Radiofrequency Ablation Eustachian Tuboplasty for the Treatment of Chronic Otitis Media with Effusion and Premature Extrusion of the Tympanostomy Tube.

Comparison of tympanostomy tube insertion with and without radiofrequency ablation eustachian tuboplasty for treating chronic otitis media with effusion.

Analysis of Paparella Type 1 tympanostomy tubes in pediatric patients: A single-center retrospective review

Clinical Practice Guideline: Tympanostomy Tubes in Children

During the last decade, endoscopic surgery of the Eustachian tube (ET) has been advocated for ET dilatory dysfunction and for patulous ET. The internal carotid artery (ICA) and the ET are closely related, and knowledge of their surgical anatomy has become essential. This study was designed to establish the anatomical relationships between the endoscopically critical area along the full length of the cartilaginous ET and its closest association with the ICA. The perpendicular distance between the ET lumen and the ICA was measured from head magnetic resonance images (MRI) at three levels: (A) cartilaginous and bony ET junctional point, (B) mid cartilaginous ET point, and (C) the nasopharyngeal orifice of the cartilaginous ET. Totally, 200 sides were reviewed in MRI scans of 229 patients. The mean distances for each level were: A=4.3mm (range 1.6-10.4mm), B=25mm (range 9.0-61.6mm), and C=62mm (range 34.3-84.4mm). The perpendicular distance between ET and ICA at the nasopharyngeal orifice is large, but the distance shortens quickly while moving from the nasopharyngeal orifice of the ET to the junctional point of the ET. The potential for complications to the ICA rises as the surgical field moves closer to the isthmus of the ET because of the decreasing distance between the ET and the ICA.

Microbiology of chronic and recurrent otitis media with effusion in young infants

Executive Summary of Clinical Practice Guideline on Tympanostomy Tubes in Children (Update).

To investigate the eustachian tube (ET) function (ETF) in adults with ventilation tube (VT) inserted for the treatment of chronic otitis media with effusion (COME). A total of 17 subjects with at least one VT were enrolled. A detailed history was obtained, and risk factors were assessed with questionnaires. Examination including nasopharyngeal video endoscopy and ETF tests, the forced response test (FRT), inflation-deflation test (IDT), and nasal/nasopharyngeal maneuvers (such as sniffing and Valsalva, Toynbee, and the diver's maneuvers) were performed. Averages for FRT were 580±333 daPa, 382±251 daPa, and 138±192 daPa for opening pressure, steady-state pressure, and closing pressure, respectively. Most subjects demonstrated minimal or weak active function during the FRT and IDT. While nasopharyngeal maneuvers changed the nasal/nasopharyngeal pressures, they did not significantly change the middle-ear pressures. These results indicated that most subjects had severe obstructive ET dysfunction (ETD) with an ET lumen that required high pressure differences to open and poor active muscular function inadequate for luminal dilation. These results imply that while any treatment to widen the ET, such as balloon dilation of the ET, is not expected to change the voluntary active muscular function, it may reduce the tissue pressures and resistance, thus facilitating luminal opening both passively and actively. Most patients with VT inserted for the treatment of COME appear to have an abnormal ETF with difficulty in passively opening the ET and weak active muscular function. Management of such patients addressing only passive properties may not be sufficient for the resolution of ETD.

Outcomes of tympanostomy tube placement in children with Down syndrome—A retrospective review

Can vitamin D supplementation prevent chronic otitis media with effusion?

Test the hypothesis that the eustachian tube (ET) function measured using standard manometric test methods is different between groups of ears with tympanostomy tubes inserted for recurrent acute otitis media (RAOM) and for chronic otitis media with effusion (COME). A cross-sectional study of ET function in populations of young children with different otitis media expressions. The results for forced-response testing of ET function were compared using a general linear model between 37 ears of 26 children and 34 ears of 26 children, aged 3 and 4 years, with ventilation tubes inserted for COME and RAOM, respectively. There were no significant between-group differences in either the active measure of ET opening function, dilatory efficiency, or in the passive measures reflecting the magnitude of the forces that tend to hold the ET lumen closed, the opening and closing pressures, and passive trans-ET conductance. The results do not support the hypothesis that ET closing forces are less in ears with RAOM when compared to ears with COME, and from the results of earlier studies, ears without disease. Both groups were characterized by a low ET opening efficiency (referenced to ears of adults with no disease history). Because both disease expressions present the same pattern of ET dysfunction, other factors are required to explain why a subset of ears with that type of dysfunction develop RAOM, as opposed to the default expression of COME. 2b

<b> Introduction:</b> The Eustachian tube (ET) is the anatomical structure that connects the middle ear with the nasopharynx. It is part of a system that, in addition to the already mentioned elements, also includes the soft palate. The functions of ET are pressure equalization, clearance of secretions and protection of the middle ear from sounds and reflux of secretions from the nasopharynx. Dysfunctions of ET are multifactorial, and the diagnostics is difficult due to lack of defined standards for assessing its function prior and post treatment. </br></br> <b>Aim:</b> The aim of the study is the review of the publications concerning actual definitions and classification of ET dysfunctions, efforts of adopting unified criteria and methods of assessing its functions and ways of treatment. </br></br> <b> Material and methods:</b> In the year 2015 classification was adopted which distinguish three subtypes of ET dysfunction: (1) dilatory ET dysfunction, (2) baro-challenge-induced, (3) patulous ET. Dilatory ET dysfunctions were further divided as follows: functional obstruction (most common), dynamic dysfunction and anatomical obstruction. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) enables the systematization of symptoms. Clinical assessment of the patient with ET dysfunction should include otoscopy or otomicroscopy, tympanometry, Rinnes and Webers tuning fork tests or pure tone audiometry, nasopharyngoscopy with visualization of ET orifice and opening. Other tests of assessment of ET functions like tubomanometry, sonotubomanometry and pressure chamber tests are useful research tools. Endoscopic evaluation of ET orifice should encompass the assessment of mucosa of the torus tubarius and ET as well as dynamic process of ET opening. In surgical treatment of functional obstructions of ET, the most common method is balloon dilatation tuboplasty. Several studies showed that this is safe and in high percentage of cases successful method of treatment, however the indications for this type of surgery are not yet universally accepted.

When Should a Retained Tympanostomy Tube be Removed?

Effects of combination of balloon Eustachian tuboplasty with methylprednisolone irrigation on treatment of chronic otitis media with effusion in adults

Background and objectives: Based on our previous single-center study on optimization of treatment of chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) in children using a noninvasive system approach to lower the necessity of antibiotics, analgesic use, and surgical interventions, we proceeded to perform a multicenter investigation in an outpatient setting. The purpose of the previous prospective study in 2013–2015 was to compare outcomes in the treatment of COME and AH using the noninvasive multimodal integrative method (IM) versus conventional treatment practice (COM). Materials and Methods: In this paper, we retrospectively analyze the data of patients treated with the integrative method between 2017 and 2020 in a multicenter setting and compared the outcomes with data from 2013–2015 in order to evaluate generalizability. In both periods, all eligible and willing participants were included and treated with the IM protocol under real-life conditions. The treatment involved pneumatization exercises, education, an antiallergic diet, nasal hygiene, useful constitutional therapy, and thermal interventions (P.E.A.N.U.T.). A total of 48 versus 28 patients, aged 1–8, were assessed, presenting with COME and AH, with moderate to severe hearing impairment at entry. Results: The significant improvement found in both audiometric measures (intact hearing) and tympanometric measures (normal A-type curve) was similar in both datasets with respect to conventional treatment. The new data confirms that the P.E.A.N.U.T. method results in a significant reduction of antibiotics, analgesic use, and surgical interventions. Conclusion: In this multicenter trial, we confirm the effectiveness of the noninvasive system approach for the treatment of COME in lowering the need for antibiotics and analgesic use and elective surgery. This could be especially important with respect to a generally observed increase in antibiotic resistance. The method is easy to perform in different clinical settings and is effective, safe, and well-tolerated.

The middle ear conducts sound to the cochlea for hearing. Otitis media (OM) is the most common illness in childhood. Moreover, chronic OM with effusion (COME) is the leading cause of conductive hearing loss. Clinically, COME is highly associated with Primary Ciliary Dyskinesia, implicating significant contributions of cilia dysfunction to COME. The understanding of middle ear cilia properties that are critical to OM susceptibility, however, is limited. Here, we confirmed the presence of a ciliated region near the Eustachian tube orifice at the ventral region of the middle ear cavity, consisting mostly of a lumen layer of multi-ciliated and a layer of Keratin-5-positive basal cells. We also found that the motile cilia are polarized coordinately and display a planar cell polarity. Surprisingly, we also found a region of multi-ciliated cells that line the posterior dorsal pole of the middle ear cavity which was previously thought to contain only non-ciliated cells. Our study provided a more complete understanding of cilia distribution and revealed for the first time coordinated polarity of cilia in the epithelium of the mammalian middle ear, thus illustrating novel structural features that are likely critical for middle ear functions and related to OM susceptibility.