Stenting of the eustachian tube to prevent otitis media with effusion after maxillary swing approach nasopharyngectomy

Authors

  • Ambrose Chung-Wai Ho FRCSEd,

    Corresponding author
    1. Division of Otorhinolaryngology–Head and Neck Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
    • Send correspondence to Ambrose Chung-Wai Ho, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. E-mail: ambroseho@hku.hk

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  • Jimmy Yu-Wai Chan FRCS,

    1. Division of Otorhinolaryngology–Head and Neck Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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  • Raymond Wai-Man Ng FRCS,

    1. Division of Otorhinolaryngology–Head and Neck Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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  • Wai-Kuen Ho FRCSEd,

    1. Division of Otorhinolaryngology–Head and Neck Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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  • William Ignace Wei FRCS

    1. Division of Otorhinolaryngology–Head and Neck Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Our previous report recommended that the management of ipsilateral otitis media with effusion (OME) after maxillary swing nasopharyngectomy was observation. The idea of introducing a stent into the eustachian tube (ET) at the nasopharyngeal side after nasopharyngectomy may prevent postoperative OME. The purpose of this study was to examine the feasibility of intraoperative ET stenting and the efficacy of preventing ipsilateral OME formation.

Study Design

Prospective cohort study.

Methods

From 2009 to 2011, 28 patients with nasopharyngectomy via the maxillary swing approach were recruited. Patients with curative resection were recruited (n = 21). ET stenting was performed intraoperatively using a 16-gauge Angiocath (BD Medical Systems, Franklin Lakes, NJ) with dimensions of 1.7 mm × 30 mm. The stent stays inplace indefinitely. The otologic status was evaluated using otoscopy, pure-tone audiogram, and tympanogram at 3 months, 6 months, and 1 year after the surgery. The outcomes were analyzed and compared with historical control.

Results

There were 9 (43%) patients with no OME at 6 months after surgery, and 15 (71%) patients had no OME at 1 year postoperatively. The results were statistically significant (P < .0001) when compared with our historical control of no ET stenting. There was no incidence of adverse effects of the stenting, such as acute otitis media, dislodgement of the stent, otalgia, and nasal pain.

Conclusions

ET stenting was feasible after nasopharyngectomy. ET stenting prevented a significant number of patients from suffering from ipsilateral OME and alleviated the symptoms of unilateral aural fullness and unilateral conductive hearing impairment up to at least 1 year after the surgery. ET stenting is recommended in all patients after maxillary swing nasopharyngectomy.

Level of Evidence

4. Laryngoscope, 124:139–144, 2014

Ancillary