Saccharine and Toynbee’s Tests in Chronic Otitis Media: Gatekeepers of Tympanoplasty Success

Abstract Introduction: Chronic otitis media (COM) of the mucosal type is an inflammatory process in the middle ear space, persisting for more than 12 weeks, which can result in a nonhealing perforation of the pars tensa. The Eustachian tube function (ETF) is essential for maintaining middle ear ventilation and pressure equilibrium, and its dysfunction can exacerbate the disease. This study aimed to assess the mucociliary clearance of the middle ear by the saccharine test and the ventilatory function by the Toynbee’s test and to evaluate its impact on tympanoplasty outcome. Aim: (1) To assess the ETF in COM – Mucosal type with the Toynbee’s and saccharine tests. (2) To correlate the results of Toynbee’s and saccharine tests with the success of tympanoplasty. Materials and Methods: In this prospective cohort study, the ETF of 54 subjects with COM was evaluated using the Toynbee’s and saccharine tests. The Toynbee’s test was categorized as normal or impaired function. In the saccharine test, saccharin perception time was categorized as normal, partial dysfunction, or gross dysfunction. Postevaluation, these patients underwent tympanoplasty and were followed up for 3 months to assess graft uptake. Results: In our study of 54 patients, the Toynbee’s test was normal in 35 (64.8%) patients and impaired in 19 (35.2%) patients. The saccharine test was normal in 36 (66.7%) patients, partially impaired in 14 (25.9%) patients, and grossly impaired in 4 (7.4%) patients. Overall, 83.3% of patients achieved successful graft uptake, with normal ETF strongly correlating with better outcomes. On further assessment, of those 18 patients with abnormal mucociliary function, nine patients with normal ventilatory function had a successful graft uptake (100%), and six out of nine patients with abnormal ventilatory function had a 66.7% graft rejection. Conclusion: Both Toynbee’s and saccharine tests evaluated the ETF, and a normal finding was critical to graft uptake. Abnormal ventilatory function along with impaired mucociliary clearance capacity of the Eustachian tube significantly reduced the chances of successful graft uptake.