Surgical Solutions

The most common surgical treatments for PET include fillers, shims, grafts, and obliteration.

These are in order from least invasive to most invasive.

• Tubes (Tympanostomy Tubes): This procedure involves making a small incision in the eardrum to insert a silicone tube. While typically performed for chronic ear infections or fluid buildup, it can provide symptom relief for PET by stabilizing the pressure on the eardrum caused by air movement from the sinuses. While this does not address the underlying cause of PET, it effectively helps mitigate symptoms.

• Fillers: This procedure aims to narrow the Eustachian tube to reduce excessive openness. It involves injecting biocompatible fillers—such as silk-based gels, hydrogels, or autologous fat—into the peritubal tissues to help the tube remain closed. Radiesse, a dermal filler, is also being explored for this purpose. This typically provides temporary relief and may require multiple applications. It is a minimally invasive procedure, usually well-tolerated, and can be performed in-office under local anesthesia with minimal downtime.

• Shim (Endoluminal Shim): A small length of tubing, often derived from an IV catheter, is inserted into the Eustachian tube to fill the excess space. The length and thickness of the catheter are individualized for each patient. Often, the catheter is stitched to the tissue to prevent migration. This procedure can have a high success rate if the optimal diameter is achieved. However, if the catheter is too wide, it may over-close the tube and cause fluid buildup; if it is too thin, it may be ineffective or fall out. This is a viable option to explore as the risks are minimal and the procedure is reversible. It is performed in a clinical setting under mild sedation.

• Cartilage Graft: This technique uses a cartilage graft, typically harvested from the patient’s own ear, which is then inserted into the fatty tissue surrounding the Eustachian tube. This provides a way to "bulk" the tube using native material that will not dissipate or dissolve like synthetic fillers. The challenge with this procedure is the high level of precision required—the difference between success and over-correction is often measured in increments of 0.1mm. This procedure is performed under general anesthesia in a hospital setting.

• Eustachian Tube Ablation/Obliteration: This procedure is considered a final option for PET. It utilizes various methods, such as radiofrequency ablation (RFA) or lasers, to stiffen or scar the soft tissue of the Eustachian tube to help it remain permanently closed. Because the tube is permanently sealed, the patient will require a permanent tympanostomy tube in the eardrum of the affected ear to allow for pressure equalization and drainage. This necessitates lifelong ear care, including keeping the ear dry and managing an increased risk of infection. This procedure should only be pursued when all other treatment options have failed.