Stéphane Gargula

Objective: To critically summarize current evidence regarding the burden of Eustachian tube dysfunction (ETD) in older adults, focusing on age-related pathophysiology, diagnostic challenges, therapeutic strategies and its interaction with major geriatric clinical implications. Methods: This narrative review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed-indexed original studies, systematic reviews, meta-analyses, consensus statements and clinical guidelines addressing ETD and ageing were systematically identified and critically appraised. Evidence was synthesized narratively with particular emphasis on studies applicable to geriatric populations. Results: Current evidence demonstrates that ageing induces progressive structural and functional alterations throughout the Eustachian tube–middle ear unit, including cartilage calcification, muscular degeneration, mucosal atrophy and impaired neuromuscular coordination. These changes may increase susceptibility to ETD, which in turn can exacerbate presbycusis, vestibular dysfunction, communication disability and potentially contribute to frailty and cognitive vulnerability by increasing the cumulative burden of sensory impairment. However, evidence specifically derived from geriatric cohorts remains limited, particularly regarding long-term outcomes and therapeutic interventions and is insufficient to establish ETD as an independent determinant of these conditions. Conclusions: ETD should be recognized as an underdiagnosed and potentially modifiable contributor to hearing-related disability in older adults. Greater clinical awareness, standardized diagnostic pathways and prospective geriatric-focused studies are needed to clarify whether timely diagnosis and treatment of ETD can reduce the overall burden of hearing impairment, improve functional independence and enhance quality of life in ageing populations.

Background The infralabyrinthine approach offers a direct, hearing-preserving route to the petrous apex but is limited by substantial anatomical variability. Purpose To develop a reproducible computed tomography based morphometric protocol for preoperative assessment of the infralabyrinthine approach to the petrous apex. Methods This retrospective, single-centre morphometric study, conducted according to STROBE guidelines, included 40 adults with high-resolution temporal bone CT scans allowing clear delineation of infralabyrinthine landmarks. Patients with prior otologic surgery or congenital inner ear malformations were excluded. Nine bilateral anatomical distances of the infralabyrinthine corridor were bilaterally measured in the Pöschl plane. Intra- and interobserver reproducibility were assessed with Lin’s concordance coefficient, while correlations were tested with Spearman’s. 3D modelling and surgical videos illustrated findings. Results Among 80 ears, 34 (42.5%) had at least one direct limiting measurement (≤3 mm), and 65 (81.25%) when including indirect projections. The most restrictive distances involved the jugular bulb's proximity to inner ear structures. In contrast, distances between the facial nerve and the dura of the posterior cerebral fossa, the internal auditory meatus and the jugular bulb, the cochlea and the dura of the posterior cerebral fossa, and the internal carotid artery and the internal auditory meatus rarely showed such limitations. Conclusions Preoperative CT morphometry allows reproducible assessment of infralabyrinthine access to the petrous apex. Key distances, especially between the jugular bulb and inner ear structures, can guide surgical feasibility. This approach may enhance planning, navigation, and patient safety.

Introduction: Third-window syndromes (TWS), including superior semicircular canal dehiscence (SSCD) and enlarged vestibular aqueduct (EVA), cause paradoxical auditory and vestibular symptoms such as apparent conductive loss, bone-conduction hyperacusis, and sound- or pressure-induced vertigo. Numerical modeling provides a unique means to explore the mechanical consequences of lesion size, geometry, and location. Methods: A structured search of PubMed, Scopus, and Google Scholar (July 2025) identified nine studies applying lumped-element, finite-element (FE), or computational fluid dynamics (CFD) models to SSCD or EVA, which were analyzed qualitatively. Results: Lumped-element models reproduced air–bone gaps and bone-conduction hypersensitivity, showing that lesion size and location modulate functional severity. FE and CFD simulations offered anatomically detailed insights, revealing that dehiscence geometry strongly shapes basilar membrane motion, that sound-induced endolymphatic streaming can account for the Tullio phenomenon, and that large vestibular aqueducts transmit intracranial pressure fluctuations. Validation across studies remained limited. Conclusion: Numerical models provide complementary insights into TWS. Lumped-element approaches are rapid and clinically interpretable, while FE and CFD enable detailed exploration of fluid–structure interactions. Patient-specific simulations may eventually support individualized diagnosis and surgical planning but remain speculative.

Objective: To determine the prevalence and clinical relevance of labyrinthine abnormalities detected by delayed 3D FLAIR MRI in untreated otosclerosis with labyrinthine symptoms, and to evaluate correlations with clinical and audiometric data. Design: Retrospective observational study, single tertiary referral center. Methods: Thirty‐four patients (58 ears) with confirmed otosclerosis by high‐resolution CT presenting with labyrinthine symptoms and no prior surgery underwent 3T labyrinthine MRI with a post‐contrast delayed 3D FLAIR sequence. Two blinded neuroradiologists independently reviewed CT to confirm otosclerotic and MRI to assess endolymphatic space anomalies and blood–labyrinth barrier (BLB) disruption. Findings were correlated with clinical symptoms and bone‐conduction thresholds. Results: Otosclerotic foci most frequently involved the pre‐stapedial region (57/58, 98%). Morphological anomalies of the endolymph were rare, with one case of endolymphatic hydrops (1/58, 2%). In contrast, BLB disruption was identified in 34/58 ears (59%), predominantly in the basal cochlear turn (34/58, 59%) and peri‐saccular region (32/58, 55%). BLB disruption was strongly associated with endosteal involvement (76%) and round window involvement (89%), and was universally present in obliterative round window involvement (100%). Its prevalence increased with hearing loss type (55% in conductive, 66% in mixed, and 100% in pure sensorineural hearing loss). However, no significant correlation was found between BLB intensity and bone‐conduction thresholds. Conclusion: Endolymphatic hydrops was rare in untreated otosclerosis with labyrinthine symptoms. Conversely, BLB disruption was frequent in this symptom‐select population, spatially correlated with otosclerotic foci, reflecting underlying microvascular remodeling. While not directly predictive of hearing thresholds, BLB disruption may represent an imaging biomarker of disease activity. Level of Evidence: 4.