Should Nasal Function be Considered Prior to Tympanoplasty?

Abstract

OBJECTIVE:To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS and METHODS:The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS:Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION:Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

Does Nasal Septal Deviation Affect the Eustachian Tube Function and Middle Ear Ventilation?

“…As a result, Maier and Krebs suggested that septoplasty should be performed before the chronic otitis surgery. On the contrary, Akyıldız et al (17) proposed that patients with NSD generally had poor ET function; however, this did not affect the outcome of tympanoplasty.…”

The Effect of Types of Nasal Septum Deviation on the Eustachian Tube Function

“…Recent studies show that ETF may not be affected by NSD. Akyıldız et al (2) showed that NSD decreased ETF but not at a level that would affect tympanoplasty results. They concluded that performing septoplasty before tympanoplasty is not necessary (2).…”

“…Akyıldız et al (2) showed that NSD decreased ETF but not at a level that would affect tympanoplasty results. They concluded that performing septoplasty before tympanoplasty is not necessary (2). Also, Tan et al (16) did not recommend performing septoplasty before tympanoplasty and they indicated that septoplasty does not have effect on tympanoplasty results.…”

“…Nasal pathologies (anatomic, functional) may affect the middle ear ventilation by acting on the ET. The effects of nasal obstruction on the pathophysiology of middle ear diseases and the success rates of the surgeries (tympanoplasty, miringoplasty) performed in this region are debated (2).…”

“…However, whether before all middle ear surgeries, all septal deviations in the nose should be corrected is still controversial. In the literature, there are studies claiming that surgical operation is needed to provide healthy functions of the ET (ETF) and for the successful middle ear surgeries (3)(4)(5), as well as there are studies claiming that surgical operation is unnecessary (2,6,7). Because we do not have a common practice, the choice is mostly left to the physician.…”