Selective epitympanic dysventilation syndrome.

OBJECTIVES/HYPOTHESIS Although middle ear aeration is certainly related to eustachian tube (ET) function, other anatomic factors may play an important role in ventilation of these spaces, particularly the epitympanum. STUDY DESIGN A prospective case series study group with retrospective case series comparison. METHODS Eight patients affected by non-self-cleaning attic retraction pockets or attic cholesteatoma of the middle ear and normal tubal function (verified by type A tympanogram or Williams' test) underwent endoscopic surgery. Anatomic findings were noted and collected, with particular attention paid to middle ear folds. A control group was used for comparison. The prevalence of an isthmus blockage with a complete tensor fold in pathologic ears was compared between the study group and control group. RESULTS The higher prevalence of an isthmus blockage associated with a complete tensor fold in the study group was found to be statistically significant (P = .001). CONCLUSIONS A selective epitympanic dysventilation syndrome is hypothesized; normal ET function seems to be insufficient for complete ventilation of the middle ear, and an open tympanic isthmus or an incomplete tensor fold may be necessary for epitympanic recess ventilation. The selective epitympanic dysventilation syndrome would consist of the contemporary presence of the following four conditions: attic retraction pocket or cholesteatoma, normal tubal function tests, complete epitympanic diaphragm, and isthmus blockage.