Orifice Of Eustachian Tube Research Articles

Wideoendoskopowa ocena funkcji gardłowego ujścia trąbki słuchowej u dzieci z chorobami ucha środkowego

Eustachian tube (ET) dysfunction play an important role in the development, persistence and recurrence of otitis media with effusion (OME) and chronic otitis. Evaluation of the type of obstruction in the cartilaginous portion of ET is important for decision concerning methods of treatment and prognosis of surgical outcome. The aim of this study was to identify characteristics of dynamic function of the pharyngeal orifice of ET in children with OME and chronic otitis by video endoscopy. Transnasal endoscopic examination of the nasopharyngeal opening of ET during swallowing was performed on 21 children - 13 with OME, 8 with chronic otitis. Video recording were made for dynamic slow-motion analysis of ET dilation and closing processes. Most cases of ET dysfunction in children were obstrucive (81%), associated with mucosal oedema and hyperplasia. Dynamic type of dysfunction is caused by the reduced movement of the tensor veli palatini. Dynamic video analysis is useful in the identify type of ET dysfunction in children. Obstructive dysfuntion need diagnostic procedures for chronic infection, nasopharyngeal reflux and alergic diseases.

Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report

Pharyngeal orifice of the eustachian tube was ligated on ten patients, 15 ears with intractable patulous eustachian tube. While the eustachian tube orifice was observed by an endoscope inserted through the contralateral nostril, the orifice was ligated transnasally and/or transorally using instruments usually used in the endoscopic nasal surgery. Now 13-27 months after the surgery, the outcome was excellent (both symptoms and sonotubometry were normalized) in two ears, good (either symptoms or sonotubometry was improved) in seven ears, and unchanged in the remaining six ears. In one of the ears with an outcome of unchanged, the ligation was found to be spontaneously released soon after surgery, but the symptom was improved after the second operation 2.5 months after the first operation. Temporary otitis media with effusion was seen in one ear, mild inflammation around the ligated site also in one ear, but no other serious complication has been observed. Although further improvement in the surgical procedure and further discussion about its long-term outcome should be required, this procedure appeared to be one of the therapeutic options for intractable patulous eustachian tube.

Floating the uvula: An intraoperative method for detecting bifidity

A bifid uvula, midline diastasis of the palatal muscles, and notching of the posterior hard palate have classically formed a triad diagnosing submucosal clefts. The uvula has thus served as a tool for clinicians to detect the earliest signs of clefting. In this case report, we discuss how mucosal lining may be held together by mucous viscosity, making it difficult to detect notching or a grossly bifid uvula. We demonstrate a simple intraoperative technique to easily overcome this force. This paper involves a case report of an 8-year-old female undergoing an adenotonsillectomy. A previously undetected bifid uvula was found only after floating the uvula in normal saline solution. This changed our surgical approach from a complete to a partial adenoidectomy. A bifid uvula may be considered the earliest form of a cleft palate, and more importantly, it has been shown in the literature to be associated with other anomalies as submucosal cleft, hyoplastic eustachian tube orifice, and absence of the salpingopharyngeal folds. The intraoperative technique of floating the uvula helps to overcome mucous viscosity and identify an otherwise missed bifid uvula.

Possible Role of Helicobacter pylori in the Etiopathogenesis of Chronic Otitis Media

To investigate a possible contribution from Helicobacter pylori to the etiopathogenesis of chronic otitis media. Prospective clinical trial. Tympanomastoidectomy, radical mastoidectomy, and modified radical mastoidectomy procedures were performed according to the pathology of ear disease. Biopsy specimens were taken from middle ear, mastoid antrum, and tympanic orifice of eustachian tube. Helicobacter pylori DNA was extracted from these biopsy specimens by using nested polymerase chain reaction. Helicobacter pylori DNA was detected in 3 (7.9%) of 38 chronic otitis media patients. Even though it is possible to detect Helicobacter pylori in middle ear cleft in chronic otitis media, its role in the etiopathogenesis of the issue is controversial.

Selection Criteria for PE Tubes versus PE Tubes Plus Adenoidectomy

Source: Nguyen LHP, Manoukian JJ, Yoskovitch A, et al. Adenoidectomy: selection criteria for surgical cases of otitis media. Laryngoscope. 2004;114:863–866.Placement of pressure equalizing tubes (PET) is undoubtedly the most frequent surgical option used for persistent otitis media with effusion (OME) and refractory recurrent acute otitis media (AOM). Researchers from Canada’s McGill University and the University of Kuwait evaluated the efficacy of concomitant adenoidectomy in decreasing the failure rate of PET placement. They evaluated 63 patients, aged 18 months to 18 years and with a history of either: 1) recurrent AOM, defined as more than 3 episodes in the previous 6 months or more than 4 episodes in the preceding 12 months; 2) persistent OME, defined as effusion persisting for more than 3 months or producing a hearing deficit of 30 dB or greater; or 3) both. Study patients were randomly assigned to either PET placement alone or PET with adenoidectomy. In all patients, the adenoids were evaluated during surgery to assess whether they abutted the eustachian tube orifice (ETO). Failure was defined as: 1) 2 episodes of AOM within 6 months or 3 episodes in 1 year not related to water exposure (ie, swimming); 2) OME for greater than 3 months or causing a greater than 30 dB hearing loss; or 3) reinsertion of PET. Of 63 patients, 40 (63%) underwent PET placement alone and 23 (37%) underwent PET placement with adenoidectomy. Thirty-four (54%) of the 63 patients had adenoids abutting the ETO, of which 16 were in the PET group and 18 in the PET plus adenoidectomy group.Failure rates in the adenoidectomy and non-adenoidectomy groups were 21.7% and 42.5%, respectively (P=.096). After stratifying patients by whether or not they had adenoidal abutment, statistically significant differences were found. Adenoidectomy did not decrease failure rates in patients without adenoidal abutment of the ETO (P=.92). However, among patients with adenoidal abutment of the ETO, those who underwent PET placement and adenoidectomy were less likely to have a failure of treatment compared to those who underwent PET placement alone (P<.05).Financial Disclosure: Dr. Willner has disclosed that he has no relationships relevant to this commentary.Financial Disclosure: Dr. Wohl has disclosed that he has no relationships relevant to this commentary.If the results of this small study are replicated by other clinicians in other populations, it may, at long last, provide the basis for a rational approach to the decision about adenoidectomy at the time of PET placement. A previous study found that in patients aged 4 to 8 years, PET placement, with or without adenoidectomy, led to an increased time until recurrence of effusion, and that adenoidectomy was associated with a reduced need for subsequent medical and surgical intervention.1 It was theorized that adenoidectomy provided a long-term benefit by removing persistent nasopharyngeal bacterial carriage. The authors of that study recommended adenoidectomy and bilateral myringotomy in patients of this age with 60 days of effusion refractory to multiple antibiotic courses and with bilateral associated hearing loss. Other investigators have commented that adenoidectomy is associated with more morbidity than PET placement alone.1 A consensus panel recommended that the treatment of each child should be individualized based on the duration of OME, the child’s response to medication and the time of year.2The above study suggested that relieving adenoid abutment at the ETO had a positive effect on PET placement success. Unlike previous studies, the current study included patients with both recurrent AOM and persistent OME as criteria for surgical intervention. Nevertheless, the results suggest that specifically evaluating the adenoids for abutment of the ETO is helpful in determining whether it is reasonable to proceed with adenoidectomy at the time of PET placement, and allows for further individualization of each patient’s care.

Squamous cell metaplasia of the nasopharyngeal epithelium and its association with adult-onset otitis media with effusion

ConclusionThe common association between adult-onset otitis media with effusion (AO-OME) and squamous cell metaplasia (SCM) of the epithelium of Rosenmüller's fossa, which is near the Eustachian tube orifice, implies the predictive role of metaplasia, which probably compromises the drainage function of the middle ear.ObjectiveTo determine the effects of nasopharyngeal epithelial changes (SCM) on AO-OME. AO-OME is a multifactorial and insidious disease that may necessitate detailed investigation, i.e. biopsy of the nasopharynx, because of possible underlying nasopharyngeal malignancy.Material and methodsFifty-two patients with AO-OME (study group) and 29 with a unilateral neck mass in the posterior triangle without AO-OME (control group) were enrolled. Nasopharyngeal biopsies taken from all subjects were evaluated with regard to surface epithelial changes of the nasopharynx.ResultsNasopharyngeal biopsies revealed SCM in 34/52 patients (65%) in the study group and 9/29 (31%) in the control group (p<0.05). During the follow-up period, recurrence of effusion occurred in 56% of the group with SCM and 22% of the group without it.

Turicella otitidis in a Young Adult With Otitis Externa

Turicella otitidis in a Young Adult With Otitis Externa

Assessing accuracy using different image guidance registration methods

Problem: To determine the accuracy of image guidance technology using point registration and surface match registration protocols. Methods: This was a prospective case series and experimental study using a plastic model. Results: Image guidance technology is rapidly becoming commonplace and provides a significant improvement in the management of complex and revision surgeries. One of the potential areas where error can be induced in the use of image guidance is in the registration process. We studied 3 types of registration (point registration, point registration with surface matching, and a pure surface-matching protocol using a plastic model) subsequently in a series of cases. Accuracy was assessed at an assigned surface point and at a deep anatomic point. For the model, this point was represented by a marker at the center of the model, and for patients the Eustachian tube orifice was used as a landmark. Registration using individual points yielded accuracy that varied with the number of points used. The larger number of registration points yielded greatest accuracy and produced a large volume of registered space. Newer pure surface-matching protocols using an LED-covered mask yielded equivalent accuracy to best point-registered models. The use of 3 anchor points with subsequent surface matching was less accurate. The use of similar registration protocols in patients showed that surface matching yielded accuracies of 1 + 0.23 mm at the Eustachian tube with point registration yielding accuracies of 1 + 0.34 mm. Conclusion: Surface match registration provides an accurate registration even at deep points within the surgical target. Significance: Surface match registration using an LED mask may make the use of image guidance more time-efficient. Support: None reported.

Dermal choristoma of nasopharynx

The dermal choristoma of the nasopharynx is a developmental tumor that has been reported under a variety of different terms, including accessory auricle, hairy polyp, and dermoid. Although the majority of these lesions arise from the vault of the nasopharynx near the region of the eustachian tube orifice, they have also been reported to arise within the eustachian tube itself, from the nasopharyngeal surface of the soft palate, the oropharynx in the tonsillar region, and, rarely, in the middle ear and mastoid area. We report a case of an otherwise healthy 15-month-old female who presented with a 1-year history of right-sided clear rhinorrhea. Nasopharyngoscopy revealed a 1-cm firm, pinkish-white, smooth-surfaced, spherical, pedunculated mass arising from the left nasopharyngeal wall. The left-sided lesion acted as a ball valve to produce intermittent right-sided obstruction of the nasal passage. Imaging studies demonstrated a homogenous solid mass of the density of adipose tissue. It was excised without complication using cautery. Histopathologic examination revealed a solid mass of fibroadipose tissue that was surfaced by essentially normal skin. The keratinized stratified squamous epithelial surface exhibited a granular layer and numerous dermal appendage structures, including hair follicles, sebaceous glands, and sweat glands. The lesion did not exhibit elastic cartilage. These clinical and histologic findings support the diagnosis of dermal choristoma, a lesion that should be included in the differential diagnosis of nasopharyngeal masses in young individuals.

Transoral endoscopic resection of a nasopharyngeal hairy polyp

Hairy polyps are rare congenital benign tumors that usually present a pedunculated mass in the oronasopharynx. A hairy polyp originating from the left eustachian tube orifice was found in a 7-month-old girl presenting sleep apnea and blood-tinged vomiting. This was successfully removed by transoral surgery under endoscopic visualization. The endoscope-guided surgery may help avoid undesirable complications as well as completely excise the lesions attached close to the eustachian tube openings.

Direct Application of Dexamethasone for the Treatment of Chronic Eustachian Tube Dysfunction

We undertook a prospective study to determine the safety and effectiveness of the direct administration of a steroid to the eustachian tube via the Silverstein MicroWick in 11 patients with chronic eustachian tube dysfunction, including two who had Samter's triad. All patients had previously been treated with medical therapy and surgical middle ear ventilation without resolution. The MicroWick was placed directly in the eustachian tube orifice through a pressure-equalization tube. Patients received 3 drops of dexamethasone 4 mg/ml three times a day. The drops were discontinued after 4 weeks, and the MicroWick and ventilation tube were removed after 3 months. At study's end, eight patients (72.7%) reported subjective improvement in terms of a reduction in aural pressure and fullness. Audiometric testing demonstrated a 55% reduction in the mean air-bone gap and a 3% increase in the mean speech discrimination score. Bone pure-tone averages remained stable. Tympanometry showed that five patients (45.5%) converted from type B or C tympanograms to type A. Four patients (36.4%) had persistent perforations. Both patients with Samter's triad improved with therapy. These preliminary results suggest that direct dexamethasone administration to the eustachian tube is safe and effective for the treatment of chronic eustachian tube dysfunction. Long-term studies to confirm these findings are under way.

Tympanic Membrane and Nasopharyngeal Orifice of Eustachian Tube of Former Leprosy Patients

Tympanic Membrane and Nasopharyngeal Orifice of Eustachian Tube of Former Leprosy Patients

Adult-onset otitis media with effusion: results following ventilation tube insertion.

The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied. Of 53 patients studied, 28 had had a previous history of ventilation tube insertion. Furthermore, at 15-27 months following ventilation tube insertion, the ventilation tube had already extruded in 31 patients and the OME had already recurred in 19 of these. Endoscopic examination revealed that many patients still had evidence of inflammation at the lateral nasal wall (26.4 per cent) and at the eustachian tube orifice (51 per cent). There is also a strong history of atopy in the studied group and the skin prick test was positive in 57 per cent of the patients. This study shows that many patients with adult-onset OME have underlying pathology that could lead to recurrence of OME following ventilation tube extrusion.

Expression patterns of cytokeratins in retraction pocket cholesteatomas.

To investigate the patterns of cytokeratin (CK) expression in retraction pocket cholesteatoma. An animal model study. Retraction pocket cholesteatomas were induced by electrocautery of the eustachian tube orifice in 24 mongolian gerbils. They were divided into normal and cholesteatoma groups of clinical stages I to IV. The antibodies to pan-cytokeratin CK 1/10, CK 5/6, CK 4, and CK 13/16 were used for immunohistochemical staining. The intensity of staining in each group as measured with densitometry was compared regarding anatomical sites and clinical stages. In retraction pocket cholesteatoma, CK expression was altered only at focal sites such as the pars tensa of the tympanic membrane. The change of CK expression was observed only at certain stages of cholesteatoma formation. In keratinocytes from cholesteatomas, CK 13/16 was overexpressed compared with control specimens, indicating hyperproliferation. The site with the most prominent change in retraction pocket cholesteatoma was somewhat different from that in canal ligation cholesteatoma in a previous study. The results suggested that aural cholesteatoma is a disease with a spectrum of pathological conditions and that the transmigration and hyperproliferation process of squamous epithelium occurs in areas adjacent to the cholesteatoma.

Laterally hypertrophic adenoids as a contributing factor in otitis media

Adenoidectomy has been demonstrated in randomized controlled studies to be effective in the prevention of otitis media with effusion (OME). Despite an apparent lack of correlation between adenoid size and outcome, it has been suggested that the role of adenoid tissue in the pathophysiology of OME relates either to obstruction of the Eustachian tube (ET) with impairment of its function, or to adenoid tissue serving as a reservoir of infection. The aim of this study was to further delineate the relationship between adenoid hypertrophy and OME. This prospective survey was performed in an ambulatory care setting of a tertiary care pediatric hospital, where data was collected on 273 consecutive adenoidectomy patients. At the time of surgery, adenoid position in relation to the ET orifice was recorded as well as concurrent procedures performed (e.g. pressure equalization tubes; PET). Sixty percent of patients undergoing simultaneous PET insertion were found to have laterally hypertrophic adenoid tissue encroaching upon the ET orifice versus only 22% for those undergoing adenoidectomy alone. Thus, a strong correlation was found to exist between OME, requiring the placement of PET and lateral adenoids abutting the torus tubarius ( χ 2=39.12; P<0.001). The clinical relevance of this finding is that it may allow the prediction of children with OME, who will benefit most from undergoing adenoidectomy. Patients with OME requiring PET insertion, who are found to have lateral adenoid hypertrophy encroaching upon the ET orifice, could be selected for adenoidectomy, thus allowing a more judicious application of this surgical procedure in the setting of OME.

Eustachian tube in atrophic rhinitis.

Atropic Rhinitis is a chronic non-specific disease characterised by atrophy of mucosa and turbinate bones. Maxillary antrum may sometimes be involved as result of primary disease or at time secondary to mucosal pathology or crusting. Extension of disease involving the eustachian tube is uncertain. In the present study, endoscopy of the nasopharynx was performed in 20 patients with atrophic rhinitis to find out the type, nature and site of lesion at the orifice of the eustachian tube. The lesion was found in seven cases (35%) involving the eustachian tube. The lesion occurs in form of atrophic changes with crusting granuloma and thick mucoid area. Endoscopy is also found to be therepeutic value in removing the thick discharge crust etc. at the orifice of eustachian tube to prevent the otological complications.

上咽頭粘表皮癌例

We report a case of mucoepidermoid carcinoma in the nasopharynx. A woman, aged 59, who suffered from chronic otitis media with effusion was referred to our department due to a mass lesion on the Rosenmuller's fossa. The mass lesion was pathologically diagnosed as a mucoepidermoid carcinoma. CT and MRI scans showed a well bordered round shadow which was limited to the orifice of the left eustachian tube, without invasion of the skull base.As the patient did not agree to surgical treatment, we selected radiotherapy using a gamma knife for treatment of the nasopharyngeal tumor. The tumor responded well to gamma knife treatment and disappeared with 30Gy irradiation (Edge dose). The patient has shown no recurrence of the tumor for a year and 6 months after treatment. Gamma knife radiotherapy may be one potential treatment strategy for intractable lesions of the head and neck such as mucoepidermoid carcinoma in the nasopharynx.

Nasopharyngeal radium irradiation: fundamental considerations.

This article discusses the potential carcinogenic effects of radiation exposure from nasopharyngeal radium irradiation exposure and issues to consider when deciding whether to recommend screening for asymptomatic patients who have been treated by nasopharyngeal radium irradiation. The radiation exposure from the radium is primarily the result of gamma-rays, which are very penetrating. beta-Particles would affect only the tissues located within 1 cm of the eustachian tube orifice. On the basis of a quantitative risk assessment, the lifetime risk of brain cancer developing was estimated to be approximately 3 per 1000 persons, and the lifetime risk of a fatal cancer 5.6 per 1000 persons. When the medical benefits of screening asymptomatic patients are assessed, several factors, including the medical risks and benefits and cost-effectiveness of follow-up, should be considered.

Nasopharyngeal radium irradiation: Fundamental considerations

This article discusses the potential carcinogenic effects of radiation exposure from nasopharyngeal radium irradiation exposure and issues to consider when deciding whether to recommend screening for asymptomatic patients who have been treated by nasopharyngeal radium irradiation. The radiation exposure from the radium is primarily the result of γ-rays, which are very penetrating. β-Particles would affect only the tissues located within 1 cm of the eustachian tube orifice. On the basis of a quantitative risk assessment, the lifetime risk of brain cancer developing was estimated to be approximately 3 per 1000 persons, and the lifetime risk of a fatal cancer 5.6 per 1000 persons. When the medical benefits of screening asymptomatic patients are assessed, several factors, including the medical risks and benefits and cost-effectiveness of follow-up, should be considered. (Otolaryngol Head Neck Surg 1996;115:399-402.)

Schneiderian-type mucosal papillomas of the middle ear and mastoid.

Five cases of schneiderian-type mucosal papillomas arising in the middle ear space are reported. The patients were all women, ranging in age from 19 to 57 years (median, 31 years). Clinical complaints--unilateral conductive hearing loss, pain, or otorrhea--ranged from those lasting several months to recurrent problems spanning 20 years. All of the patients had a history of chronic otitis media predating the development of the papillomas; none of the patients had a history of sinonasal or nasopharyngeal schneiderian-type papillomas. Clinically, three patients had intact tympanic membranes, while the other two patients had perforated tympanic membranes through which a bulging polypoid mass was identified. Radiographic studies showed opacification of the middle ear space without evidence of osseous destruction. The intraoperative findings were of polypoid lesions filling the middle ear space, including involvement of the eustachian tube orifice. Histologically, the tumors were identical to sinonasal schneiderian papillomas. Immunohistochemical evaluation for human papillomavirus was negative. Surgical excision is the treatment of choice. In four of the patients, recurrent tumor was identified, necessitating additional surgery. In only one patient did the initial surgery result in complete ablation of the tumor. All patients are alive and free of recurrent disease over periods ranging from 6 months to 120 months (median, 84 months).