Endoscopy of the eustachian tube has been performed through the middle ear and nasopharyngeal orifices and has given us new insights into tubal physiology and pathophysiology.22,23 The cartilaginous tube is best studied by positioning an endoscope at the nasopharyngeal orifice and directing the view angle superiorly and laterally toward the lumen. Tubal movements are observed during swallows, yawns, and other maneuvers, captured on video, and studied in slow motion. Most tubal pathology involves mucosal edema that causes functional obstruction, but a number of patients have muscular or dynamic dysfunction. Endolum-inal laser surgery is now being performed for the treatment of refractory tubal dysfunction when ventilating tubes have been inadequate.21,22
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