Role in Management of Otitis Media

Some specific management options to treat and prevent otitis media and certain related conditions are related to Eustachian tube dysfunction, whereas others are not. An understanding of the role that tubal dysfunction plays in the currently available nonsurgical and surgical options can be helpful not only in the decision-making process to treat or not to treat but also the reasons for complications related to the treatment, such as post–tympanostomy tube otorrhea. From evidence-based clinical trials, some of the options have been shown to be effective, whereas others have yet to be scientifically proven. Thus, an understanding of the role of the Eustachian tube in the pathogenesis of the disease can provide a rationale for specific treatment options, even if proof of efficacy is lacking (see Chapter 6, “Pathogenesis”). This chapter presents the role that the Eustachian tube plays in management related to acute otitis media, otitis media with effusion, and Eustachian tube dysfunction; the latter conditions may be obstruction (including barotrauma) or the patulous Eustachian tube. Chapter 10, “Role in Certain Complications and Sequelae of Otitis Media,” deals with the complications and sequelae of otitis media and Eustachian tube dysfunction that are most likely related to tubal dysfunction, such as atelectasis of the middle ear, retraction pocket, and some aspects of acquired cholesteatoma, perforation of the tympanic membrane, and chronic suppurative otitis media.