Tensor Veli Palatinopexy as a Novel Treatment for Eustachian Tube Dysfunction: A Cadaveric Feasibility Study

Abstract

Objective To demonstrate the feasibility of a novel procedure whereby a suture is placed transorally in the tensor veli palatini muscle to tighten it, thereby dilating the cartilaginous portion of the eustachian tube (ET). Study Design The study design was a prospective cadaveric experiment to examine the feasibility of a novel treatment for ET dysfunction. Setting Academic medical center in a research-oriented operating room with intraoperative computed tomography (CT) capabilities. Methods Seven fresh-frozen cadaver heads were obtained, each of which was thawed for 36 hours prior to use. The preprocedural volumes of the cartilaginous ET were measured by filling the ET with an iodine-containing radiocontrast agent via the nasopharynx and then obtaining CT images. Submucosal flaps in the soft palate were raised, and sutures were placed in the tensor veli palatini bilaterally to increase tension. After completion of the procedure, contrast placement and CT imaging were repeated. Three-dimensional models of the ETs were created, and the volumes were measured and compared. Results Of the 14 ETs evaluated, 13 showed an increase in postprocedure volume. On average, postprocedure volumes showed a 57% increase from preprocedure volumes (mean relative change, 57.1%; P = .013). Conclusion Placement of a tension-holding suture in the tensor veli palatini muscle can reliably dilate the cartilaginous portion of the ET. Such a procedure may be useful in the treatment of ET dysfunction.

The Eustachian Tube Dysfunction in Children: Anatomical Considerations and Current Trends in Invasive Therapeutic Approaches

“…Moreover, cadaveric studies have shown the efficacy of standard endovascular balloons for ET dilation [ 73 ]. Finally, there have been some interesting experimental techniques in cadavers with metallic stents in the cartilaginous part of the tube [ 74 ] and with tensor veli palatinopexy in an attempt to improve the muscular mechanism of active tube opening [ 75 ]. Nevertheless, ET dilation is a promising technique that will undoubtedly evolve and eventually gain popularity in the future; it has already been proposed that ET dilation may be efficiently performed under local anesthesia in an office setting, substantially reducing costs [ 76 ].…”