Eustachian Tube Function Tests Research Articles

Reproducibility of the Forced Response Test in Children With Chronic Otitis Media With Effusion

Eustachian tube function is stable over time in children with ventilation tubes for chronic otitis media with effusion. Clinical studies report that Eustachian tube function tests in patients with a persistent tympanic membrane perforation predict the success of myringoplasty, and those in patients with ventilation tubes for chronic otitis media predict disease recurrence after the tubes become nonfunctional. In those studies, Eustachian tube function was usually tested only once, which presumes a semi-stable basal level of function for greatest diagnostic and prognostic usefulness. We investigated the stability of repeated measurements of Eustachian tube function using the forced response test. Thirty-nine children aged 36 to 83 months with bilateral ventilation tubes for chronic otitis media with effusion were evaluated using the forced response test 3 times at 3- to 4-month intervals. The variability across test sessions in the Eustachian tube opening pressure, closing pressure, and dilatory efficiency was estimated using regression/correlation analyses. For all test parameters, the between-session and between-ear correlation coefficients were significant, but the shared variance in the parameters among test sessions and between ears at the same test session was relatively low. The average slope for each parameter as a function of the time with a ventilation tube was zero. The low between-test shared variance for the test parameters raises questions as to whether a single forced response test captures sufficient information to accurately diagnose the cause of any dysfunction or to predict with high specificity and sensitivity future disease experience or surgical results.

Evaluation of the Function of Auditive Tube

Objective: Evaluate the possibility of glucose test in assessing the function of the Eustachian tube. Method: Prospective study included 20 subjects with chronic otitis media not cholesteatoma, presenting dry tympanic perforation for at least 30 days. These patients were subjected to instillation of ear drops of glucose solution in the ear with dry tympanic perforation. Later these patients were subjected to a audiologic evaluation with impedance and Eustachian tube function test. Results: In glucose test there was a statistical difference between the 2 responses of test, since it can be stated that there is a greater percentage of subjects with positive responses (80%). There was no statistical difference between the 2 responses in Eustachian tube function test. The test with the greater percentage of semipermeable was glucose test, with 80%, versus 45% of Eustachian tube function test. Consequently the Eustachian tube function test had a greater percentage of not permeable, with 50% versus 20% of glucose test. The glucose test has an excellent sensitivity (100%) and specificity is very low (33.3%). Conclusion: The glucose test gives informations about the function of the auditive tube.

Laser Eustachian Tuboplasty

Laser Eustachian tuboplasty (LETP) with ablation of the epipharyngeal orifice of the Eustachian tube (ET) shows good results in clinical observation. However, to this day, there are no reports evaluating the surgical procedure with valid test methods. The purpose of this study was to test the effect of minimally invasive LETP by means of a pressure chamber ET function test. Prospective surgical trial. Tertiary and university hospital. Thirty patients with a history of ET dysfunction during pressure changes were examined. Minimally invasive LETP was performed with an 812-nm diode laser under local anesthesia as an outpatient procedure. The ET function was tested preoperatively and postoperatively by pressure chamber ET function test. Eustachian tube closing pressure (ETCP) was evaluated as a measure of the tissue pressure of the ET. In cases of a severely impaired ET function, a "blocked" pattern was evident, and no measurement of ETCP was possible. Before minimally invasive LETP, 17 patients showed a completely blocked pattern. Postoperatively, 13 patients of this group showed an improved ET function with a restored normal opening pattern (p < 0.001). The ETCP was reduced from 6.24 ± 3.46 mbar preoperatively to 4.06 ± 2.36 mbar postoperatively (p < 0.013). The results strongly indicate that the effect of minimally invasive LETP can be proven by measuring the ET function in a pressure chamber. Results must be interpreted in combination with clinical methods like Valsalva maneuver and tympanometry. Patients with ET dysfunction during pressure changes seem to benefit from the minimally invasive LETP.

Tympanometry, a Prognostic Indicator of Myringoplasty with Assessment of Eustachian Tube Function

Objective: To determine Eustachian tube function in tubotympanic type of chronic ear disease and to correlate Eustachian tube function with pathological change in middle ear mucosa. Materials and Methods: A prospective study of the cases of tubotympanic type of chronic suppurative otitis media was undertaken. Patients were subjected to clinical examination followed by audiometry tests and impedence audiometry to determine eustachian tube functions. Patients were then subjected to myringoplasty and eustachian tube function were then reassessed post operatively. Results: In our study, out of 30 cases who underwent myringoplasty, 21 cases had successful surgical outcome and 9 cases were failed. Out of 24 cases of good Eustachian tube function, 21 cases had successful surgical outcome intends of taking up graft, absence of otorrhea and improvement in hearing. In remaining 3 cases, there was recurrence of otorrhea with central perforation. All the 6 cases with poor Eustachian tube function had surgical failure. Conclusion: The prognosis of the middle ear reconstructive surgery has direct correlation with Eustachian tube functions and Eustachian tube function tests should be a routine investigation in all the cases planned for surgical reconstruction of the middle ear.

耳症状にて受診したスキューバダイバー患者の耳管機能の評価

The scuba diving population has increased very much recently, bringing with it a rise in barotrauma. Ninety-seven patients with scuba diving-related accidents (34 males and 63 females; mean +/- SD: 36.6 +/- 10.3 years) and 39 healthy volunteers (9 males and 30 females; mean +/- SD: 41.1 +/- 16.9 years) without a history of Eustachian tube dysfunction participated in this study. All patients underwent audiometric measurements, including hearing testing, tympanometry, and Eustachian tube function testing (sonotubometry and impedance test). The tympanometry results of the majority of the patients were normal (Jerger A type), however, 83 of 97 patients (85.6%) were diagnosed as having Eustachian tube dysfunction: all patients had tubal stenosis. Compared with healthy volunteers, the Eustachian tube function in scuba diving patients was significantly lower. According to whether the affected parts were one ear or both ears, we classified these patients into 2 types, that is, the unilateral group and the bilateral group. The symptoms in the unilateral group were more serious than those in the bilateral group. In the unilateral group, the Eustachian tube functions of the affected ear did not always show lower than those of the healthy ear, so we thought that excessive positive pressure at the mesotympanum caused by the Valsalva maneuver might have affected not only the affected ear but also the healthy ear and have resulted in healthy ears being severely impaired by excessive positive pressure. To prevent scuba divers from pressure injury, we think that divers should have their Eustachian tube dysfunction accurately evaluated and any problems should be treated well.

A Comparative Study of Eustachian Tube Functions in Normal and Diseased Ears with Tympanometry and Videonasopharyngoscopy

Eustachian tube is a bony and fibrocartilagenous tube extending from the antero-inferior part of middle ear cleft to lateral wall of the nasopharynx. Its main functions are ventilation of middle ear to equalize the middle ear pressure with atmospheric pressure and mucociliary clearance. The functioning of eustachian tube has a direct impact on normal middle ear function. As a corollary, dysfunction of eustachian tube inevitably leads to retraction of the tympanic membrane initially and sterile effusion and subsequent conductive deafness later. Secretory otitis media today is the most common cause of conductive deafness in children with an intact ear drum. Evaluation of function of eustachian tube assumes paramount importance in this scenario. To evaluate eustachian tube functions in normal and diseased ears with tympanometry and videonasopharyngoscopy and to compare the tympanometric tests of eustachian tube function with videonasopharyngoscopy and to assess their reliability. The study was conducted at Army hospital (R&R) Delhi Cantt from October 2005 to April 2007. Hundred (100) ears were examined and were divided into two groups, the control group with normal tympanic membrane on otoscopy and case group with complaints of diminished hearing and intact but retracted tympanic membrane. Their eustachian tube function was evaluated by tympanometric tests and videonasopharyngoscopy. Thereafter a comparison was made between the two. The study revealed that videonasopharyngoscopy was highly accurate and reliable test for eustachian tube function as compared to tympanometry. Slow motion video analysis of eustachian tube dynamics is a useful tool for further understanding the pathophysiology of tubal dysfunction.

Multimodal Assessment of Normal Eustachian Tube Function

Objective: Evaluate normal human Eustachian tube (ET) function during swallowing and other maneuvers that open the ET using a variety of modalities including EMG of the Tensor veli palatini (mTVP), Levator veli palatini (mLVP), and submental muscles, videoendoscopy, and sonotubometry; and compare these results with ET function tests in a pressure chamber. Method: In adult volunteers surface electrodes and needle EMG electrodes were placed into the mTVP and mLVP muscles. A 45° telescope was used to video-record the ET orifice, and sonotubometry recorded the ET openings. A subset was also tested in a pressure chamber. Results: Seventeen subjects were enrolled. EMG data was recorded from both the mTVP and mLVP in 15 subjects but from only one muscle in 2 subjects. In 9 subjects ET functions tests were performed in the pressure chamber. Video recording of ET opening was consistent with the EMG activity and ET openings by sonotubometry. mTVP activity had a shorter duration but a greater amplitude than mLVP activity. mLVP activity occurs before that of mTVP and the submental muscle group. Tests conducted in the pressure chamber demonstrated ET function consistent with the multimodal test results. Conclusion: Multimodal assessment of ET openings by monitoring the EMG of the paratubal and submental muscles, video recordings of the ET, and sonotubometry with ET function testing in the pressure chamber in adult volunteers is a novel and promising method for expanding our knowledge of middle ear physiology and pathophysiology.

Eustachian Tube Function in Adults without Middle Ear Disease

We sought to develop normative values for 5 eustachian tube function (ETF) test protocols in adults without otitis media (OM). Twenty adults (19 to 48 years of age) without a recent history of OM (5 had OM in childhood) underwent unilateral myringotomy and were evaluated for ETF by use of the forced response, inflation, deflation, forcible "sniff", and Valsalva test protocols. When possible, these tests were repeated on a second day. Normative values for the parameters of these protocols in adult subjects without a recent history of OM were developed. Between-day data for the forced response test were highly correlated. A percentage of these tests showed eustachian tube "constriction" during swallowing--an abnormal condition. The percent reduction in applied pressures for the inflation and deflation tests was high, indicative of good ETF. Few subjects had a positive "sniff" test, whereas most had a positive Valsalva test, and the results for both tests were effort-dependent. Results of ETF tests in adults with and without recent OM have not been published. Normative data are now available for comparison with ETF test results in adults with OM. These protocols will be used to evaluate the efficacy of surgical procedures designed to improve ETF.

Eustachian tube function tests (tubo-tympano-aerodynamic graphy and sonotubometry) in patients with patulous eustachian tube

Eustachian tube function tests (tubo-tympano-aerodynamic graphy and sonotubometry) in patients with patulous eustachian tube

Tympanometric study of eustachian tube function in oral submucous fibrosis

Background: Oral submucous fibrosis (OSMF) is a premalignant condition. Incidence of OSMF in India is 0.5%, mainly found in southern states and also in Saurashtra region. The pathological changes can involve mucosa, submucosa and the underlying muscles. The changes of tubal and paratubal muscles can affect the eustachian tube function. So, this study was carried out with an aim to determine the effect of OSMF on the eustachian tube function. Materials and Methods: 54 ears of 27 patients with OSMF and 50 ears of 25 normal persons were screened by eustachian tube function test (ETFT) after thorough history taking and clinical examination. Results: Out of the 54 ears in the OSMF group, type A curve was obtained in 42 (77.8%) ears, type B curve in none and type C curve was found in 12 (22.2%) ears, as compared to the normal group in which type A curve was obtained in 46 (92%) ears, type B curve in 2 (4%) ears, type C curve was found in 2 (4%) ears. On testing compliance of the middle ear, no change was observed at -200 daPa in 15 (27.8%) ears in the OSMF group and 5 (10%) ears in the normal group. Conclusion: The data observed were statistically analyzed by chi-square test, which suggested significant association between OSMF and eustachian tube function. Therefore, it can be concluded that eustachian tube function may be affected in OSMF and vice versa. So, while treating OSMF, hearing disability due to eustachian dysfunction has to be kept in mind and vice versa because treatment of hearing disability without taking care of OSMF will not be successful.

Eustachian tube function in patients with Meniere's disease

Objective The aim of the present study was to clarify the relationship between Eustachian tube function and inner ear function, especially with respect to the hearing ability of patients with Meniere's disease. Methods Patients with Meniere's disease underwent nystagmic examinations and audiometric measurements, including hearing tests, tympanometry, and Eustachian tube function tests (sonotubometry). We compared the audiometric examination results of normal subjects to those of patients with Meniere's disease. Results Twenty-five percent of patients with Meniere's disease exhibited Eustachian tube dysfunction, but 92% displayed normal tympanometry findings. Their sonotubometry durations and amplitudes were not significantly different from those of normal subjects. However, the patients’ hearing level was significantly correlated to sonotubometry duration and amplitude. Our patients were classified according to the four stages of Meniere's disease: stage 1 ( n = 9); stage 2 ( n = 5); stage 3 ( n = 8); and stage 4 ( n = 2). The incidence of Eustachian tube dysfunction in these four groups of patients were 0% (0/9); 40% (2/5); 38% (3/8); and 50% (1/2), respectively. Conclusion Our study provides evidence demonstrating that treatment of Eustachian tube dysfunction may be useful in preventing the hearing of Meniere's patients from becoming worse.

Pressure Regulating Ear Plug Testing in a Pressure Chamber

Middle ear barotrauma is a condition frequently associated with flying. It is usually caused by Eustachian tube (ET) dysfunction. Pressure-regulating earplugs (PREP) should improve complaints due to pressure equalization problems. There were 21 patients with a history of pressure equalization problems while flying who were examined. ET function was measured with exploratory tests and in a pressure chamber. In a double-blind study, PREP were examined using continuous impedance measurement in the pressure chamber. Eardrum deflection and pressure-equalizing maneuvers were also examined. During pressure exposure the subjective state of patients with and without PREP was compared. Evidence of ET dysfunction was found in twice as many patients with the impedance method in a pressure chamber compared to tympanometry or the Valsalva test. Use of PREP reduced the rate of pressure changes in the external auditory canal. Maximum pressure was reached with a delay of about 7 min. The number of pressure-equalizing maneuvers did not differ significantly. Using PREP the patients reported a significantly better subjective state on the VAS scale of 2.19 +/- 1.50 compared to 3.38 +/- 2.33 without PREP. Continuous impedance measurements in the pressure chamber identified ET dysfunction more often than the exploratory ET function tests commonly used in routine diagnostics. This novel finding requires further validation. Although use of PREP showed no signs of improving ET function, it did significantly improve individual subjective state during sudden pressure changes.

Auditory changes in patients undergoing orthognathic surgery

During orthognathic surgery, especially on the maxilla, osteotomies and displacements cause paratubular muscle dysfunction due to edema and muscle traction. This can cause auditory dysfunction. The aim of this study was to determine the effects of orthognathic surgery on the auditory status of patients. 54 consecutive patients who met the inclusion criteria underwent audiometric tests 24h preoperatively, and 48 h 6 weeks and 8 weeks postoperatively (2 weeks after maxillomandibular fixation removal). Surgery was on the maxilla, mandible or both. The types of movements were recorded. Audiometric examinations included pure tone audiometry, tympanometry and Eustachian tube function test. In the maxillary and bimaxillary procedures, there was some auditory system dysfunction (p<0.05). At the end of the study, a few patients had some mild dysfunction (p<0/05). In conclusion, orthognathic surgery (mainly maxillary and bimaxillary procedures) can cause some auditory system dysfunction, which is mild and transient in most cases and requires no intervention.

Assessment of eustachian tube function in tympanoplasty

Objective A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to evaluate the mucociliary function of the ET by saccharin and methylene blue test, and compare the outcome of surgery with normal and abnormal ET functions. Study Design Case series with planned data collection. Setting Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), a tertiary care center in South India. Subjects and Methods This study comprised 86 patients diagnosed with mucosal chronic otitis media in quiescent/inactive stage. All were subjected to a detailed clinical examination and investigations. Preoperative evaluation of ETF was compared with postoperative outcome of surgery, and the results were analyzed. Results The saccharin test and methylene blue dye test had a good correlation in evaluating ETF. The mean value for saccharin perception time and the clearance time for methylene blue were 17.5 and 8.1 minutes, respectively. ETF was best in anterior, worst among posterior, and intermediate in subtotal perforations. Type 1 tympanoplasty was successful in 94 percent with normal ETF and in 68 percent with partial dysfunction. Conclusion The saccharin test is a simple, cost-effective, and valuable diagnostic tool to assess the mucociliary function of the ET. The outcome of middle ear surgery would be a success in normal ETF, whereas in partial dysfunction the outcome need not necessarily be a failure.

Clinical evaluation of Eustachian tube transience and function in patients with different types of increased nasal resistance

Eustachan tube is a connection between throat and the middle ear. Inflammatory processes and malformations of nasal cavity could lead to dysfunction of the whole upper respiratory tract, thas emphasizing the evaluation of the Eustachian tube function both in surgery and in medicine in general. The aim of this study was to evaluate the Eustachian tube passage and function by tympanometry in different types of nasal resistance. Eustachian tube passage and function was tested in 102 patients with different types of nasal pathology and nasal resistance and compared to the results of 41 healthy persons with normal values of nasal resistance included in the control group. The patients with nasal pathology were divided into three subgroups: with mechanical, inflammatory and mixed alterations. Nasal resistance was carried out with constant body plethysmography (Jaeger). The test of Eustachian tube passage and function was performed using tympanometric Toynbee-deglutition/Valsalva-deglutition test. The results of measurements were compared with those in the healthy control group and analyzed by means of parametric and nonparametric statistic tests, Pearson chi2 test, Fisher test of exact probability and variance analysis. The subgroup with inflammatory alterations had significantly higher values of pathological tympanograms than other subgroups and the control group (p < 0,05). The dysfunction of the Eustachian tube was significantly more present in all subgroups than in the control group (p < 0,05). Pathological form of tympanograms is more often present in purely inflammatory changes of nasal cavities with higher nasal resistance than in mechanical nasal obstruction. All forms of higher nasal resistance are more often accompanied with Eustachian tube dysfunction. There was no significant differences in Eustachian tube passage between the subgroups and the control group.

Objective assessment of autophony in patients with patulous Eustachian tube

The objective of the present study is to evaluate the Eustachian tube (ET) acoustic patency during phonation. The sound level in the EAC during phonation of the "A" and "N" sounds was measured by microphones in the bilateral EACs of nine normal subjects and 31 patients with patulous ET. The measured sound pressure differences between the right and left ears were correlated with the differences in severity of autophony between the bilateral ears assessed by a visual analogue scale (VAS). The patulous condition was often remarkable when the "N" sound was phonated. In some patients with patulous ET, the patulous condition was indicated only by the present method, and not by conventional ET function tests such as tubo-tympano-aerodynamic-graphy or sonotubometry.

Patulous Eustachian tube associated with hemodialysis

The objective of the present study is to demonstrate that hemodialysis (HD) is a possible causal factor for patulous Eustachian tube (ET). We present a representative case report and results of a mass examination in the HD unit. The present patient (a 55-year-old woman) reported aural fullness and autophony were often experienced after HD. The findings of eardrum and ET function tests revealed that her patulous ET condition was observed soon after HD and then disappeared until the next HD. A survey in the HD unit was carried out to identify patients who noticed patulous symptoms after HD. Patients underwent further examination, including detailed interview, otoscopy, and ET function tests with sonotubometry and tubo-tympano aerodynamic-graphy just before and soon after HD. The survey at the HD unit found 13 of 147 HD patients (8.8%) had HD-related patulous ET. Aural symptoms occurring after HD are frequently caused by patulous ET.

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.

Comparison of effects of dry versus wet swallowing on Eustachian tube function via a nine-step inflation/deflation test

The aim of the present study is to evaluate the effect of swallowing type (dry versus wet) on the outcome of a nine-step inflation/deflation tympanometric Eustachian tube function (ETF) test in healthy adults. Fourteen normal healthy volunteers, between 19 and 28 years of age, were included in the study. The nine-step test was performed in two different test procedures: (1) test with dry swallows (dry test procedure) and (2) test with liquid swallows (wet test procedure). If the equilibration of middle-ear (ME) pressure was successful in all the steps of the nine-step test, ETF was considered 'Good'. Otherwise, the test was considered 'Poor', and the test was repeated at a second session. In the dry test procedure, ETF was 'Good' in 21 ears at the first session and in 24 ears after the second session (p > 0.05). However, in the wet test procedure, ETF was 'Good' in 13 ears at the first session and in 21 ears after the second session (p < 0.05). At the first session, ETF was 'Good' in 21 and 13 ears in the dry and wet test procedures, respectively. The difference was statistically significant (p < 0.05). However, after the second session, the overall number of ears with 'Good' tubal function was almost the same in both test procedures (24 ears at dry test procedures versus 21 ears at wet test procedures;p > 0.05). Dry swallowing seems to be more effective for the equilibration of ME pressure. Thus, a single-session dependent evaluation of ETF may be efficient for the dry test procedure of the nine-step test. Swallowing with water may be easier for subjects, but a repetition of the test at a second session may be necessary when the test result is 'Poor'.

Eustachian Tube Function Before Recurrence of Otitis Media With Effusion

To study the role of eustachian tube function in the development of recurrent otitis media with effusion (OME) in children treated with tympanostomy tubes for OME. Prospective cohort study. Three academic and general hospitals. Children aged 2 to 7 years with a first clinical episode of OME that persisted for at least 3 months; 136 (81%) of 168 eligible children participated. All children received tympanostomy tubes for bilateral OME at study entry. Recurrence of OME within 6 months of tube extrusion. No statistically significant differences were present in eustachian tube function test results between ears that developed recurrent OME and those that did not. The difference in passive ventilatory function between ears with and without OME recurrence was 10 daPa (95% confidence interval, -24 to 43 daPa) for opening pressure and -3 daPa (95% confidence interval, -18 to 11 daPa) for closing pressure. The overall difference in the proportion of ears with and without OME recurrence that could not equilibrate positive and negative applied pressures was 12% (95% confidence interval, -2% to 26%). The proportions of ears with and without OME recurrence that induced negative pressure in the middle ear by forcefully sniffing were 22% and 31%, respectively (P = .75). Measurement of ventilatory and protective eustachian tube function using the forced response test, the pressure equilibration test, and the sniff test has no value in predicting whether children have an increased risk of OME recurrence.