ 5 on CT was higher in the obstructive ETD group than in controls (17.9% vs. 4.2%; OR, 5.00; 95% CI, 2.47-10.11; p < 0.001). Both anterior and posterior compartments showed greater opacification in obstructive ETD (p = 0.002 and p < 0.001), with no significant between-compartment difference in effect size. Ipsilateral and contralateral cavities showed comparable inflammatory burden, and both exceeded controls.

Adults evaluated for obstructive ETD had a higher bilateral sinonasal inflammatory burden on CT than controls, involving both anterior and posterior drainage pathways. These findings support awareness of coexisting sinonasal inflammation in obstructive ETD and warrant prospective studies on integrated sinonasal and otologic management.

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