Eustachian Tube Malfunction Research Articles

Wideband Acoustic Immittance in Children.

As wideband absorbance (WBA) gains popularity, it is essential to understand the impact of different middle ear pathologies on the absorbance patterns as a function of frequency in children with various middle ear pathologies. More recently, the use of wideband tympanometry has enabled clinicians to conduct WBA at ambient pressure (WBA amb ) as well as the pressurized mode (WBA TPP ). This article reviews evidence for the ability of WBA measurements to accurately characterize the normal middle ear function across a wide range of frequencies and to aid in differential diagnosis of common middle ear disorders in children. Absorbance results in cases of otitis media with effusion, negative middle ear pressure, Eustachian tube malfunction, middle ear tumors, and pressure equalization tubes will be compared to age-appropriate normative data. Where applicable, WBA amb as well as WBA TPP will be reviewed in these conditions. The main objectives of this article are to identify, assess, and interpret WBA amb and WBA TPP outcomes from various middle ear conditions in children between the ages of 3 and 12 years.

Oral Submucous Fibrosis: Association of Clinical and Histological Severity with Hearing Loss and Middle Ear Function.

OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in OSMF patients by audiometry and tympanometry. Two Hundred patients of < 40years of age with OSMF were examined and followed by PTA and impedance audiometry. Impaired mobility was seen in 20(10%) ears, and retraction of tympanic membrane was found in 36(18%) ears. Clinical staging was done in four stages. Majority of the patients were males (58%) in the age group of 21-30years belonging to stage III (38%) and IV (26%) respectively. PTA showed varying degrees of hearing loss in 73 (36.5%) ears. In Grade I, mild hearing loss was seen in 10 (35.71%) ears and moderately severe hearing loss was in 5 (11.36%) ears whereas in Grade II mild hearing loss in 11(25%) ears. Grade III and IV showed mild hearing loss in 11(14.47%) and 12 (23.07%) respectively. Tympanometry revealed type A curve in 126 (63%) ears followed by C curve in 50 (25%) and B curve in 24 (12%) ears. In patients of OSMF, there is involvement of palatal/paratubal muscles in the fibrosis process, which causes eustachian tube malfunction leading to disturbed middle ear functions and negative middle ear pressure. Most patients of oral submucous fibrosis showed direct association with grade of hearing impairment and eustachian tube dysfunction. Higher clinical grades, both clinically and histologically showed similar findings thereby we concluded that if the disease is treated early, preventing patients from having higher grades of disease, involvement of ear can be avoided, and patients can be saved from hearing impairment.

Assessment of eustachian tube dysfunction in middle ear pathologies

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Auditory tube dysfunction is suspected as primary cause of chronic otitis media and leads to surgical related complications in otitis media with tympanic membrane perforation. The diagnosis of eustachian tube malfunction is essential to know the pathogenesis of chronic otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total 150 cases and 75 age, sex matched control subjects between age group 20-50 years were selected. Pre and post-surgical history was noted and detailed ear examination, tympanometry was done. Auditory tube function was evaluated through Valsalva test, nasopharyngoscopy, pneumatic otoscopy. Intact tympanic membrane was assessed by Williams test, perforated tympanic membrane by Toynbee’s test. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Postoperative assessment of eustachian tube function by Toynbee’s test for 19 cases with failed tympanoplasty showed normal ET function in 5 cases, 8 cases had partial and 6 cases had gross ET dysfunction. Postoperative assessment ET function by William’s test showed 4 cases among 19 cases had partial ET dysfunction and 01 cases had gross ET dysfunction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Efficient surgical outcome of middle ear complications always depends on eustachian tube function. Most of the cases with residual CP showed partial or gross ET dysfunction. Patients with tubal dysfunction should be evaluated for underlying cause and treatable causes should addressed before proceeding for surgery as it increases the success rate of tympanoplasty.&lt;/p&gt;

Pre and Post Operative Status of Contralateral Ear in Unilateral Chronic Otitis Media.

Chronic otitis media (COM) is one of the oldest disease affecting ears and undoubtedly represents the main area of interest within modern otology. As the main cause of COM is malfunction of Eustachian tube, it is probable that a patient with COM will have a disorder in contralateral ear (CLE) as suggested by the Minneapolis group- called as Continuum Theory. This prospective, observational study was conducted in department of ENT at a tertiary care centre of central India from Sep 2012 to May 2015. Study consisted of 537 patients of unilateral COM who fulfilled the eligibility criteria. After careful history and thorough examination of diseased ear and CLE, findings of diseased ear, CLE and 6months postoperative findings CLE were entered into performa. The data was entered into SPSS software and further analysis was performed. Out of 740 patients of COM operated in our department, 535 (72.9%) patients had unilateral COM which were included in the study. The mean age was 24.3 (SD±10.63) ranging from 11 to 55years, of these 51.4% were females and 48.6% were males. Out of 535 unilateral COM, 365 (68.2%) had mucosal while 170 (31.8%) had squamous type of disease and 30.9% of total CLE had abnormal findings. The pre and post-operative findings were compared which came out to be statistically significant and there was significant difference in pre and post-op PTA also (0.001). The significant improvement in postoperative status of CLE achieves our objective and also strongly supports the theory of Continuum. The unilateral COM should not be taken as a static phenomenon but as a continuous process in other ear too. We could also shows a significant improvement in the CLE after treatment of diseased ear, this knowledge can be effectively used in therapeutic planning of diseased ear, counselling of patient regarding other ear and if necessary providing therapeutic intervention in the other ear at the earliest.

Prevention of Infant’S Otic Barotrauma – Observing the Infant Prior to Air Travel and Identifying Infants Less Likely At Risk

Otic barotrauma is a potential risk for travelers using commercial aircraft. A significant proportion of passengers are infants. No literature exists regarding pre-flight assessment for prevention of barotrauma in infants due to air travel. Infants are preverbal in their development and cannot communicate their distress with words, though will show age-typical distress and pain responses. Pain and concomitant trauma, where possible, are ideally prevented. This paper suggests that it may be possible for parents to detect prior to flight whether their infant is likely to suffer pain from Eustachian tube malfunction with in-flight cabin pressure changes. This may be achieved by co-incidental observation of infants and their subsequent distress with small rapid air pressure change, such as in rapid elevator ascent/descent, which elicits ear popping in the parents. This may help predict a healthy infant's response to change in air pressure during air travel. A case example is given. Barotrauma in the context of the infant's neuropsychology is described and relevant literature to the topic is reviewed.

The canal wall-up technique versus the canal wall-down in tympanoplasty with mastoidectomy

Canal wall-up (CWU) tympanoplasty with mastoidectomy gave increasing percentages of failures and recurrences. Eustachian tube malfunction has been proved in all cases of chronic suppurative otitis media (CSOM). This presentation is a mathematical comparison between CWU and canal wall-down (CWD) techniques in favor of CWD.

Problems of pediatric cholesteatoma and countermeasures

We report a retrospective study of 35 children, aged 3 to 15 years, with 37 affected ears who underwent surgery for cholesteatoma between 1985 and 1998 in our clinic. The patients were followed for an average of 56 months (range 7 to 147 months). Patient data was collected from clinical records, audiology files, and radiological records in order to reexamine problems of pediatric cholesteatoma and consider the countermeasures. Twenty nine (85%) of ears with acquired cholesteatoma had a history of otitis media. Purulent otorrhea was observed in 71% of the affected ears at the first medical examination, 4 cases were complicated by acute mastoiditis. Sonotubometry showed eustachian tube dysfunction in 10 (91%) of affected 11 ears. Among patients who underwent open & reconstructive tympanoplasty combined with mastoid obliteration during the early study period (1985-1992), the total recurrence rate was 39%, including residual cholesteatoma in 8% (n=1) of 13 ears, and recurrent cholesteatoma in 31% (n=4). The recurrence rate decreased to 22% (residual cholesteatoma in 0 %, and recurrent cholesteatoma in 22%, n=2), in 9 patients who underwent intact canal wall tympanoplasty during the latter period (1993-1998). Postoperative hearing tests showed that modified type III and N tympanoplasties using artificial ossicular chain prostheses appeared to be superior to tympanoplasties using the residual ossicle. Mastoidectomy did not influence development the temporal bone in terms of length. We conclude that infection and eustachian tube malfunction might be involved in rapid and wide spread of pediatric cholesteatoma and contribute to the high recurrence rate. Therefore, appropriate antibiotics should be given and sufficient cleaning of the ear should be carried out, especially before and during the surgery. Although the surgical approach should be tailored to the particular features of each case, the one-stage operation using the canal-up technique seems to be advantageous.

Eustachian Tube Function of Patients with Nasopharyngeal Carcinoma

Prolonged observations of the eustachian tube (ET) function were made on 40 ears of 20 patients with nasopharyngeal carcinoma (NPC) who survived more than 5 years after radiotherapy in a state of remission. The ET function tests included passive opening, inflation-deflation, and clearance, and were performed before, at 6 months, and at 5 years after radiotherapy. The test results were found to be worst at 6 months after radiotherapy and improved at 5 years after radiotherapy. Tubal obstruction and inflammation are the main causes of the ET malfunction that results in otitis media with effusion (OME) in NPC patients after radiotherapy. Insertion of a ventilation tube into the ear with OME can relieve tubal obstruction but can aggravate inflammation. Thus, myringotomy and aspiration of effusion and local treatment may be preferable to insertion of a ventilation tube in NPC patients with OME. When hearing improvement in prolonged survival of NPC patients with OME is needed, the use of amplification is recommended.

Selection of Cases and Classification of Tympanoplasty

Meticulous mastoid surgery does not always result in a dry, stable ear. Eustachian tube malfunction has been accepted as an important factor in chronic and recurrent middle ear infection. There are many parameters of eustachian tube malfunction, which form a complicated problem for investigation and analysis. Of most importance appears to be varying degrees of malformation of the nasopharynx and palate. A gradient from mild to overt deformity appears to be related to the degree of eustachian tube function. Other factors, such as nasal infection and allergy, nasopharyngeal scar tissue and tumors, and general resistance to infection, are of less importance but must be considered in the etiology of chronic ear disease. Tympanoplasty is relatively unsuccessful in a chronic discharging ear, as the infection ultimately destroys a surgical repair. Persistent otorrhea can be caused by either eustachian tube malfunction or a reservoir of chronic infection in the mastoid cavity. A mastoidectomy often controls the infection in the mastoid cells and a tympanoplasty may be done as a secondary procedure when the cavity is stable. A careful preoperative evaluation should be made in every case to determine the responsible factors for persistent ear infection. If possible, attempts should be made to eliminate the causative factors prior to the tympanoplasty. Classification of cases into four groups helps to separate those cases with a good prognosis from those that will continue to suppurate and will have a poor functional result. A dual classification of tympanoplasty has been established in which the type of reconstruction is documented and the stability of the ear against infection is estimated. Classified clinical material forms the basis for a clearer representation of the cases under investigation and the results of tympanoplastic surgery become statistically comparable. Classification of cases also aids in the selection of cases for surgery by identifying preoperatively those cases that will be successful from those that may not have a good result. With this information at hand it is possible to more accurately inform the patient preoperatively regarding hearing improvement and control of infection following a tympanoplasty.

Eustachian tube function following adenoidectomy: an evaluation by sniffing

Recent investigations have demonstrated an association between sniff-induced negative middle ear pressure and otitis media with effusion. This is taken as evidence of Eustachian tube malfunction. Adenoidectomy is frequently performed as part of the surgical management for otitis media with effusion, but whether this affects Eustachian tube function is uncertain. The aim of this study was to investigate the hypothesis that if adenoidectomy improved Eustachian tube function, children who had undergone adenoidectomy would show less tendency to generate a high negative intratympanic pressure by sniffing. Eustachian tube function was studied actively in 40 children with otitis media with effusion. Twenty children, selected at random, underwent adenoidectomy and all 40 had a unilateral grommet inserted. Eighty-five percent of the children could create a negative middle ear pressure by sniffing, but there was no difference in the number of 'sniff + ve' children between the adenoidectomy and control groups (P greater than 0.5), or in the magnitude of the negative pressure induced. It is concluded that a high percentage of children with otitis media with effusion are capable of inducing a negative middle ear pressure by sniffing, but this parameter of Eustachian tube function is not affected by adenoidectomy.

A middle ear implantable hearing device for controlled amplification of sound in the human: a preliminary report.

Millions of people in the United States suffer from hearing impairment that is not benefited or poorly benefited by surgery or conventional hearing aids. Recently, we introduced an implantable Temporal Bone Stimulator (TBS) designed for those patients having a hearing loss due to external canal conditions; such as, external canal atresia or disease, inoperable ossicular problems, atelectasis or eustachian tube malfunction, and chronic open-cavity mastoid disease. This device requires relatively good cochlear function. However, the electromagnetic application of this device has led to the development of a new device we call the Implantable Hearing Device (IHD). This device stimulates, by an electromagnetic field, an independent electromagnetic sensitive prosthesis attached to the ossicular chain. This direct energy transfer to the ossicular chain provides a high degree of sound amplification and fidelity, thus providing benefit for those with various degrees of sensorineural hearing impairment. Preliminary disclosure of the device design, the animal experimental results, and the data from human testing will be given.

Assessment of eustachian tube functions in patients with ear drum perforation

Tubal malfunction is the most important factor in the development and persistence of otitis media. When the eustachian tube malfunction persists, the most carefully performed surgery will fail because the initiating pathogenetic factors of eustachian tube function and middle ear ventilation are still present. Measurement of the eustachian tube function is therefore an important part of the medical and surgical evaluation of the middle ear disease.

Diagnosis and Management of Eustachian Tube Malfunction

The eustachian tube is an essential part of the pressure regulating system of the middle ear. The physiologic function of the tube is to equalize the middle ear pressure with that of the atmosphere, and at the same time make the middle ear independent of the nasopharyngeal environment with its loud sounds, extensive respiratory pressure changes, and potentially harmful bacterial flora. Thus, the protective closing action is essential in the normal physiology of the eustachian tube, and lack of protection is central in tubal malfunction. We have come to consider eustachian tube closing failure and the subsequent induction of negative middle ear pressure as an important causative factor in the development of chronic ear disease, for example, persistent middle ear effusion and manifest retraction of the tympanic membrane. Here, the patient's behavior may be of more importance than the simple tubal mechanics. In the presence of tubal closing failure, if the patient sniffs habitually, the middle ear cavity will be evacuated repeatedly. This constitutes a repetitive barotrauma which may have secondary effects. As a result of the negative pressure the tympanic membrane retracts, and increased transudation and secretion of fluid may give rise to effusion. Tubal closing failure also implies reduced protection against ascending infection with increased susceptibility to acute otitis media. Repeated sniff-induced barotrauma and repeated purulent infection may together be responsible for the development of manifest structural lesions seen in chronic ear disease. Is it possible to determine the function of the eustachian tube? This question is crucial since it is difficult or impossible to give normative values for tubal function tests. The variability of tubal responses with time has been found to be considerable. Thus, the result of a test represents only one specific moment in time, having little prognostic value. Tubal function is a continuous and composite variable that cannot be "determined" according to a static scheme. Our knowledge of eustachian tube physiology is still fragmentary, and continued study is necessary in order to learn more. Presently, tubal function tests have little value from the clinical viewpoint. When a tympanoplastic procedure is considered, the need for surgery should be determined by the clinical judgment based on the otomicroscopic findings and the hearing. In the case of a central perforation of the eardrum the prognosis for hearing is good, irrespective of results obtained in tubal function tests.(ABSTRACT TRUNCATED AT 400 WORDS)

Eustachian tube closing failure in children with persistent middle ear effusion.

One important role of the Eustachian tube is to protect the middle ear from the extensive physiological pressure variations that take place in the nasopharynx, for example on sniffing. In a previous investigation in 50 children with persistent middle ear effusion a surprisingly high percentage of ears were evacuated by sniffing. The present study was undertaken in a second series of children, and results were found to be reproducible. In total 156 ears in 100 children have been investigated. In 63% of ears (73% of subjects) evacuation of the middle ear took place on sniffing. Results show that Eustachian tube malfunction in these subjects is characterized by a reduced protective function; a condition denoted "Eustachian tube closing failure".

Eustachian tube closing failure. Occurrence in patients with cleft palate and middle ear disease.

Previous studies in patients with middle ear disease have shown that high negative pressure is frequently induced actively in the middle ear cavity by sniffing. The present study concerns 84 ears in 42 patients with cleft palate and middle ear disease. Sniff-induced evacuation of the middle ear was studied by direct pressure recording or tympanometry. Sixty-one percent of diseased ears showed tubal closing failure; 18% had constantly or intermittently wide-open tubes. In most cases, negative intratympanic pressure was not equalized on swallowing. It is suggested that eustachian tube malfunction in patients with cleft palate is constituted by the combination of closing failure with evacuation of the middle ear on sniffing, and by a secondary opening failure with inability to equalize the sniff-induced negative intratympanic pressure.

Eustachian tube pathophysiology

Studies of eustachian tube physiology have mainly focused on the ability of the tube to open. For this reason, impaired opening ability has been regarded as the basis of eustachian tube malfunction. Characteristic patterns have been found in pressure measurements in patients with chronic middle ear disease. Simultaneous measurements of nasopharyngeal and middle ear pressures in patients with atelectatic tympanic membranes and retraction cholesteatoma have shown that high negative intratympanic pressure is generated by the voluntary act of sniffing. Eustachian tube malfunction in these patients is thus characterized by failure of the tube to close.

Assessment of long-term middle ear ventilation.

Pathologic changes of the middle ear cavity are almost invariably caused by eustachian tube malfunctions which are either permanent, fluctuating or recurrent. The process may deteriorate from middle ear effusion to atelectasis of the middle ear, adhesive otitis, and can potentially end in cholesteatoma. Close association with eustachian tube malfunction is common in the following conditions: cleft palate, allergy, obstructive lymphoid hypertrophy, hypoimmune state, etc. Negative intratympanic air pressures typify the above conditions, leading to the progressive pathology of the ear drum and cavity. Localized atelectatic retraction pockets signal the alarm of impending irreversible complications. They may be localized in any part of the eardrum, predominantly in the posterosuperior quadrant. Inpocketed by the continuous vacuum, these invaginations may fill with trapped epithelial debris. Re-establishment of adequate middle ear ventilation is the key in every attempt to arrest and reverse this pathology. Clinical, photographic, tympanometric and manometric documentations are presented to demonstrate the reversibility of even far advanced cases. This was achieved by the application of long-term silicon ventilating tubes in 203 ears. 1 744 ears treated with standard home-made polyethylene tubes served as controls. The following period covered six years. The standard tubes retained their position for an average of six months, the comparable figure for the long-term tubes was thirty-six months. In 53% of the ears, the retraction pockets were eliminated and in 29% their progress was checked. Hearing improved in 93 % throughout the study period. Complications occurred in 22% of the long-term ventilated ears. This study demonstrates that with minor surgical intervention, far-advanced seemingly irreversible, pathology in the middle ear and mastoid cavity may often be arrested. Immediately following insertion of the tubes the air bone gap is closed and optimal hearing is secured. This approach, if employed early enough, with persistence, may postpone or even render many complicated and difficult major surgical procedures unnecessary. It is preferable and easier both for the patient and for the surgeon, to ventilate the tympanic cavity for prolonged periods in an attempt to control the deterioration to adhesive otitis and cholesteatoma, rather than to correct them with intricate surgery that is not fail-proof and has many inherent risks.

ステロイド点耳後の体内動態について

Betamethasone (BM) solution (0.1%) was topically administered at 2:00p.m. to the ear of seventeen preoperative patients, and then the serum concentrations of both BM and hydrocortisone, product of the adrenal gland, were measured at 3:00p.m. and 4:00p.m. The tested ears showed various kinds of pathology, such as a large central perforation, attic perforation, eustachian tube malfunction. The of preoperative diagnoses were as follows: 2 otosclerosis, 1 sudden deafness, 1 traumatic dislocation of the ossicles, and 13 chronic otitis media. The purpose of this study was to ascertain whether or not the ear-drop steroid suppressed the adrenal function, and to speculate the total steroid dose that might be absorbed from the external canal skin, tympanic membrane, middle ear mucous membrane and tubal mecous membrane. The results were summarized as follows: 1) Three drops of 0.1% betamethasone to the ear may suppressed the adrenal function in patients with the perforated tympanic membrane. 2) The rate of absorption of ear-drop steroid was speculated. If the tympanic membrane was perforated and tubal function was good, the rate was calculated to be 100%, similar to that of oral administration, and if not, the rate might be less than 25%.

Membrane ventilating tube for the middle ear.

A pilot study was conducted to evaluate the efficacy of a membrane ventilating tube as a Eustachian tube prosthesis in 20 patients with otitis media. The design was based partly on assumptions since many of the physiological parameters required to calculate the gas transport processes have not been previously reported. An elementary gas transport model with assumed partial pressures of gases was developed. A semipermeable membrane covering a tympanostomy tube was fashioned and used to ventilate the middle ear cavity. From this preliminary investigation, the device successfully maintained atmospheric pressures in the tympanum, compensated for Eustachian tube malfunction, prevented otorrhea and recurrence of middle ear effusions.

Eustachian tube function in cleft lip and palate patients.

Eustachian tube function in 28 young-adult cleft palate patients was compared with that of 28 young-adult noncleft control subjects using the sound conduction method of Perlman. A 200-Hz tone was delivered to one nostril while a condenser microphone with an attached probe tube was inserted into one external auditory canal. Subjects were asked to swallow repeatedly, and the output of the microphone was amplified and led to a powerlevel recorder. Results indicate that poorer than normal eustachian tube function is not characteristic of cleft palate, per se, at least not in the young adult age group. Eustachian tube malfunction does appear, however, to be related to observed pharyngeal wall activity, in both cleft and noncleft subjects.