2025 Poster Presentations
P083: ENDOSCOPIC TRANSPTERYGOID EUSTACHIAN TUBE MANAGEMENT IMPACT ON LONG-TERM HEARING OUTCOMES
Rita Snyder, MD; Sophie Peeters, MD; Shirley Y Su, MBBS; Ehab Y Hanna, MD; Franco DeMonte, MD; Shaan M Raza; The University of Texas MD Anderson Cancer Center
Background: The eustachian tube must be mobilized or resected to gain full access to the petrous apex via an endoscopic transpterygoid approach (ETPA). However, its removal may theoretically result in long-term conductive hearing loss due to subsequent chronic fluid accumulation in the middle ear, recurrent infections, and scarring. Translocation and preservation of the eustachian tube may potentially decrease hearing morbidity, however, this modification may also reduce exposure and increase operative time. Additionally, many patients with petroclival malignancies who undergo ETPA receive adjuvant radiotherapy, which can cause secondary sensorineural hearing impairment, thus nullifying attempts to mitigate hearing morbidity by preserving this structure. We sought to compare the hearing outcomes of patients who undergo open resection of petroclival region malignancies with ETPA [CPK classification type E] approaches accessing the petrous apex, to determine whether a significant difference in hearing outcome exists that could justify further investigation into eustachian tube preservation.
Methods: A single-center retrospective review was performed. Two cohorts of patients were selected: those who previously underwent resection of a petroclival region malignant pathology via open approach, and patients who underwent an ETPA where the eustachian tube was resected or translocated to access malignancy within the petrous apex. Cases involving obliteration of the labyrinth, cochlea, or ear canal were excluded. Demographic variables, baseline hearing function, preoperative and postoperative audiometric data, and rates of mitigating strategies for hearing loss (myringotomy, tympanostomy, hearing aid) were collected. All statistical analysis was performed in SPSS 29 (IBM Corp, NY, USA).
Results: 31 patients (52% male, mean age 43 years) who underwent open resection of a petroclival region malignancy were included in Group 1. Group 2 consisted of 31 patients (55% male, mean age 49 years) who underwent ETPA with either mobilization or transection of the eustachian tube to access the petrous apex (class E approach). Rate of all new hearing loss was not significantly different between the two groups (P=0.10) neither was persistent hearing loss (P=0.17). However, Kaplan Meier survival analysis did demonstrate a significant difference, signifying earlier hearing morbidity with the endoscopic group (P<.001). Postoperative mastoid effusion was more likely to occur with the ETPA group (P=0.005), as well as unilateral hearing loss (P=0.001). Patients were also more likely to undergo mitigating strategies for ETPA approaches (P=0.049). Gross total resection was more likely in the endoscopic cohort (52% vs. 19%, P<0.001). Hearing outcomes were not significantly different between transection and translocation of the eustachian tube (P=0.56) however this may be attributed to the small number of cases where translocation was performed (N=5); further investigation may be warranted.
Conclusion: The ETPA approach was not associated with a higher rate of new post-treatment hearing loss while yielding significantly higher rates of gross total resection. However, the time course to new hearing loss was significantly shorter in the ETPA cohort. The data suggests no difference in morbidity between eustachian tube translocation versus resection. These findings help clarify the potential morbidity associated with the ETPA with eustachian tube management relative for petroclival malignancies.
