Restoring middle ear pressure equalization in divers by laser Eustachian tuboplasty.

INTRODUCTION

Impaired Eustachian tube function can limit one's fitness to dive. This study investigated the effect of minimally invasive laser Eustachian tuboplasty (laser tuboplasty) on tube function in divers and its long-term effect on their diving habits.

METHODS

In a prospective surgical trial in nine divers with tubal dysfunction, laser tuboplasty was performed and the results were controlled pre- and postoperatively with impedance measurement in a pressure chamber.

MAIN OUTCOME MEASURE: Tube function was analyzed pre- and postoperatively by pressure chamber and standard clinical tests. Eustachian tube closing pressure was evaluated as a measure of tissue pressure. With severely impaired Eustachian tube function a "blocked" pattern was evident, and no measurement of closing pressure was possible. All divers were interviewed four years postoperatively for their diving habits.

RESULTS

Before laser tuboplasty, five divers showed a blocked pattern in pressure chamber testing. However, in four of them a normal opening pattern was restored postoperatively. Closing pressure was reduced from 7.40 +/- 1.52 mbar (0.74 +/- 0.152 kPa) to 2.85 +/- 1.11 mbar (p < 0.005). In the long term, all subjects reported a restored ability for pressure equalization, and seven of nine were diving again.

CONCLUSION

Divers with tubal dysfuction seem to benefit from the minimally invasive laser tuboplasty.