Endoscopic transnasal eustachian tube reconstruction via light cable technique: A technical report

P eustachian tube (pET) is a rare but disabling condition in which the cartilaginous portion of the ET is open at rest. Normally, the tube valve remains closed, opening transiently during swallow and yawn. Patients with pET describe autophony, aural fullness, and hearing one’s own physiological sounds such as swallowing and respiration. Imbalance can also occur along with these other symptoms. The condition has been described as disabling to many patients. pET has been treated surgically with varying degrees of success using autologous cartilage grafting, silicone plugging, autologous fat grafting, suture ligation, transtubal cautery, and luminal reconstruction. Recently, the senior author published a longitudinal case series showing that a multilayer approach using cautery, fat plugging, and suture ligation of the ET to be effective in decreasing the autophony of pET. One patient in our series unexpectedly developed complete obliteration of her ET several months postendoscopic ligation. Although her autophony had resolved, she was now faced with constant middle ear effusion, myringotomy tube clogging, and ear pain and pressure, all of which severely limited her function. Her symptoms became even more debilitating than those caused by the original pET condition. After several attempts to suction the ear and replace the myringotomy tubes, it became evident that reopening the obliterated ET was the only option. Because her anatomy was drastically altered by scar tissue, there was no lumen visible and hence a conventional endoscopic dissection was not viable. In this technical report, a novel tuboplasty method using a fiberoptic light cable is described.