Teprotumumab is a monoclonal antibody introduced in 2020 to treat thyroid eye disease (TED) with potential adverse effects on the cochlea and fat tissue around the eustachian tube. This study investigates the incidence and odds of developing hearing loss and tinnitus associated with Teprotumumab. TriNetX, a multi-institutional database, was queried for U.S. adults (≥ 18 years) with TED. Patients who were and were not prescribed Teprotumumab were matched using a propensity score by demographics and comorbidities. Outcomes were queried based on ICD-10 codes for sensorineural hearing loss (SNHL) and tinnitus. Odds ratios (OR) were calculated in TriNetX. A total of 947 TED patients used Teprotumumab (mean [S.D.] age 56.4 [14.7]) while 258 520 TED patients did not (age 48.4 [17.6]). After propensity score matching, each analytic cohort included 947 patients. At a mean follow-up of 28.6 (18.2) months (S.D.) for the Teprotumumab group and 26.8 (21.3) months (S.D.) for the non-use group, the incidence of SNHL was 10.0% and 3.7%, respectively. Tinnitus incidence rates were 5.6% in the Teprotumumab group and 1.8% in the non-use group. TED patients treated with Teprotumumab demonstrated higher odds of SNHL (OR, 2.89; 95% CI:1.92-4.36) and tinnitus (OR, 3.13; 95% CI:1.79-5.46) compared to TED patients not treated with Teprotumumab. Teprotumumab use is significantly associated with the development of SNHL and tinnitus among TED patients. Patients receiving Teprotumumab should be monitored for otologic outcomes to avoid possible irreversible damage. Further research is needed to establish clinical guidelines for standardized monitoring and treatment adjustment protocols.

3D Otoscope: toward an extra diagnostic dimension for middle-ear related issues.

A Case of Long-term Survival of a Patient with Eustachian Tube Mucosal Melanoma

Balloon dilation of the Eustachian tube (BDET) is the preferred escalation for dilatory dysfunction unresponsive to conservative therapy. The TubaInsert introducer and TubaVent Short balloon catheter form a slim single-use BDET system requiring a four-handed technique with intraoperative endoscope handover. This enables two-handed catheter insertion. This study evaluated usability.Sixteen ENT physicians (aged 26-65) without prior four-handed BDET experience performed bilateral procedures on cadaveric heads. A surgical assistant guided the endoscope. The procedure was divided into 22 steps assessed by observation and user surveys.All 16 participants completed bilateral BDET successfully. In 32 test runs, full balloon application was achieved. All procedural steps, including four-handed insertion, were performed correctly (100% success). Endoscope handover did not impair technical safety or feasibility.This study shows high usability of the TubaInsert BDET system across users with varying experience. The four-handed technique appears reliable, technically safe, and potentially tissue-sparing.

Multi-feature machine learning classification of sonotubometry for eustachian tube dysfunction assessment.

Background: The body mass index (BMI) is the metric currently in use for defining anthropometric height/weight characteristics in adults and for categorizing them into groups. It is a convinient indicator of body fat and it correlates sufficiently well with direct measures of total body fat. Eustachian tube (ET) is a fibrocartilagenous structure consisting of two parts: the first solidly connected with the temporal bone, close to the tympanic cavity; the second soft, partly ligamentous, partly cartilaginous, directed towards the nasopharynx. ET functions to protect the middle ear against nasopharyngeal pressure variations, ascending secretions, and microorganisms. Change in BMI with resultant change in adipocyte tissue around the tube (Ostmann’s fat) can affect the normal ET function that would manifest in the change in tympanometric parameters. Aim: The aim of this study was to determine the effects of body mass index on tympanometric parameters. Materials and methods: This is a descriptive community based cross sectional study conducted on adult population aged (18-60 years) in Kano metropolis, northwestern Nigeria. Participants with no history of chronic ear disease, ear surgery or active upper respiratory tract infection were selected using simple random sampling technique. A total of eighty (80) participants and hundred and sixty (160) ears were examined. Each participant had detailed otoscopy, nasal endoscopy, throat examinations, Rinne’s and Webar tests and tympanometry. Each participant had weight and height measured and BMI calculated. Findings were recorded and analyzed. Results: The mean height of the participants was 1.62±0.11M while the mean weight of the participants was 55.96±10.78kg. There was statistically significant difference between the tympanometric parameters of the right and left ears p<0.05. There was statistically significant difference between the tympanometric parameters of male and female participants p<0.05. Tympanometric peak pressure (TPP) was found to be more positive in participants with lower BMI and (ECV) was found to be higher in participants with higher BMI. Discussion: This study found ECV was higher for the right ears compared with the left ears. TPP was also found to be more positive in the right ears compared to the left, however, no statistically significant difference was found in the static compliance (SC) of the right and left. TPP, ECV and SC were all found to be higher in male participants than in female participants. TPP was found to be more positive in participants with lower BMI and more negative as the BMI was increasing, similarly ECV was found to be increasing as the BMI was increasig, with statistically significant correlation. Conclusion: This study established statistically significant relationship between tympametric parameters of the right and left side, with parameters on the right side showing statistically higher values. A statistically significant relationship was equally established between tympanometric parameters of the male and female participants, affirming the effect of genger on tympanometric parameters. BMI was found to have statistically significant relationship with tympanometric parameters, with participant with higher BMI showing more negative TPP and lower SC, signifying higher risk of developing eustachian tube dysfunction (ETD) among overweight and obesse individulas.

This study aimed to investigate the correlation between Eustachian tube (ET) dimensions and Eustachian tube dysfunction (ETD). A total of 28 patients with ETD symptoms ≥ three months and ten controls underwent 3 Tesla magnetic resonance imaging (MRI) and Cone beam computed tomography (CBCT) scans. The images were fused with software using anatomical landmarks. ET dimensions and angles were registered. Patient and control demographics were comparable. The length of ET was longer in ETD ears compared to controls (p = 0.035) but not compared to the ETD patient's asymptomatic ears (p > 0.05). ET length was longer in males compared to females in the ETD group (p < 0.001). The osseous ET was longer in the patients' ETD ears compared to their asymptomatic ears. Cartilaginous ET was shorter in controls compared to ETD ears. No significant length differences (p > 0.05) were observed between sides in ET, CET, or OET. A positive correlation was found between ET length and height (p < 0.001). No significant differences in angles were found between ETD ears, asymptomatic ears, or controls against either the horizontal or the sagittal plane. Fusion of MRI and CBCT is feasible for evaluating ET. Adjusting for height, no differences in ET length between sexes were found. OET was longer in symptomatic ears, and CET was shorter in controls. ETD seems associated with a longer ET. Ostmann's Fat Pad and the levator veli palatini muscle were smaller in ETD ears, suggesting atrophy of ET components.

Fibroepithelial polyps are benign mesodermal lesions that are an uncommon occurrence within the external auditory canal and the middle ear. The present case involves a 39-year-old male patient who has been experiencing hearing loss and intermittent ear discharge for a period of 10 years. Otoscopic examination revealed a smooth mass that completely filled the external auditory canal. A thorough analysis of the computed tomography results revealed the presence of soft-tissue density extending to the middle ear and Eustachian tube, with no evidence of bone destruction. Noncontrast magnetic resonance imaging showed a T1 hypointense signal, a T2 hyperintense signal, and no diffusion restriction. This case exemplifies an exceedingly rare condition involving a substantial portion of the temporal bone. It is essential to be aware of this condition to prevent misdiagnosis as a malignant lesion. An accurate diagnosis depends on a radiological-histopathological correlation.

This article reviews otitis media with effusion (OME) in children with cleft palate (CP), the current evidence and recommendations regarding management of OME in cleft palate with a focus on interdisciplinary communication, and the impact this condition has on patients and caregivers. OME is nearly ubiquitous in children with CP due to the anatomical variation of the palatal musculature and resultant Eustachian tube dysfunction. If untreated, OME can negatively affect hearing, speech development, cognitive development, and social integration. Patients with CP have the potential to be negatively impacted by the otologic, cognitive, and psychosocial consequences of untreated chronic OME if not actively managed for this condition. Multidisciplinary management, appropriate intervention, shared decision-making, and appropriate surveillance optimize the wellbeing, cognitive development, and social progression of CP patients with OME.

Allergic rhinitis is a growing global health issue, which is one of the most popular chronic diseases. Its prevalence is influenced by both environmental exposures and climatic factors. Therefore, this study aims to give the view of the positive effects of the climate to allergic rhinitis from the past paper, including the characteristics of the disease, relevant climate factors, pollution and geographical factors. The hypersensitivity response to allergens, mediated by immunoglobulin E (IgE), triggers allergic rhinitis, and children have a high prevalence of this condition. The symptoms include nasal symptoms, such as nasal congestion and rhinorrhoea, as well as extra-nasal manifestations such as sinus pressure, eustachian tube dysfunction, and headache. Air pollution can exacerbate allergic responses, and natural allergens are correlated with disease risk. The temperature positively correlates with prevalence. Global warming lifts the factors that directly related to the temperature, humidity and concentration of carbon dioxide, high temperature, humidity and carbon dioxide concentration correlate with increased pollen load and ability to cause allergic inflammatory response through global warming, as well as the higher concentration of spores of fungus and mould in atmosphere. Some extreme weather events that related to global warming, such as wildfire and flood, increase their frequency and intensity as well as the related allergens. The latitude and altitude have a negative correlation with the prevalence of allergic rhinitis in general. The urban resident a higher prevalence, considering the increased air pollution and the natural allergen due to heat islands. The region with different climate type shows diverse main allergens and highincidence season.

Treatment of Eustachian Tube Dysfunction - Balloon Dilation and Isthmus Probing

To examine the associations between cannabis use-individually and in combination with e-cigarettes or cigarettes-and obstructive eustachian tube dysfunction (OETD) among US adults. Cross-sectional review of participants from the National Health and Nutrition Examination Survey (2015 to 2018) with complete data on tympanometry and drug and smoking questionnaires (n=2777). Cannabis and e-cigarette use were categorized as never, nonregular, or regular use. Cigarette smoking was categorized as never, former, or current use. OETD was defined as middle ear pressure less than -100 Decapascals. Multivariable logistic regression analyses were performed to determine associations. Among US adults, 4.9% (95% CI: 3.4%-7.0%) had tympanometry findings consistent with OETD. Regular cannabis use, defined as >15 days of use in the last 30 days, was significantly associated with OETD (OR: 1.95, 95% CI: 1.02-3.72) in a multivariable model adjusting for e-cigarette, cigarette use, and other relevant demographic and clinical factors. Both ever and regular cigarette use were significantly associated with OETD (OR: 1.62, 5% CI: 1.02-2.56; OR: 2.18, 95% CI: 1.27-3.74, respectively), while e-cigarette use (ever, nonregular, or regular) was not independently associated with OETD in multivariable models. The combined use of all 3 substances was associated with greater odds of OETD (OR: 2.10, 95% CI: 1.23-3.58). This study suggests that regular cannabis use and combined use of cannabis, e-cigarettes, and cigarettes are associated with greater odds of OETD. Future research is needed to better understand the effect of cannabis, independently and in combination with other substances, on OETD.

Introduction: According to Acharya Sushruta, Karnasrava is a disease characterized by the discharge from the Karna (ear) and is caused mostly by Vata Dosha Avarana. Acute Suppurative Otitis Media is an inflammatory illness that affects the mucous membrane of the middle ear cleft and is characterized by purulent ear discharge, swelling, pain, and tympanic membrane perforation. Main clinical finding: Patient presented presenting with complaints of discharge from right ear in the last 15 days, pain from right ear in the last 15 days, itching from right ear in the last 12 days. Diagnosis: In this case, a 53-year-old male patient had been experiencing symptoms of discharge, in his left ear for 15 days. On ear examination patient presented with central perforation in anteroinferior quadrant of right ear tympanic membrane, mucopurulent discharge and erythema seen in external auditory canal. Interventions: Karnadhoopana with Nimbharidradi Varti, and an Ayurvedic medication (Sitopaladi Churna, Tankana Bhashma, Trikatu Churna, Musta Churna, Gandhakrasayan) were used in this study for 21 days. Discussion: The major goal of treatment should be to clear the Eustachian tube blockage, ventilate the middle ear cleft, and manage the secretions, systemic therapy through the oral route was also administrated. The Karnadhoopana with oral medications not only dries up the Srava, but also makes it difficult for bacteria to flourish, also acts anti-inflammatory, antiseptic, and antibacterial. Conclusion: Hence it can be said that Ayurvedic medicine and procedures can be useful in the management of Karnasrava (A.S.O.M.)

Eustachian tube balloon dilation is increasingly recognised as a minimally invasive option for middle ear effusion. However, its role in children with cleft lip and palate remains under-explored. We prospectively evaluated 14 cleft lip and palate children (28 ears) with middle ear effusion. Group 1 (intervention) comprised 14 ears that underwent Eustachian tube balloon dilation with intranasal corticosteroids, while Group 2 (control) included 14 ears treated with intranasal corticosteroids alone. Tympanometry, pure-tone audiometry and Eustachian Tube Dysfunction Questionnaire-7 were administered before and six weeks after intervention. Eustachian tube balloon dilation significantly improved hearing thresholds (p = 0.03) and air-bone gap (p = 0.04), with favourable tympanometric changes (p < 0.05) and a significant reduction in Eustachian Tube Dysfunction Questionnaire-7 scores, indicating symptom improvement. No major complications occurred. Eustachian tube balloon dilation is a safe, well-tolerated and potentially effective adjunctive procedure for cleft lip and palate children with middle ear effusion. Larger randomised controlled trials are needed to validate these findings.

This study aimed to estimate the prevalence of Eustachian tube dysfunction and identify associated risk factors in a consecutive cohort of children undergoing adenotonsillectomy for sleep-disordered breathing. This was a retrospective study of children with sleep-disordered breathing admitted for adenotonsillectomy in two tertiary public hospitals in South China from January 2019 to November 2023. The prevalence of Eustachian tube dysfunction was assessed based on tympanograms. Demographic information and clinical characteristics were collected for risk factors analysis. A total of 1,044 children aged 3 to 14 years were enrolled in the present study, 375 (35.92%) of whom had Eustachian tube dysfunction. Risk factors for Eustachian tube dysfunction included age less than or equal to six years, allergic rhinitis, sinusitis, adenoid hypertrophy and hypoxemia. No significant association was found between Eustachian tube dysfunction and gender, disease duration, tonsillar hypertrophy, obesity or obstructive sleep apnoea. Eustachian tube dysfunction is highly prevalent in children undergoing adenotonsillectomy for sleep-disordered breathing and, therefore, warrants further attention and intervention.

BackgroundSecretory otitis media (SOM), a common otorhinolaryngological disorder, impairs hearing and quality of life. Eustachian tube balloon dilatation (ETBD) is increasingly used, and its combination with tympanic membrane catheterization (TMC) may enhance outcomes. This study compared ETBD alone with ETBD combined with TMC in adult SOM.Material/MethodsNinety patients (110 ears) with SOM were randomized equally into 2 groups between September 2020 and September 2022. The balloon-only group received ETBD, while the balloon plus catheterization group underwent ETBD combined with TMC. Clinical efficacy was defined as symptom resolution, effusion clearance, and hearing recovery. Eustachian tube function was assessed by manometry (R score) and Eustachian Tube Score (ETS). The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) assessed symptom burden of ear pressure, pain, tinnitus, and muffled hearing. Serum procalcitonin, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured by ELISA. Hearing thresholds were determined using pure-tone audiometry. Six-month recurrence was defined as the reappearance of effusion or symptoms following tympanic membrane healing, determined by otoscopy, tympanometry, and symptom verification.ResultsThe effective rate was significantly higher in the ETBD combined with TMC group (95.56%) than the ETBD-only group (77.78%, P<0.05). Combination therapy yielded greater improvements in R scores, ETS, ETDQ-7, and hearing thresholds, and greater reductions in procalcitonin, hs-CRP, and IL-6 (all P<0.05). Recurrence was lower (4.44% vs 22.22%, P<0.05), with comparable complication rates (P>0.05).ConclusionsETBD combined with TMC significantly enhanced ET function, symptom relief, inflammatory control, and hearing recovery while reducing recurrence, supporting its adoption in adult SOM management.

Introduction: Eustachian Tube Dysfunction is a prevalent pathology in the ge­neral population, with a higher prevalence in children than in adults. Eustachian Tube Dysfunction results in inadequate ventilation of the middle ear and mastoid, which can lead to multiple symptoms and diseases such as hearing loss, recurrent serous otitis media, chronic otitis media, retraction and perforation of the tympanic membrane, and eventually the formation of cholesteatoma. Methods: A descripti­ve, cross-sectional observational study was conducted, in which 91 patients with symptoms of Eustachian tube dysfunction were evaluated. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was administered, with a minimum score of 7 and a maximum score of 49. Results: In our study, 82.5% of the patients had a total ETDQ-7 score greater than 14.5. Tympanometry revealed a Type A curve in most patients in both ears, with 48.8% in the right ear and 61.5% in the left ear. Regarding the relationship between the ETDQ-7 and tympanometry findings, among patients with a score greater than 14.5, a Type A tympanometric curve was more frequently observed in the right ear (43.9% of cases), and in the left ear, 56.4% of those with an ETDQ-7 score above 14.5 presented a Type A curve on tympanometry.

This study aimed to examine the clinical impact of Eustachian tube dysfunction (ETD) on the treatment outcomes of Meniere's disease (MD). Retrospective study. Tertiary referral centre. A total of 287 MD patients admitted between January 2015 and June 2024 were included. The primary outcomes included improvement in vertigo and relief of aural fullness. Clinical parameters and treatment outcomes were compared between MD patients with and without ETD and between patients treated by ESS alone versus ESS combined with balloon dilatation of the Eustachian tube (BDET). Propensity score matching (PSM) was performed to balance group differences. Logistic regression was conducted to evaluate the prognostic value of BDET in relieving aural fullness. Of the 287 patients with MD, 96 (33.4%) had ETD. Patients with ETD showed a significantly shorter disease duration compared to patients without ETD (p = 0.041) and experienced more severe aural fullness symptoms (61.5% vs. 48.7%, p = 0.041). After adjusting for age, sex and initial hearing threshold using PSM, the ETD group continued to demonstrate a significantly shorter disease duration than matched controls (median 2 years [IQR 0.5, 5] vs. 3 years [IQR 1, 7.75]; p = 0.003). Patients receiving ESS combined with BDET reported a significantly higher rate of subjective aural fullness relief than patients treated with ESS alone (69.2% vs. 30%, p = 0.002), as well as a higher proportion of Class A vertigo improvement. Logistic regression confirmed that ESS combined with BDET significantly correlated with improved aural fullness (OR = 4.40, 95% CI: 1.41-15.79, p = 0.010). For patients whose initial treatments were unsuccessful, combining ESS with BDET may provide greater improvements in aural fullness and vertigo symptoms compared to ESS alone.

Comparative evaluation of The Eustachian tube in Iraqi individuals with cleft lip and palate and those without: A CBCT analysis.

Patulous eustachian tube（PET） is an otolaryngological disorder caused by various factors, characterized by the loss of normal closure function of the eustachian tube in a resting state, resulting in persistent patency. Surgical treatment is recognized as an effective method for the management of refractory PET, but the surgical approaches for PET are diverse, with therapeutic outcomes varying significantly. The surgical procedure involving the occlusion of the tympanic ostium of the eustachian tube through the tympanic membrane, using specially designed silicone plugs, has shown excellent therapeutic outcomes. This minimally invasive procedure is considered highly safe and is considered as the preferred surgical option for patients with refractory PET. The purpose of this article is to review the current status and progress of endoscopic trans-tympanic eustachian tube plug implantation surgery in the treatment of patulous eustachian tube syndrome.