Managing Eustachian Tube Disorders

[Walter Kutz]
Yeah. I mean, I think the first patient you're describing, the ones that ... They have ear fullness. They have some intermittent pain. It's suggestive of eustachian dysfunction. They come in, but every time they come in, their tympanograms are normal. You don't see fluid. You don't see retraction. At that point, I'm probably thinking about other problems. Most commonly, temporomandibular joint dysfunction, or TMJ dysfunction, is what I'm really thinking about if they have a normal exam. If a patient has cervical spine issues, sometimes that can radiate to the ear and they may have ear fullness and ear pain from that.

Of course, you always want to make sure they don't have any sort of neoplasm, so a good head-neck exam is always important, especially if they have persistent otalgia. But in the patients that say "Well, my ear is full all the time" or "My ears are full all the time" but their tympanograms are normal and their exams are normal, I'd be very hesitant to do any more than talk to them about allergies and allergy treatments. You may think about "Well, should I place a tympanostomy tube or not?" In my experience, seeing patients that have had that done on the outside coming in ... A lot of times they're not very happy with the tube. They sort of feel there's a tube there and their symptoms worsen.

One thing you could try ... I don't know if you've ever tried this, Ashley, or Gopi, but you can offer somebody just do a myringotomy. You can just say "Hey. Let's just make a small incision of the ear drum. Why don't you kind of test drive that for a week or so by the time it heals?" and if their symptoms are better with that, then you can place a tympanostomy tube, and you really haven't placed a tube with really not needing one. So, I think that's a good technique to try on some of these patients.

[Gopi Shah]
Yeah. I agree. I would favor that route as well, as opposed to putting in a tube, just to kind of see how things go, because if they do ... If the discomfort of the fullness truly is due to eustachian tube dysfunction, they should feel relief with a myringotomy, right?