PHYSIOLOGICAL tympanostomy is advanced as a ‘substitute’ eustachian tube because it opens regularly only on swallowing, as does the ‘natural’ eustachian tube. The efficacy of the physiological tympanostomy operation was first proved in experimental animals (two dogs). Subsequently, six patients with eustachian insufficiency were successfully managed by this new surgical technique within period of one year, with no post-operative complications. The hearing improved and the middle ears remained air-filled.

The method seems to have the following merits: permanent ventilation of the tympanum with preservation of an intact drum (from the functional point of view); no tympanophonia or autophonia; simple technique, short operative period (five minutes); no risk of postoperative complications; and no danger of ascending infection of the middle ear from the ear canal. The demerits appear to be: drainage not ensured; no facility to increase the middle ear pressure by the Valsalva manoeuvre or, Politzerization.