Eustachian tube dysfunction (ETD) and permanent occlusion of the Eustachian tube (POET) are two otological entities with significant clinical implications. While both share a common anatomical region, their etiologies, manifestations, and treatments differ considerably. Chronic middle ear diseases often associate with POET, resulting from compromised pressure equalization and drainage capacities [1]. On the other hand, ETD encompasses a broader spectrum of underlying pathologies.

Distinguishing POET from functional Eustachian tube (ET) obstruction or dilatory ET dysfunction is crucial [2, 3]. Various mechanisms can cause POET. This includes complications from surgical procedures, radiotherapy, and numerous rheumatological disorders that induce chronic inflammation or mechanical obstructions [4, 5]. Surgical interventions, particularly adenoidectomy, orthognathic surgery, sinus surgery, and turbinectomy, often result in scar formation or a distorted nasopharyngeal anatomy. This culminates in a non-functional ET, causing conditions like glue ear, chronic otitis media, and cholesteatoma [6,7,8].

ETD is multifaceted and often stems from a functional mucosal obstruction within the cartilaginous portion of the ET [9]. This impairs the ventilation of the middle ear and mastoid cavity, resulting in conditions like glue ear and chronic otitis media. The subsequent diseases may manifest as tympanic membrane perforations, ossicular chain erosion, and cholesteatoma. Consequently, patients may experience impaired hearing thresholds or even deafness [10,11,12]. Those with POET typically present with aural fullness, conductive hearing loss, and often undergo procedures such as myringotomy, grommets, or middle ear surgeries.

Lesions of the nasopharynx, radiotherapy of the adjacent tissue, and surgical interventions around the ET have a potential risk of otitis media with effusion [13, 14].

Several factors can cause or exacerbate ETD and POET. Lesions in the nasopharynx, adjacent tissue radiotherapy, and surgical interventions around the ET can precipitate otitis media with effusion [13, 14]. However, achieving a permanent Eustachian tube occlusion during translabyrinthine acoustic neuroma surgeries often meets limited success [15]. Other systemic diseases, like sarcoidosis, tuberculosis, and granulomatosis with polyangiitis, can lead to inflammation and subsequent closure of the pharyngeal ET orifice, manifesting as crusting, swelling, and scarring [16]. While dilatory ET dysfunction (DETD) rarely results in complete ET lumen occlusion, it does allow for balloon dilation Eustachian tuboplasty [9]. Predominantly, in POET patients, the nasopharyngeal orifice or the cartilaginous portion is affected. Conservative treatment or balloon dilation tuboplasty alone cannot restore this condition. This particular entity significantly impacts the patient’s quality of life due to the associated hearing impairment and other otological symptoms [17, 18].

Given the complexities surrounding ETD and POET, this preliminary study focuses on exploring the potential of surgically reopening the ET for patients diagnosed with POET. By addressing this lesser-known otological disorder, this research aims to shed light on its implications and therapeutic interventions, raising awareness, and contributing to improved clinical outcomes.