Cartilaginous Eustachian Tube Research Articles

Does balloon Eustachian tuboplasty increase the success rate in repair of subtotal tympanic membrane perforations with resistant tubal dysfunction?

ObjectivesTo evaluate the effect of balloon Eustachian tuboplasty on the results of surgical reconstruction of subtotal tympanic membrane perforations in cases of resistant Eustachian tube dysfunction. DesignProspective randomized study. SettingTertiary care university hospital. PatientsSeventy-two patients with dry subtotal tympanic membrane perforations and resistant Eustachian tube dysfunction, aging 19–51years, were distributed randomly in two groups A and B. InterventionsBoth groups underwent underlay myringoplasty using temporalis fascia graft. In group A, myringoplasty was preceded by balloon dilatation of the cartilaginous Eustachian tube. Main outcome measuresGraft take rate, hearing results and middle ear pressure. ResultsGraft take rate at 12months postoperative showed a significant difference between the two groups where it was 89.2% in group A (33 of 37 cases) and 80% in group B (28 of 35 cases). Pure tone audiometry results at 12months postoperative showed a significant improvement of air conduction curves at all frequencies in both groups. The middle ear pressure was significantly better in group A at 6months (mean pressure: −29daPa in group A, −60daPa in group B) and at 12months postoperative (mean pressure: −55daPa in group A, −79daPa in group B). ConclusionBalloon Eustachian tuboplasty is a safe, easy and effective procedure that yields better results in reconstruction of subtotal tympanic membrane perforations in cases of resistant Eustachian tube dysfunction.

Balloon Catheter Dilatation of Eustachian Tube

Eustachian tube dysfunction is a common problem and transnasal endoscopic balloon dilation of the Eustachian tube (ET) is a new surgical technique. The goal of this study is to review the evolution of this novel technique and study the preliminary outcomes. Balloon catheter dilation of the 100 Eustachian tubes in 70 adults was performed at a tertiary medical center from January 2009 to January 2011. A 5-mm sinus balloon catheter was endoscopically placed transnasally into the proximal ET to dilate the cartilaginous ET. Cases were reviewed with respect to indications, outcomes, and complications. Of the 100 ETs, ear fullness and pressure were improved in 71% of patients studied for 26.3 weeks (± 3.6). Of 8 patients followed for a minimum of 34 months, 87% reported persistent improvement. One complication is reported. Endoscopic transnasal ET balloon dilation is a novel approach to treating ET dysfunction. Benefits can be durable up to 3 years. This technique holds much promise and merits further investigation.

Growth change in cartilaginous Eustachian tube angulation and its relationship with age at onset of otitis media

Middle ear infection (otitis media, OM) is amongst the most common childhood diseases in the United States. Despite this, there is a lack of data on growth of the Carilaginous Eustachian tube (CET) and how this may relate to onset of OM. This study investigated growth changes in reconstructed CET dimensions. Its length (between its orifice on the temporal bone and medial pterygoid tubercle) and orientation (angle made with the medial pterygoid plate posterior edge) were quantified in a dry cranial growth series (n=258) divided into dental eruption stages. 3D landmark coordinate data were digitized from each specimen using a Microscribe digitizer. A total of 54 landmarks on the face, upper respiratory tract, and temporal bone were used. These data underwent Procrustes scaling so that relative dimensions could be directly compared between growth stages with Bonferroni‐adjusted T‐tests. Results showed no significant growth change in relative CET length but CET angulation underwent marked and significant (p<0.05) growth change between infancy and adulthood with greatest amount of change occurring within the first three years of life, coinciding with peak onset age for OM. The results suggest that the development of OM may be related to CET angulation and absolute length.Grant Funding Source : Mount Sinai School of Medicine

Removal of Hairy Polyp of the Eustachian Tube Using a Novel Skull Base Approach: Extended Transmastoid Excision

Hairy polyps are rare dermoid tumors associated with the temporal bone. The majority of reported cases have been left-sided, in women, and with significant middle ear or nasopharyngeal components, allowing removal by a simple transmastoid or endoscopic approach. We present the case of a 3-year-old girl with a hairy polyp of the left eustachian tube. Diagnosis was made at surgery 14 months after initial presentation. Preoperative CT and MRI aided surgical planning but were nondiagnostic. The location of this lesion high in the eustachian tube and its intimate association with the carotid artery precluded a traditional transcanal, endoscopic, or simple transmastoid approach and required more aggressive surgical dissection. A novel extended transmastoid skull base approach with removal and replacement of the anterior external canal wall and glenoid fossa provided complete visualization of the intrapetrous portion of the carotid artery, which was immediately adjacent and adherent to the tumor, and granted access to the apex of the cartilaginous eustachian tube from which the tumor arose. This exposure allowed for complete excision of the tumor and reconstruction of the ear with the usual features of a canal wall down mastoidectomy. This case represents the 15th such lesion reported in the English literature and the first described extended transmastoid skull base approach for complete visualization of the intrapetrous portion of the carotid artery and access to the cartilaginous eustachian tube.

Calcification of the cartilaginous Eustachian tube

Calcification of the cartilaginous Eustachian tube

Balloon Dilation of the Cartilaginous Eustachian Tube

(1) To translate techniques developed in a previous cadaver study of balloon dilation of the cartilaginous eustachian tube (ET) into clinical treatment for refractory dilatory dysfunction and (2) to study the safety/efficacy of the technique in a pilot clinical trial. Prospective with subjects as their own historical controls since June 2009. Regional academic center. Eleven consecutive adult patients with longstanding otitis media with effusion (OME) who were unable to autoinsufflate their ET by Valsalva, swallow, or yawn and who had previous tympanostomies (average, 4.7). At the time of intervention, 5 of 11 had a tube; 2 of 11 had a tympanic membrane (TM) perforation. Four of 11 had intact TMs, 2 with OME and tympanogram type B and 2 with TM retraction and tympanogram types B and C. Balloon dilation of the cartilaginous ET was performed with sinus dilation instruments via transnasal endoscopic approach under general anesthesia in a day surgery setting. Inflation was to a maximum of 12 atm for 1 minute. ability to Valsalva, rating of ET mucosal inflammation, tympanogram, and otomicroscopy findings. All cases successfully dilated. Eleven of 11 could self-insufflate by Valsalva (P < .001); tympanograms were A (4/11), C (1/11), or open (6/11). All atelectases resolved. Procedures were well tolerated, without pain or complications related to dilation. Dilation of the cartilaginous ET appeared to be beneficial and without significant adverse effects in the treatment of ET dilatory dysfunction. Larger controlled trials with long-term results are now justified and needed.

Balloon Dilation of the Cartilaginous Eustachian Tube

Free accessAbstractFirst published online August 2010Balloon Dilation of the Cartilaginous Eustachian TubeDennis Poe, MD, presenter and Juha Silvola, MD, PhDVolume 143, Issue 2_supplhttps://doi.org/10.1016/j.otohns.2010.06.133

Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model

Background Balloon catheter dilation of diseased sinus ostia has recently demonstrated efficacy and safety in the treatment of chronic sinus disease with 2 years of follow-up. Similar to sinus surgery, initial studies of partial resection of inflamed mucosa from within the cartilaginous eustachian tube (ET) have demonstrated efficacy and safety in the treatment of medically refractory otitis media with effusion. Therefore, balloon dilation of the cartilaginous ET was investigated as a possible treatment modality for otitis media. Methods A protocol for sinus balloon catheter dilation was evaluated in each of the cartilaginous ETs in 8 fresh human cadaver heads. Computed tomographic scans and detailed endoscopic inspections with video or photographic documentation were performed pre- and posttreatment, and gross anatomical dissections were done to analyze the effects of treatment and to look for evidence of undesired injury. Results Catheters successfully dilated all cartilaginous ETs without any significant injuries. There were no bony or cartilaginous fractures, and 3 specimens showed minor mucosal tears in the anterolateral or inferior walls. Volumetric measurements of the cartilaginous ET lumens showed a change from an average of 0.16 to 0.49 cm 3 (SD, 0.12), representing an average increase of 357% (range, 20–965%). Conclusions Balloon catheter dilation of the nasopharyngeal orifice of the ET was shown to be feasible and without evidence of untoward injury. A significant increase in volume of the cartilaginous ET was achieved. A clinical study is now indicated to determine whether balloon dilation will demonstrate lasting benefits and safety in the treatment of otitis media.

Balloon Dilation Of The Cartilaginous Portion Of The Eustachian Tube: Initial Safety And Feasibility Analysis In A Cadaver Model

Background: Balloon catheter dilation of diseased sinus ostia has recently demonstrated efficacy ☆ Disclaimer: Th interest with Acclaren ☆☆ Presented as Phoenix, AZ, May 28 ⁎ Corresponding Hospital, 300 Longwo 617 355 3794. E-mail address: d 0196-0709/$ – see fro doi:10.1016/j.amjoto.2 and safety in the treatment of chronic sinus disease with 2 years of follow-up. Similar to sinus surgery, initial studies of partial resection of inflamed mucosa from within the cartilaginous eustachian tube (ET) have demonstrated efficacy and safety in the treatment of medically refractory otitis media with effusion. Therefore, balloon dilation of the cartilaginous ET was investigated as a possible treatment modality for otitis media. Methods: A protocol for sinus balloon catheter dilation was evaluated in each of the cartilaginous ETs in 8 fresh human cadaver heads. Computed tomographic scans and detailed endoscopic inspections with video or photographic documentation were performed preand posttreatment, and gross anatomical dissections were done to analyze the effects of treatment and to look for evidence of undesired injury. Results: Catheters successfully dilated all cartilaginous ETs without any significant injuries. There were no bony or cartilaginous fractures, and 3 specimens showed minor mucosal tears in the anterolateral or inferior walls. Volumetric measurements of the cartilaginous ET lumens showed a change from an average of 0.16 to 0.49 cm (SD, 0.12), representing an average increase of 357% (range, 20–965%). Conclusions: Balloon catheter dilation of the nasopharyngeal orifice of the ET was shown to be feasible and without evidence of untoward injury. A significant increase in volume of the cartilaginous ET was achieved. A clinical study is now indicated to determine whether balloon dilation will demonstrate lasting benefits and safety in the treatment of otitis media. © 2011 Elsevier Inc. All rights reserved.

MANAGEMENT OF CEREBROSPINAL FLUID LEAKS AFTER ACOUSTIC TUMOR REMOVAL

To present a logical algorithm for management of postoperative cerebrospinal fluid (CSF) leak that occurs after acoustic tumor removal, and to describe a method for eustachian tube resection. We present an algorithm in the form of a flow chart, describe middle fossa craniotomy for eustachian tube resection, and present three cases in which this technique was used. For CSF leak, pressure dressing at the wound and bed rest for the patient are advised; lumbar drain is indicated if the leak does not resolve. Occasionally, wound exploration is required. CSF rhinorrhea is treated first with a lumbar drain. If this approach is unsuccessful, the choice of treatment depends on the patient's hearing status. If a patient has no hearing, we perform a blind sac closure of the ear canal and pack the eustachian tube. If a patient has hearing, wound reexploration and lumbar drainage are advised. When conservative and initial surgical procedures for resolving CSF leak fail, we perform a middle fossa craniotomy to identify, divide, and remove a segmental portion of the cartilaginous eustachian tube and then cauterize and occlude both ends. At centers where surgical removal of acoustic tumors is frequently performed, a logical protocol should be in place for treatment of postoperative CSF leak. The leak location and the patient's hearing status are factors in determining the appropriate treatment method. Middle fossa craniotomy for resection of the eustachian tube is a safe, definitive management option for treatment of recalcitrant CSF rhinorrhea that occurs after acoustic tumor surgery.

Laser Eustachian Tuboplasty: Two‐Year Results

Laser eustachian tuboplasty (LETP) combined with appropriate medical management will eliminate the chronic presence of middle ear effusions in selected patients. The study population consisted of 13 adults with otitis media with effusion (OME). Patients underwent slow-motion video endoscopy to identify the location and extent of surgical resection. A diode or argon laser was used to vaporize areas of hypertrophic mucosa and submucosa along the cartilaginous eustachian tube. Patients were evaluated at 6, 12, and 24 months. Successful outcome was defined as absence of OME. Patients with evidence of reflux disease or allergic rhinitis were treated with medical therapy before surgery and throughout the follow-up period as indicated. LETP combined with medical management eliminated OME in 36% (4 of 11) of patients at 6 months, 40% (4 of 10) at 1 year, and 38% (3 of 8) at 2 years. Failure of LETP correlated with presence of laryngopharyngeal reflux (P = .01) or allergic disease (P = .05) for the results at 1 year but not at 2 years. LETP combined with appropriate medical management may be an effective treatment in select patients with chronic persistent eustachian tube dysfunction. A controlled trial with a larger number of subjects will be necessary to determine the efficacy of LETP and identify those factors predictive of successful outcome.

Update on eustachian tube dysfunction and the patulous eustachian tube

The purpose of this review is to summarize the recent knowledge on eustachian tube dysfunction and the patulous eustachian tube. A clinically useful test for eustachian tube function is still lacking. Narrowing of the isthmus alone was demonstrated to be an insufficient cause of otitis media. Inflammatory mediators identified within the eustachian tube and middle ear cells were causally linked with otitis media with effusion. Increasing evidence was found that allergic disease and reflux may be two of the most important contributors of tubal inflammation causing otitis media with effusion. The adenoid size and proximity to the torus tubaris may also be important in considering which patients with persistent otitis media with effusion may benefit from adenoidectomy. Computed tomography scan has documented loss of soft tissue within the cartilaginous eustachian tube in patients with patulous eustachian tubes. An endoscopic approach to seal the tubal lumen has been found to be effective in relieving patulous symptoms. These studies suggest that allergic rhinitis and gastroesophageal reflux should be investigated in patients with eustachian tube dysfunction. Adenoidectomy should also be considered in patients who have adenoids that obstruct the torus tubaris. Patients with a patulous eustachian tube may benefit from an endoscopic closure. Further research is needed to identify a clinically useful test for eustachian tube dysfunction.

Temporal bone morphometric study on the eustachian tube and its associated structures in patients with chromosomal aberrations.

This study characterized phenotypic anomalies of the eustachian tube (ET) and its associated structures in individuals with various chromosomal aberrations (trisomies 13, 18, 21, and 22 and inversion of chromosome 1). The morphological characteristics of the ET and its accessory structures from 10 temporal bone-ET specimens, obtained from 10 individuals with chromosomal aberrations who ranged from the 26th gestational week to 1 year in age, were compared with the same structures from 21 age-matched control subjects without anomalies. The subjects with chromosomal aberrations had a significantly smaller volume of the lateral lamina (LL) of the ET cartilage, a reduced attachment of the tensor veli palatini muscle (TVPM), and, in some cases, a reduced volume of the lumen of the cartilaginous ET. The volume of the medial lamina (ML) of the ET cartilage was normal at birth, but smaller in specimens more than 2 months of age; this finding suggests that the prenatal development was normal, but that the postnatal growth was retarded. The subjects with chromosomal aberrations also displayed a smaller ratio of the volume of the LL to that of the ML (LL/ML ratio). Our results suggest that individuals with various chromosomal aberrations have rather similar anomalies of the ET and its associated structures. We speculate that these anomalies might be closely related to ET dysfunction in these patients.

The eustachian tube caliber and craniofacial skeleton in guinea pigs

The temporal bone and eustachian tube (ET) keep developing up to adulthood in conjunction with facial growth, and the researchers considered that insufficient tubal function in childhood might be related to size, shape and position of the ET. In this study, we performed correlation and stepwise regression analyses between craniofacial skeletal parameters and diameter of the cartilaginous ET in 90 guinea pigs. Data showed that, not the potency of the lumen at the superior part of the cartilaginous ET, but the configuration of the cartilage surrounding the superior part of the ET, and position of the lateral lamina appeared to be significantly associated with the balance of the growth potentials between the naso-premaxillary unit, maxillo-zygomatic unit and the anterior cranial base. Therefore, we may hypothesize that the balance between these subunits of the developing craniofacial skeleton has determinative effect on tensor veli palatini muscle (TVPM).

Surfactant-producing Epithelium in the Dojsal Part of the Cartilaginous Eustachian Tube of Mice: Light, Transmission, and Scanning Electron Microscopic Observations

The nonciliated area in cartilaginous roof tubothelium of 14 conventional mice was examined histologically and classified as a modified transitional respiratory epithelium. On the free cell surface numerous short microvilli were found. On the lower roof surface in the midcartilaginous portion and especially near the pharyngeal orifice, a convoluted pattern of ridges and pits was observed. These structural peculiarities are interpreted as adaptive features, ensuring survival of the cells in a dynamic tubal environment. On the basis of systematic observations of the multilamellar bodies in the cytoplasm resembling the phospholipid lamellar bodies of pulmonary surfactant, which are discharged in the tubal lumen and to be found in the pits, it is suggested that the nonciliated cells are "specialized" surfactant-producing tubocytes. The synthesis of surfactant-precursors starts in the basal layer. Different phases of the secretory process were observed in the neighboring cells. This finding is related to the cell-cooperation constantly releasing the secretory product, and natural cell-turnover. Unlike the previously reported surfactant-producing cells in the lower tubothelium of other species, roof tubothelial cells of mice are morphologically similar to type II pneumocytes.

Relationship of eustachian tube bony landmarks and temporal bone pneumatization.

Anatomic and functional differences of the eustachian tube have been suggested as etiologic factors in patients with otitis media. We studied eustachian tube lengths and vectors of the tensor veli palatini muscle in 25 unilateral specimens from adult human cadavers. The extent of temporal bone pneumatization, as determined by computed tomography and plain lateral radiographs, was used as an indicator of prior otitis media. Increased length of the cartilaginous eustachian tube was associated positively (r = .53, p less than .01) with volume of pneumatization. However, neither the length of the bony eustachian tube nor the vector of maximum pull of the tensor veli palatini muscle was associated statistically with the extent of pneumatization. It may be that the longer cartilaginous eustachian tube is more protective of the middle ear.

Eustachian tubal function: changes throughout childhood and neuro-muscular control.

The anatomy of the cartilaginous Eustachian tube is the key to function and malfunctions. Serial sections of the tube at various ages show that there are very considerable anatomical changes throughout childhood during which period the tensor palati is the muscle of prime importance. It is suggested that both tensor palati and tensor tympani are functionally tubal muscles and might, perhaps, be termed "extrinsic muscles of the ear". Together they largely control tubal opening. Some clinical implications may be drawn from these anatomical observations.