Manometric and endoscopic study of tubal function in drum perforation.

Since good ventilation of the middle ear is a prerequisite to successful myringoplasty, it was our policy to study the tubal function in dry central perforation of the drum and to correlate the manometric with the endoscopic findings. Normal manometric results with patency of the tube (as proved by fluorescein-endoscopy) indicated good tubal function, with good prognosis for myringoplasty. Abnormal manometric results with failure of fluorescein to pass into the nasopharynx indicated mechanical tubal obstruction that was, in most cases, correctable. Nasal endoscopy proved to be indispensable in diagnosing, localizing, and even treating "hidden" lesions in their key areas that may be responsible for the obstruction. Thus, the correction of the mechanical tubal obstruction must precede ear surgery. Whenever tubal obstruction is diagnosed as functional or idiopathic, the ventilation of the middle ear should be facilitated during ear surgery by addition of a tympanostomy tube to the graft or drum remnant, with guarded prognosis.