Eustachian Tube In Patients Research Articles

The Variability of function of the Eustachian tube in patients with chronic sinusitis.

BackgroundThe Eustachian tube is a complex and inaccessible structure, which is responsible for the ventilation of the middle ear. The aim of the study was the assessment of an impact of chronic sinusitis on the auditory tube function. MethodsThe prospective analysis of 84 surgically treated chronic sinusitis patients was carried out. This study is based on preoperative results of impedance audiometry in correlation with the data from the medical history of chronic sinusitis, symptoms reported by the patients, results of Computered Tomography (CT) and the stage of inflammatory changes according to Lund and Mackay score. ResultsThe significant majority of patients of our study (65) had advanced auditory tube symptoms, while 4 patients suffered from symptoms significantly impacting daily life. In patients with chronic sinusitis the analysis demonstrated that tympanometry type B (12.67) and C (12.4) occured with significantly higher number of points of Lund-Mackay score than type A (9.2). In allergy sufferers type B of tympanometry was more often observed with characteristically bilaterally located inflammatory changes in maxillary and anterior ethmoid sinuses.ConclusionThe profile of chronic sinusitis patient in whom Eustachian Tube Dysfunction is more often observed, is as follows: Lund and Mackay score above 12pathological changes are bilaterally observed in maxillary and frontal ethmoid sinuses decrease of nasal patency nad postnasal dripAllergyoverusing alcohol and cigarettes, at least alcoholWorse result of Lund and Mackay score and the age of patients are 2 factors favoring the dysfunction of the Eustachian Tube.

STATE OF HEARING FUNCTION AND EUSTACHIAN TONSILS IN PATIENTS WITH SECRETORY OTITIS MEDIA AT DIFFERENT STAGES OF ITS DEVELOPMENT

The problem of hearing pathology is relevant as we have seen the number of those patients increasing yearly. According to the literature, about 30% of all cases of hearing loss are related to middle ear pathology. The cause of the development of many forms of hearing loss is the dysfunction of the Eustachian tube which can lead to retraction of the tympanic membrane, development of secretory otitis media or even adhesive otitis media that can be the reason for constant conductive hearing loss, and require surgical intervention to restore mechanism of sound conduction.
 Prevention and treatment of hearing disorders is not only a medical, but also a social-economic problem. In our researches, we’ve decided to study the peculiarities of hearing impairment in patients with secretory otitis media in different stages of its development, depending on the condition of the tubal tonsils and lymphoid tissue around the orifice of the Eustachian tube.
 The aim. Study the relationship between the state of auditory function and pathomorphological changes of the tubal tonsils and lymphoid tissue around the orifice of the Eustachian tube in patients with secretory otitis media in different stages of its development.
 Material and methods. There were examined 89 patients, age between 18 and 65 years old, with secretory otitis media. All patients were performed a detailed collection of complaints, disease anamnesis, examination of the ENT-organs – by a routine method and with the help of endoscopic and microscopic equipment, as well as pure-tone audiometry and tympanometry. Patients were divided into III groups. Group I – 21 patients with catarrhal stage of secretory otitis media, group II – 38 patients with serous stage, group III – 30 patients with mucous stage.
 The results. When examining patients with secretory otitis media during nasopharyngeal endoscopy, the changes in the tubal tonsils and surrounding area in the form of inflammation, hypertrophy, or hyperplasia were found. The form of these changes affects the nature of the disease stage. According to pure-tone audiometry, the average hearing thresholds at speech frequencies by air conductivity in all patients were significantly increased. At the same time, in patients of group III with mucous exudate in the middle ear space, average hearing thresholds by bone conduction were slightly increased, which is associated with significantly restricted or absent movement of the tympanic membrane and ossicular chain in the presence of thick mucous exudate.
 Conclusions. Analyzing the patients’ complaints, clinical picture, data of otoscopy, endoscopy of the nasal cavity and nasopharynx, data of pure-tone audiometry and tympanometry – there was determined a cause-and-effect relationship between the condition of the tubal tonsils, the stage of secretory otitis media and, accordingly, hearing impairment in the examined patients. The performed studies indicate that one of the reasons for the development of secretory otitis media in adults may be pathomorphological changes in the tubal tonsils and lymphoid tissue surrounding the orifice of the Eustachian tube, namely their pathomorphological changes: inflammation, hypertrophy, or hyperplasia. Inflammation of the tubal tonsils, as a rule, is the cause of the development of the catarrhal and serous stage of secretory otitis media, and their hypertrophy or hyperplasia leads to the long-term dysfunction of the Eustachian tube, which in turn is the cause of the mucous stage of secretory otitis media.

Radiological dimensions of the Eustachian tube in patients with adhesive otitis media.

This study aimed to analyse the computed tomography parameters for effective ventilation in patients with adhesive otitis media. Twenty-six patients with unilateral adhesive otitis media were included in the study. The patients' temporal bone computed tomography images were retrospectively reviewed. Eustachian tube length and diameter were measured. Mastoid pneumatisation and middle-ear size were evaluated by measuring petroclival and Eustachian tube-tympanic cavity ventilation angles. The average Eustachian tube length was 38.4 mm and 38.9 mm in adhesive otitis media and healthy ears, respectively. The Eustachian tube diameter of the adhesive otitis media ears (1.47 mm) was significantly narrower than that of the healthy ears (1.83 mm). There were no significant differences in the angles between adhesive otitis media and healthy ears. A narrow Eustachian tube diameter was associated with developing adhesive otitis media. Measuring Eustachian tube diameter is simple and can be routinely performed when examining temporal bone computed tomography images for Eustachian tube function evaluation.

Long-term Changes of Hearing Thresholds and Eustachian Tube Function After Balloon Dilation of the Eustachian Tube in Patients With Chronic Otitis Media.

This study aimed to evaluate long-term changes after balloon dilation of the Eustachian tube (BDET) in chronic otitis media (COM) patients with Eustachian tube (ET) dysfunction that persisted after tympanomastoidectomy (TM). We retrospectively reviewed the medical records of consecutive patients who were diagnosed with COM and ET dysfunction and underwent TM at our tertiary hospital from 2016 to 2017. The tympanic membrane status, the presence of a ventilation tube, ability to perform the Valsalva maneuver, and audiologic changes after dilation of the ET were analyzed. This study included 20 patients (with 21 ears) who underwent TM but could not perform the Valsalva maneuver, showed a persistent air-bone gap, and eventually underwent BDET (male:female, 8:13; right:left, 11:10). Four ears showed perforation of the tympanic membrane after TM. Among the remaining 17 ears, 15 ears underwent ventilation tube insertion before BDET, while two ears underwent ventilation tube insertion and BDET simultaneously. Although none of the patients were capable of the Valsalva maneuver before BDET, 13 (62%) were able to perform the Valsalva maneuver successfully after BDET. When evaluating the tympanic membrane status at the latest follow-up, ventilation tubes were still present in eight ears. In the other 13 ears, intact tympanic membranes were present in nine out of 11 ears n the successful Valsalva group, whereas none of them were intact in the unsuccessful Valsalva group (P=0.014). The successful Valsalva group after BDET showed an improved air-bone gap of 8.9±12.4 dB, while the unsuccessful Valsalva group showed an aggravated air-bone gap of 3.8±11.8 dB at 1 year after BDET; this difference was statistically significant (P=0.031). The Valsalva maneuver could be performed successfully after BDET by 62% of patients with COM and ET dysfunction. BDET is helpful for successful hearing improvement and improved tympanic aeration in COM patients with ET dysfunction.

Role of preoperative tympanometric evaluation of eustachian tube in patients undergoing type-1 tympanoplasty for chronic otitis media

<p class="abstract"><strong>Background:</strong> A dysfunctional eustachian tube can cause failure of middle ear pressure regulation which leads to chronic otitis media and tympanoplasty failure. The functional status of eustachian tube can non-invasively be assessed prior to tympanoplasty by impedence audiometry. This help to predict the outcome of the procedure as well as aid surgeons to plan the surgery accordingly. The aim of the study was to determine the role of pre-operative tympanometric evaluation of eustachian tube function in patients with chronic otitis media.</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 42 patients with chronic otitis media underwent type-1 tympanoplasty in department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history, clinical and audiological evaluation done. Type-1 tympanoplasty performed and reassessed after 3 months. Data compiled and analysed using SPSS.</p><p class="abstract"><strong>Results:</strong> Intra-operative findings were similar to the audiometric results. Majority of patients with dysfunctional eustachian tube got a non-satisfactory hearing outcome compared to patients with good eustachian tube function, and this comparison is statistically significant with p value 0.006. The graft uptake in patients with dysfunctional eustachian tube is poor compared to patients with good eustachian tube function, which is statistically significant with p value 0.013.</p><p class="abstract"><strong>Conclusions:</strong> Impedence audiometer can very reliably assess and ascertain eustachian tube dysfunction pre-operatively. The outcome of type-1 tympanoplasty in patients with eustachian tube dysfunction is uniformly poor. Better outcome probably would be gained by using more resilient materials like cartilage.</p>

Three-Dimensional Assessment of Eustachian Tube in Patients With Cleft Palate Versus Controls: A CBCT Study.

To compare the morphological characteristics of the Eustachian tube (ET) between patients with cleft palate and healthy controls with the use of cone-beam computed tomography (CBCT). Retrospective assessment of treated nonsyndromic patients with cleft palate and a control group. CBCT images of 51 patients with cleft palate who had previously undergone surgery to close the cleft palate and a control group of 51 patients were included in this study. Syndromic patients were excluded. The cleft group were divided into 3 groups according to the palatoplasty technique, which was done in the infancy period to close the cleft palate (Nadjmi modification of Furlow, Sommerlad, and V-Y pushback). Finally, ET length (ETL), ET angle, and auditory tube angle (ATA) were measured in all patients. The ETL, ETA, and ATA in the cleft and the normal control groups were 29.73 ± 3.14 and 32.18 ± 3.34 mm, 33.18 ± 2.57 and 35.40 ± 3.93, and 141.64 ± 4.13 and 138.87 ± 4.96, respectively. All 3 features were statistically significant among the groups (All Ps < .05). ETL and ETA were significantly higher in Nadjmi modification of Furlow and Sommerlad palatoplasty techniques compared to the V-Y pushback technique, while there was no significant difference in the ATA between the palatoplasty groups. Cleft palate can significantly affect the morphological characteristics of the ET. Type of the infancy palatoplasty can influence some of its dimensions.

Enlargement of Eustachian Tube Lumen in Patulous Eustachian Tube Patients Compared to that by Aging.

To evaluate the Eustachian tube (ET) dimensions in patulous ET (PET) patients compared with that by aging using sitting 3D computed tomography (CT). Retrospective study. Tertiary referral center. A retrospective survey of medical records in Sen-En Rifu Hospital identified 105 ears of 76 PET patients and 65 ears of 34 patients without ET dysfunction findings (non-PET). Subjects in both PET and non-PET groups were then divided into two age groups. Groups A and C defined as non-PET and PET subjects respectively, who were under the age of 60 years, while Groups B and D defined of non-PET and PET subjects respectively, who were 60 years and above. 3D CT (Accuitomo; Morita, Kyoto, Japan) was performed on all subjects in the sitting position. The ET lumen from the ET pharyngeal orifice to 15 mm was analyzed. No significant difference in the ET lumen near the pharyngeal orifice was found between Group A and C; however, there was a significant difference in the ET at points lateral to the pharyngeal orifice. The ET lumen was significantly larger at the site close to the pharyngeal orifice in Group B as compared to that of Group A. For the two groups of PET classified according to the size of the pharyngeal orifice and area close to the isthmus, age was only significantly different between two groups of pharyngeal orifice. On the contrary, sonotumometry and Ohta method were significantly different between the two groups of the area close to the isthmus. The lumen of the ET is enlarged in both PET and aging. However, the responsible site was found to be different. While the enlargement of the ET lumen in 60 years and above subjects without PET mainly occurred near the pharyngeal orifice of the ET, it was near the isthmus in under 60 years PET patients. Further study of possible clinical implications of these findings as well as treatment strategy are required.

The effect of balloon dilatation eustachian tuboplasty combined with grommet insertion on the structure and function of the eustachian tube in patients with refractory otitis media with effusion.

The treatments for refractory secretory otitis media with effusion usually choose long-term grommet insertion. This study evaluated the effect of balloon eustachian tuboplasty combined with grommet insertion on the function and the opening length of the eustachian tube in patients with refractory otitis media with effusion. Fifty-seven patients with refractory otitis media with effusion were enrolled. A three-dimensional reconstruction of an iohexol-enhanced computed tomography image was applied to evaluate the structural and length changes of the eustachian tube at both resting and Valsalva maneuver states. The grommet was removed 3 months after the operation and postoperative follow-up was carried out from 3 to 12 months. We performed pre- and post-operative observation of the following: appearance of the tympanic membrane, pure-tone audiometry threshold, eustachian tube score, seven-item Eustachian Tube Dysfunction Questionnaire scores (ETDQ-7), quantitative examination of eustachian tube function dynamic observation of tympanogram peak pressure point, and computed tomography examination of the eustachian tube. The pure-tone audiometry at 1, 3, 6, 9, and 12 months postoperatively were all significantly lower compared to the preoperative value (all P<0.05). There was no significant difference between the pure-tone audiometry at 6 and 9 months postoperatively, neither was for the air-bone conduction gap at these time points. The quantitative examination peak pressure deviation was markedly increased at 6 months postoperatively compared with that before the operation (all P<0.05). The peak pressure deviation of tympanometry at 6 and 9 months postoperatively were both higher than the value at 12 months after surgery (P<0.05). The eustachian tube score at 1, 3, 6, 9, and 12 months postoperatively were notably higher than that before the operation (all P<0.05). A significant difference was also observed between the 6- and 12-month postoperative eustachian tube score (P<0.05). There was a significant difference in the ETDQ-7 scores at 6- and 12-month postoperatively (P<0.05). The quantitative examination peak pressure deviation and eustachian tube score were both correlated with development length of the eustachian tube after three-dimensional computed tomography reconstruction (P<0.05). Eustachian tube balloon dilatation combined with grommet insertion is an effective treatment for refractory otitis media with effusion.

Efficacy of balloon dilatation of the eustachian tube in patients with refractory otitis media with effusion after radiotherapy for nasopharyngeal carcinoma.

To investigate the efficacy of balloon dilatation of the eustachian tube (BDET) in patients with refractory otitis media with effusion (OME) after radiotherapy for nasopharyngeal carcinoma. A total of 58 patients (74 ears) who had received BDET for treatment of refractory OME after radiotherapy for nasopharyngeal carcinoma were enrolled. The efficacy was evaluated by seven-item eustachian tube scores (ETS-7), tympanogram type and air-bone gap, and the total effective rate was also calculated. All patients were followed up for 2years. ETS-7 scores at every postoperative visit were significantly higher than preoperative scores (all P<0.05). ETS-7 score 6months after surgery was the highest, which declined sharply from the 6th to the 24th month after surgery. Air-bone gap from the 1st to the 18th month after surgery was significantly smaller than preoperative one (all P<0.05). Air-bone gap 6months after surgery was the smallest, followed by that 12months after surgery. The improvement in tympanogram type 6months after surgery was the highest. The improvement of tympanogram type declined sharply from 12 to 24months after surgery. According to evaluation of efficacy, only one patient completely recovered, and five patients partially recovered during the 2-year follow-up. BDET can only significantly improve efficacy of refractory OME after radiotherapy for nasopharyngeal carcinoma for a certain period of time during the 2-year follow-up.

Eustachian tube functional assessment among patients with CSOM undergoing tympanoplasty surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pre-operative test of eustachian tube (ET) function is important for achieving a satisfactory result of tympanoplasty for CSOM patients. The saccharin test and methylene blue test seems to provide adequate information of the mucociliary function and patency of the ET. The aim was to study the ventilatory and mucociliary function of Eustachian tube in patients with chronic suppurative otitis media planned for tympanoplasty surgery and to assess the success rate of tympanoplasty in relation to the Eustachian tube function&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective longitudinal study was conducted for a period of one year. Patients aged more than 15 years with features of chronic suppurative otitis media of either tubotympanic type or atticoantral type were included in the study. The total number of study subjects included in our study was 82 patients with CSOM. The ventilatory and the mucociliary functions of the auditory tube were assessed preoperatively using saccharin test and methylene blue test. All patients with CSOM underwent tympanoplasty surgery and the outcome of the surgery was assessed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall success rate of tympanoplasty surgery was 76.8%. It was observed in our study that the success rate of tympanoplasty was higher among patients with normal eustachian tube function.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Preoperative evaluation of eustachian tube function is mandatory for all the patients planned for tympanoplasty. Preoperative and intraoperative corrective measures should be taken in patients with partial and absent tubal function to improve the success rate of tympanoplasty surgeries.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Feasibility and Safety of Transtympanic Balloon Dilatation of Eustachian Tube.

Assess safety and feasibility of transtympanic dilatation of proximal (tympanic-end) of the cartilaginous segment of the Eustachian tube in patients undergoing surgery for chronic ear disease. Case series. Tertiary care hospital. We reviewed the charts of 40 consecutive patients undergoing chronic ear surgery in our practice with manometric evidence of obstruction who underwent attempted transtympanic dilatation of proximal (tympanic-end) segment of the Eustachian tube. A range of outcome measures were reported that included pre and postdilatation opening pressure measurement of the Eustachian tube, closure of perforation, audiometric data, and complications. Dilatation of proximal (tympanic-end) of the cartilaginous segment of the Eustachian tube was technically feasible in 37 of 40 patients (93%). Postdilatation inspection of protympanum showed increased aperture in all dilated tubes. Opening pressure of Eustachian tube declined in 36 of 37 patients (97%). Residual perforation was evident in 5 of 40 patients (12%). No facial nerve or carotid complications were observed. Two patients had severe dizziness (5%) with one patient sustaining severe cochlear loss. Transtympanic dilatation increases the patency of the Eustachian tube immediately after instrumentation. No carotid complications were observed. Continuous endoscopic control is essential to avoid subluxation of stapes. Further study of this technique is warranted to identify its role, if any, in chronic ear surgery.

Comparison between the angle of Eustachian tube in patients with chronic suppurative otitis media and normal ears based on computed tomography scan of temporal bones in Haji Adam Malik general hospital Medan

The function of the Eustachian tube plays a significant role in increased risk chronic suppurative otitis media (CSOM). The angle of the Eustachian tube is a predisposing factor for Eustachian tube dysfunction and clearance disorder of the middle ear. The aim of this study was to compare the mean angle of a Eustachian tube of CSOM ears and normal ears. This research was a cross-sectional study consisting of 19 patients of CSOM without cholesteatoma, 19 patients of CSOM with cholesteatoma and 19 patients with normal ears. All patients were examined using CT Temporal, and the angle of the eustachian tube was measured using multiplanar reconstruction technique. The mean angle of Eustachian tube in CSOM patients without cholesteatoma was 32.82° (SD=3.82), in CSOM with cholesteatoma was 27.74° (SD=4.44) and in normal ears was 33.61° (SD=3.83). Based on Kruskal-Wallis test, there was a significant difference in the angle of a Eustachian tube of these three groups (p<0.001). There was a significant difference between the mean angle of the Eustachian tube in CSOM ears and normal ears.

The 678\xa0Hz acoustic immittance probe tone: a more definitive indicator of PET than the traditional 226\xa0Hz method

BackgroundThe accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to determine whether a 678 Hz probe tone is a more accurate indicator of Patulous ET (PET) than the 226 Hz probe tone when used in compliance over time (COT) testing.MethodsTwenty subjects (11 normal ET ears and 7 PET ears) were individually seated in an examination room and connected to a GSI TympStar Middle Ear Analyzer. The order of probe tone frequency (678 or 226 Hz) was randomized. Baseline “testing” COT recordings for each ear undergoing testing were completed. Subjects were instructed to occlude their contralateral nostril and to breathe forcefully in and out through their ipsilateral nostril until the test had run to completion. This process was repeated with the probe tone that had not been previously run. For the control group, each subject had one random ear tested. For the experimental group, only the affected ear(s) was tested. Wilcoxon rank rum tests were performed to determine statistical significance.ResultsThe baseline COT measurements for the control group and PET group were similar, 0.86 mL (SD = 0.34) and 0.74 (SD = 0.33) respectively. Comparing the 226 Hz tone between groups revealed that PET patients had a median COT difference 0.19 mL higher than healthy ET patients, and for the 678 Hz tone, PET patients had a median COT difference of 0.57 mL higher than healthy ET patients. Both were deemed to be statistically significant (p = 0.002, p = 0.004 respectively). The was a statistically significant median COT difference between the 678 Hz and 226 Hz of 0.61 mL (p = 0.034) for the PET group, while the same comparison for the control group of 0.05 mL was not significant (p = 0.262), suggesting that the 678 Hz tone yields a larger response for PET than the 226 Hz tone, and no difference for the control group, thus making it less prone to artifact noise interference.ConclusionThe 678 Hz probe tone is a more reliable indicator of ET patency, and should be preferably used over the 226 Hz tone for future COT testing.

Pathology and Treatment of Patulous Eustachian Tube in Patients with and without Habitual Sniffing

Pathology and Treatment of Patulous Eustachian Tube in Patients with and without Habitual Sniffing

Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube

Conclusions: Trans-tympanic plugging of the Eustachian tube (ET) with the silicone plug (Kobayashi Plug) induced long-term effectiveness for over 80% of chronic and severe patulous ET (PET) patients. The New Kobayashi Plug was more effective with fewer complication of plug descent to the pharyngeal orifice.Objective: To investigate the effectiveness and complications of trans-tympanic plugging of the ET using a Kobayashi Plug for chronic PET.Method: Trans-tympanic plugging of the ET using the Kobayashi Plug was performed for 252 ears of 191 patients. The Prototype Plug (115 ears of 82 patients in 2001–2007) and the New Plug (137 ears of 109 patients in 2008–2013) were inserted for chronic PET patients.Results: The success rate of the Kobayashi Plug for PET was 83.0% of a total (Prototype Plug 80.0%, New Plug 85.4%). In 26 ears, the Prototype Plugs were found to have descended toward the nasopharynx. Conversely, this did not happen with the New Plug. The rate of TM perforation (Prototype 22.6%, New 17.5%), middle ear effusion (Prototype 20.2%, New 10.2%) and ventilation tube placement (Prototype 14.8%, New 4.4%) decreased after transition to the New Plug.

Functional MRI of the Eustachian Tubes in Patients With Nasopharyngeal Carcinoma: Correlation With Middle Ear Effusion and Tumor Invasion.

We sought to combine the Valsalva maneuver with MRI to evaluate eustachian tube function in patients with nasopharyngeal carcinoma (NPC) and to correlate the extent of tumor invasion with the presence of middle ear effusion (MEE) and eustachian tube dysfunction (ETD). We performed MRI along the lengths of the eustachian tubes, before and after the Valsalva maneuver was performed, in 53 patients with untreated NPC. The images were reviewed by two radiologists. A total of 106 eustachian tubes and middle ears were studied. There was dysfunction in 37 eustachian tubes, which was always ipsilateral to the NPC. There was MEE in 26 ears of 22 patients. In all cases of MEE, there was ipsilateral ETD. ETD was correlated with tumor invasion of the ipsilateral pharyngeal recess (p < 0.001), pharyngeal opening of the eustachian tube (p < 0.001), the cartilaginous eustachian tube (p < 0.001), the eustachian cartilage (p < 0.001), Ostmann fat pad (p < 0.001), the levator veli palatine muscle (p < 0.001), and the tensor veli palatine muscle (p < 0.001). There was a strong correlation between the grade of parapharyngeal space invasion and ETD (r = 0.809; p < 0.001) and MEE (r = 0.693; p < 0.001). Combining the Valsalva maneuver with MRI is helpful in assessing the function of the eustachian tube in patients with NPC. The cause of MEE in patients with NPC is dysfunction of the eustachian tube opening, which is associated with tumor invasion around the eustachian tube.

Treatment Effectiveness for Symptoms of Patulous Eustachian Tube: A Systematic Review.

To determine the effectiveness of currently available medical and surgical interventions for treating symptoms of Patulous Eustachian Tube (PET). A comprehensive search of MEDLINE (January 1948 to July 8, 2015), EMBASE (January 1974 to July 8, 2015), gray literature, hand searches, and cross-reference checking. Original published reports evaluating an intervention to treat the symptoms of patulous eustachian tube in patients 18 years and older. Quality-of-case reviews were assessed with the National Institute of Health (NIH) Quality Assessment Tool for Case Series Studies. The search strategy identified 1,104 unique titles; 39 articles with 533 patients are included. The available evidence consists of small case series and case reports. The most common medical treatment was nasal instillation of normal saline. Surgical treatments were categorized as mass loading of the tympanic membrane, eustachian tube plugging, and manipulation of eustachian tube musculature. The available evidence for management of patients with PET is poor in quality and consists predominantly of small case series. Further research is needed to determine the comparative efficacy of the current treatments.

Site of eustachian tube obstruction in chronic ear disease.

Assess the patency of the proximal and distal segments of the Eustachian tube in patients undergoing surgery for chronic ear disease. Case study with control group. All consecutive patients presenting for surgery for chronic ear disease in our practice over 14 months underwent preoperative Valsalva computed tomography (CT), and an attempt was made intraoperatively using angled rigid scopes to evaluate obstruction of the protympanic segment of the Eustachian tube. Endoscopic examination of the same segment in 19 cadaver ears served as a control group. Preoperative Valsalva CT showed patency of the distal one-third of the Eustachian tube in 51 of 53 ears. Intraoperative endoscopy allowed visualization of the protympanic opening of the Eustachian tube in 31 of 53 ears; 21 of 31 ears showed obstruction of the protympanic opening of the Eustachian tube. A clear obstruction was more likely to be present in the protympanic opening of the Eustachian tube in the patient population undergoing surgery for chronic ear disease than in the cadaver control group, and was equally likely to be present in the distal cartilaginous tube in patients as in the control population. 4.

First Clinical Results of the Dilatation of the Eustachian Tube in Patients with Tubal Dysfunction

Objectives: One of the main causes for chronic otitis media is a tubal dysfunction which can now be treated with the endonasal dilatation of the Eustachian tube with the help of a novel balloon catheter. Methods: Since July 2010, we treated patients with a tubal dysfunction with a balloon dilatation of the Eustachian tube with the help of an endoscope through an endonasal approach. Such a dilatation was done in patients in whom we found a tubal dysfunction in the tube manometry and impedance audiometry. In 55 patients, a single-sided and in 50 patients a bilateral treatment was performed by inserting a specially designed balloon catheter into the cartilage of the Eustachian tube and inflating it with 10 bar for 2 minutes. Results: Between July 2010 and November 2011, 105 patients (age 9-71; 45 female, 60 male) were treated because of a tybal dysfunction. The dilatation was performed under general anesthesia using an endoscope and a specially designed applicator. The postoperative check-up showed improved function in 69 patients, while 36 patients still showed a limitation of the tubal function. All patients reported a subjective improvement of middle ear pressure equalization. Conclusions: The endonasal dilatation of the Eustachian tube using the balloon catheter set to enlarge the cartilage is a safe and reliable method in patients with a tubal dysfunction. Our first clinical results confirm functional improvement after one year.

Noninvasive intratympanic dexamethasone treatment for sudden sensorineural hearing loss

Conclusion: Noninvasive intratympanic dexamethasone perfusion (IDP) through the eustachian tube is an effective and safe therapy in cases of sudden sensorineural hearing loss (SSNHL). Objective: To investigate the effectiveness and safety of noninvasive IDP through the eustachian tube in patients with SSNHL. Methods: In this prospective study, 74 consecutive patients with SSNHL treated between September 2007 and March 2011 were enrolled: 35 patients fitted the criteria for initial treatment in the study (group I), while 39 patients, who had failed systemic therapy, received salvage treatment (group S). IDP through the eustachian tube was applied four times at 2-day intervals. Pure-tone test and tympanometry were performed before starting treatment, and 24 h and 1 week afterwards. Results: All patients tolerated the procedure well. No perforation or infection was noticed in any of the patients at their last visit. With regard to the74 patients who received intratympanic treatment, 80.0% (28 of 35) of the patients in group I and 64.1% (25 of 39) patients in group S had improvement in their hearing ability. Patients with simultaneous symptoms reported that the symptoms were relieved as follows: tinnitus, 73.3% (44/60); vertigo, 76.2% (16/21); and stuffy ear, 81.1% (30/37).