BackTable / ENT / Podcast / Episode #4
Managing Eustachian Tube Disorders
with Dr. Joe Walter Kutz
Dr. Ashley Agan and Dr. Gopi Shah talk with Dr. Joe Walter Kutz about the management of Eustachian Tube Disorders, including pearls and pitfalls on treating the "clogged ear".
BackTable, LLC (Producer). (2020, August 20). Ep. 4 – Managing Eustachian Tube Disorders [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Joe Walter Kutz
Dr. Joe Walter Kutz is a neurotologist and Professor of Otolaryngology and Neurosurgery at the University of Texas Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. Walter Kutz joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the essentials of caring for patients with chronic eustachian tube disorders. They emphasize that the diagnosis of patients with chronic eustachian tube disorders can be challenging. Patient history is often the driving factor in evaluation of these patients, but objective measures such as tympanograms can aid in the diagnostic process.
They describe in detail the differentiating features of patulous eustachian tube, a commonly missed diagnosis with a similar presentation as eustachian tube dysfunction. The best practices for evaluation of patulous eustachian tube are outlined, including the ideal set up for otoscopic and endoscopic nasal exams. They also touch on the treatment options for patulous eustachian tube, giving insight into procedure details as well as complications.
The discussion then evolves to focus on more complicated cases of eustachian tube dysfunction, including patients with atrophic tympanic membranes as well as those refractory to tympanostomy tube placement. The efficacy and challenges of eustachian tube targeted procedures such as balloon dilation are reviewed. The role of allergy evaluations in management and care of eustachian tube dysfunction patients are also considered. Finally, they touch briefly on some notes on the diagnosis of eosinophilic otitis media and superior canal dehiscence.
Dr. Kutz’s Website: https://utswmed.org/doctors/joe-kutz/
Dr. Kutz’s Twitter Handle: @EarDoc1
Dr. Kutz’s Instagram Handle: @walterkutzmd
PatulEND - Patulend.com
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.
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?
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