Clinical Outcomes of Transcanal Endoscopic Eustachian Tube Plug Insertion

Objective: To evaluate the clinical outcomes and safety of transcanal endoscopic Eustachian tube plug insertion for patulous Eustachian tube (PET). Study Design: Retrospective observational study. Setting: Department of Otolaryngology at Tokyo Rinkai Hospital, a tertiary referral center, from January 2023 to March 2024. Patients: Nineteen ears from 13 patients diagnosed with PET according to Japan Otological Society criteria who showed insufficient response to conservative treatment for at least 6 months. Intervention: Transcanal endoscopic silicone plug insertion. Main Outcome Measure(s): Changes in sonotubometry sound pressure levels, PET Handicap Inventory-10 (PHI-10) scores, anatomical features of the bony portion of the Eustachian tube. Results: Mean sound pressure levels increased significantly from 99.0 dB HL preoperatively to 119.4 dB HL postoperatively ( P <0.05). Mean PHI-10 scores improved from 26.2 to 7.5 points ( P <0.05). Treatment was effective in 84.2% of cases (16/19 ears). Although plug insertion presented technical challenges in cases with well-developed peritubal cells and bony prominence, endoscopic assistance enabled successful placement into the Eustachian tube in all cases. Conclusions: Endoscopic Eustachian tube plug insertion demonstrates high efficacy for refractory PET. Preoperative imaging assessment and endoscopic visualization of the bony portion of the Eustachian tube are crucial for successful plug placement.