Intended for healthcare professionals

Rapid response to:

Practice 10-Minute Consultation

Eustachian tube dysfunction in adults

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1647 (Published 11 March 2014) Cite this as: BMJ 2014;348:g1647

Rapid Response:

Re: Eustachian tube dysfunction in adults

Sproat and colleagues make the very important recommendation in their 10-minute consultation on eustachian tube dysfunction that referral to ENT services is indicated whenever symptoms of unilateral eustachian tube dysfunction persist without a clear precipitant, or despite conservative or medical therapy in primary care (1).

Cholesteatoma is non-cancerous growth of keratinising squamous epithelium in the middle ear, which causes destruction of bone (particularly the ossicles and mastoid) as it expands. Treatment is surgery to remove the growth and bones affected. Timely diagnosis is important, as a delay can result in a greater degree of permanent hearing loss (2) or, in very rare cases, life threatening complications such as meningitis or brain abscess.

The majority present with discharge, but they may be dry and present with signs similar to that of Eustachian tube dysfunction, including a feeling of fullness, ear ache, tinnitus and hearing loss. If dry, the only visible sign may be a little wax over the attic.

As a sufferer of cholesteatoma myself, I would like to reinforce the importance of referral from primary care to ENT services in any patient with unexplained unilateral symptoms as Sproat and colleagues have stated. Despite presenting a number of times over a 6 month period with the above symptoms, the GP chose not to refer to ENT since examination seemed normal. By the time cholesteatoma was diagnosed, it was extensive, resulting in significant hearing loss.

Twelve years later, when presenting with symptoms of eustachian tube dysfunction in the 'good' ear, I was fortunate to be referred to the surgeon who had made that diagnosis. Bilateral cholesteatoma is rare, but the surgeon did not rule out the possibility. Again, otoscopy was normal. Following examination under anaesthetic, cholesteatoma in the other ear was confirmed and underwent successful treatment.

Cholesteatoma can present at any age, and strictly adhering to the advice of Sproat and colleagues regarding ENT referral can reduce the damaging affects of this uncommon but very destructive disease.

Maria Garside
maria.garside@btinternet.com

1 Sproat R, Burgess C, Lancaster T, Martinez-Devesa P. Eustachian tube dysfunction in adults. BMJ 2014;348: 36-7 doi10.1136/bmj.g1647

2 Turning a Deaf Ear - Case report. MPS Casebook Vol 17 no 1, Jan 2009

Competing interests: No competing interests

09 May 2014
Maria E Garside
Associate Specialist in Anaesthesia
Bradford Teaching Hospitals NHS Foundation Trust
Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ