Predictors of eustachian tube dysfunction improvement and normalization after endoscopic sinus surgery

Abstract

Objective: Studies have demonstrated improvement in Eustachian tube dysfunction (ETD) symptomatology after functional endoscopic sinus surgery (FESS); however, factors associated with ETD symptom alteration have not been elucidated. This study evaluated factors associated with improvement and normalization of ETD symptoms after FESS.

Methods: A case-control study was performed of FESS patients who had clinically significant ETD symptoms based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7 ≥ 2.1) without middle ear effusion (MEE) preoperatively. Study patients were identified as those with a normalized ETDQ-7 at 2 months postoperatively. Controls were patients whose ETDQ-7 did not normalize at 2 months. Demographics, surgery characteristics, chronic rhinosinusitis phenotype, Lund-Mackay score, temporomandibular joint dysfunction (TMJD), preoperative ETDQ-7 and SNOT-22 scores, and tympanograms were analyzed. Univariate and multivariate analyses were performed comparing study cases and controls.

Results: Data were collected on 165 patients, with 46% patients having clinically significant preoperative ETD and 60 patients meeting final study inclusion/exclusion criteria. FESS was associated with both SNOT-22 and ETDQ-7 improvement (P < 0.001). Nasal polyposis was associated with a higher probability of ETDQ-7 normalization (OR 4.429, P = 0.035). Factors associated with failure of ETDQ-7 normalization included TMJD (OR 0.086, P < 0.001, 95% CI 0.019-0.391) and high preoperative ETDQ-7 (OR 0.140, P = 0.006, 95% CI 0.032-0.613).

Conclusion: In patients with clinically significant ETD symptoms without MEE, FESS was associated with ETDQ-7 improvement. Nasal polyposis was associated with an increased probability of normalization of ETD symptoms postoperatively, whereas TMJD had a negative association.

Level of evidence: 3b Laryngoscope, 2019.

Keywords: Chronic rhinosinusitis; disease severity; endoscopic sinus surgery; eustachian tube dysfunction; patient-reported outcome measure; quality of life; sinus surgery; temporomandibular joint dysfunction.