Ist die Chirurgie der inneren Nase vor Tympanoplastik indiziert? *

Abstract

We conclude from our data that dysfunction of the Eustachian tube frequently occurs in patients with deviation of the nasal septum and the conchae. Septoplasty and conchotomy worsen tubal function during the early postoperative period, lasting for at least one week. In a later period, improvement of tubal function may occur but in many patients no effects of nasal surgery on Eustachian tube can be measured. Thus, septoplasty before tympanoplasty cannot be generally recommended in all patients with septal deviation. We suggest that it may be useful in cases with severe nasal pathology or chronic infection of the nose or the nasopharynx, if this is accompanied by poor tubal function. We recommend analysis of Eustachian tube function before deciding on therapeutic management. Individual findings in the specific patient should be the leading criteria in all cases. If septoplasty and conchotomia are done, tympanoplasty should not be performed in the same session or in the early postoperative period, but several months after nasal surgery.

Does Septoplasty Affect Middle Ear Pressure and Eustachian Tube Function?

“…In addition to septum deviation, the existence of paranasal and pharyngeal diseases, such as allergic rhinitis, concha hypertrophy, and adenoid hypertrophy, should be taken into consideration in studies that evaluate the effects of septoplasty on ET functions. When these diseases are present, septoplasty can further disrupt the functions of ET, and in these patients, septoplasty can contribute to the recovery of ET functions (11). In our study, we aimed to see the effects of only septum deviation and septoplasty on ET by excluding patients with additional pathologies other than septum deviation.…”

“…The effects of nasal septum deviation (SD), one of the most important causes of nasal obstruction, and of its surgical treatment on ET functions have long been discussed. In studies about this topic, especially on whether or not septoplasty recovers the functions of ET, contradictory results have been reported (1,10,11). But, no study of rhinomanometry that shows objective nasal patency has been conducted in patients who have undergone septoplasty.…”

Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults?

“…However, nasal or pharyngeal pathology is often thought to be responsible for inadequate tubal function. Therefore, potential interactions among the middle ear mucosa, ET function, and nasal or pharyngeal pathology are considered when planning myringoplasty [ 7 , 8 ]. Several sinonasal and nasopharyngeal procedures can enhance tubal function and thereby improve otologic outcomes [ 8 , 15 , 16 ].…”

“…ETD can result in chronic negative middle ear pressure, which can cause TM retraction, COM with effusion, and middle ear infection [ 2 ]. Thus, some studies suggested that nasal abnormalities and pathology should be identified and corrected before myringoplasty is performed [ 7 , 8 ]. Sinonasal and nasopharyngeal procedures may improve ET function and, by extension, otologic outcomes [ 1 ].…”

“…Two studies suggested that simultaneous myringoplasty and septoplasty is feasible in adults with both middle ear and sinonasal pathology, and is attractive in terms of operative and anesthetic morbidity, time, and the lower cost of surgically repairing nasal and ear problems simultaneously [ 1 , 9 ]. However, others disapproved of simultaneous nasal surgery and myringoplasty because it increases the risk of graft reperforation [ 7 , 10 , 11 ]. Salvinelli et al [ 12 ] recommended that tympanoplasty and nasal surgery not be performed at the same time, and that middle ear surgery should be carried out when the anatomy and physiology of the nasal, pharyngeal, and tubal mucosae have returned to normal.…”