Eustachian Tube Research Articles

Patulous Eustachian Tube in a Girl with Low Body Mass Index

Patulous Eustachian Tube in a Girl with Low Body Mass Index

Assessing the usefulness of tubomanometry as a diagnostic tool in Eustachian tube dysfunction.

This study aims to evaluate the validity and reliability of tubomanometry (TMM) in diagnosing obstructive Eustachian tube dysfunction (OETD) before balloon Eustachian tuboplasty (BET). A prospective cohort study was conducted, involving 25 patients with sinonasal pathology, 75 patients with middle ear disease, and 25 healthy subjects, totaling 250 ears. All participants underwent comprehensive physical examinations, including TMM, nasal videoendoscopy, otoendoscopy, Valsalva maneuver (VM), tympanometry, and audiometry. Additionally, various scales such as ETDQ-7 and ETS-7 were employed. Tympanometry served as the gold standard for assessing OETD, and comparisons were made among the measures across the three groups. Among the 125 participants, 44.8% (n = 56) were female, and 55.2% (n = 69) were male, with ages ranging from 19 to 93years (M = 48.5; SD = 15.6). In our study, VM demonstrated high sensitivity (86.3%) when tympanometry was considered the gold standard. Conversely, TMM, ETDQ-7, and ETS-7 exhibited high specificity, with ETDQ-7 showing the highest specificity (87.4%). Regarding TMM, all R values in patients within the middle ear disease group were pathological (R > 1). TMM has exhibited notable specificity as a diagnostic tool compared to tympanogram and VM. Nonetheless, the combination of TMM and ETDQ-7 has enabled us to conduct a diagnostic assessment with high sensitivity and specificity for chronic OETD diagnosis.

Symptoms and Factors Associated With Eustachian Tube Dysfunction Among the Population of Qassim, Saudi Arabia.

Introduction The Eustachian tube regulates middle ear functions such as ventilation and pressure normalization. Eustachian tube dysfunction (ETD) is defined as the failure of the Eustachian tube to maintain one or more of its functions. It is a common condition that is associated with other middle ear disorders such as cholesteatoma, tympanic membrane atelectasis, and otitis media with effusion (OME). This study aims to assess ETD prevalence and risk factors in the Qassim region. Methodology This cross-sectional study was conducted in the Qassim region of Saudi Arabia during the period from September 20 to October 10, 2023. Data were gathered via a validated, self-administered electronic questionnaire that encompasses socio-demographic information, the prevalence of ETD, and the prevalence of its various symptoms, as assessed by the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Results Our study in Qassim, Saudi Arabia, with 467 participants reveals a high prevalence of ETD at 12.2%. The 18-25 age group dominates (50.1%), with a majority of females (66.2%). Symptom analysis using the ETDQ-7 questionnaire shows varied prevalence, with severe pain (7%) and muffled hearing (29.8%) notable. Logistic regression identifies significant predictors, including hearing loss history (odds ratio = 28.2) and smoking (odds ratio = 3.70). Specific symptoms, such as feeling blocked or underwater, significantly correlate with more severe ETD symptoms (odds ratio = 1.73). Conclusion Our study highlights a notable prevalence of ETD. Significant predictors, including hearing loss history and smoking, were identified. Specific symptoms, such as feeling blocked or underwater, were associated with more severe ETD symptoms.

Nasopharyngeal cyst of branchiogenic origin: a rare case report

Nasopharyngeal branchial cysts present laterally as well as ascend from the fossa of Rosenmuller and trace superiorly inside the bony immures of the pharyngotympanic tube. Other commonly related disease conditions with respect to nasopharyngeal cyst include the Rathke’s pouch cyst, Thornwaldt cyst from the pharyngeal bursa along with the branchial cleft cyst. Here in our study, we report a case of a 25-year-old male presented with symptoms of snoring for the past 2 years. On zero-degree endoscopic examination, a nasopharyngeal mass was seen arising from the lateral wall of the nasopharynx extending to the oropharynx. Further based on his radiological investigations, a localized non-enhancing nasopharyngeal cystic mass was seen extending from the left lateral wall of nasopharynx to oropharynx and was diagnosed as nasopharyngeal cyst. Thus, the surgical removal of the nasopharyngeal cyst has been performed through a transoral endoscopic technique with no remnants at the surgical site. The histopathological findings revealed stratified squamous epithelium with subepithelial infiltration of lymphoid follicles, thus confirming the diagnosis as branchial cleft cyst. The patient was discharged with no complications and have been periodically advised for a follow-up. Conclusively, the cyst of 2nd branchiogenic origin in the nasopharynx is extremely sporadic and till date, only a small number of cases have been reported.

Anatomical Analysis of the Eustachian Tube in the Temporal Bone Through the Middle Fossa Window.

This cadaveric anatomical study aimed to explore precise morphometric measurements of the eustachian tube (ET) and adjacent structures in the middle cranial fossa, focusing on identifying reliable surgical landmarks when traditional markers are compromised due to tumors or trauma. Twenty-two temporal bones from 11 adult cadavers (mean age: 75.70 ± 13.75 yr, range: 40-90 yr; sex: 5 females and 6 males) were dissected bilaterally. Surgical tools, including an operation microscope, endoscope, and digital caliper, were used for meticulous measurements. Parameters such as ET dimensions, distances between key points, and relevant angles were quantified, ensuring precise anatomical data. ET width at the foramen spinosum (FS) level, the midline level, and the eustachian orifice level were measured as 2.18 ± 0.68, 2.42 ± 0.70, and 2.30 ± 0.74 mm, respectively. The distances from the zygomatic root (ZR) to FS, ET, superior semicircular canal (SSC), and internal carotid artery (ICA) were 29.61 ± 2.56, 23.28 ± 2.61, 26.53 ± 2.56, and 32.61 ± 3.69 mm, respectively. The angles between SSC-ZR-ICA and FS-ZR-ICA were measured as 36.57 ± 10.32 and 13.63 ± 3.72 degrees, respectively. No statistical difference was found between right-left or male-female measurements ( p > 0.05). The present study offers invaluable insights for neurotological surgeons performing middle fossa approaches. ET and ZR may serve as crucial reference points, enhancing surgical orientation and minimizing risks during complex procedures. These precise anatomical data may empower surgeons, ensuring safer and more confident middle cranial fossa operations, even in challenging clinical scenarios.

Cholesteatoma in the pediatric aerodigestive population

ObjectivesTo report the prevalence of cholesteatoma and related comorbidities in pediatric aerodigestive patients requiring tracheostomy or airway reconstruction procedures. To use study findings to inform clinical management of these complex patients. MethodsA repository of clinical data drawn from our institution's electronic medical records was queried to identify airway reconstruction (airway) and complex hospital control (control) patient cohorts. Retrospective chart review was then performed to investigate the occurrence of cholesteatoma and related pathologies in these patients, as well as clinical management. ResultsThe prevalence of cholesteatoma in airway and control patients was 6/374 (1.60 %) and 35/30,565 (0.11 %), respectively. The relative risk of cholesteatoma diagnosis in airway patients was 14.01 (95 % CI 6.06–32.14). Airway patients were more likely than control patients to have pressure equalization tube history (relative risk 3.25, 95 % CI 2.73–3.82). Age at cholesteatoma diagnosis and first surgical intervention was younger in airway compared to control patients (5.43 vs. 8.33, p = 0.0182, and 6.07 vs. 8.82, p = 0.0236). However, time from diagnosis to intervention and extent of surgery were similar between the groups. ConclusionThis is the first study to investigate the prevalence of cholesteatoma in the pediatric aerodigestive population. The relative risk of cholesteatoma diagnosis was found to be 14 times higher in patients with tracheostomy or airway reconstruction history. Underlying eustachian tube and palatal dysfunction are likely contributing factors to the elevated risk. Additionally, cholesteatoma in this population was diagnosed and required surgical intervention at a younger age, which may suggest a more aggressive disease course. Providers should maintain a high degree of suspicion for cholesteatoma in this complex population.

Teprotumumab-Related Hearing Loss: A Large-Scale Analysis and Review of Voluntarily Reported Patient Complaints to the Food and Drug Administration (FDA).

Accumulating case reports and series have suggested that teprotumumab may significantly increase the risk of hearing impairment that, in some cases, does not resolve. This study investigates the association between hearing impairment and teprotumumab use. A disproportionality analysis was conducted using the United States Food and Drug Administration Adverse Event Reporting System, a publicly accessible database used for postmarketing surveillance and research. All adverse event reports containing the terms "teprotumumab" or "Tepezza" and a similar comparison group from all patients with the same indications for teprotumumab use (e.g., autoimmune thyroiditis, endocrine ophthalmopathy, and hyperthyroidism) but who had not received the drug were selected. Hearing impairment events were identified using the hearing impairment Standardized MedDRA Query. A total of 940 teprotumumab-associated adverse events were identified, including 84 hearing-related adverse events, with the first reported to the Food and Drug Administration in April 2020. A comparison group of 32,794 nonteprotumumab adverse events was identified with 127 hearing-related adverse events reported. Use of teprotumumab in patients with thyroid conditions was associated with a nearly 24-fold (proportional reporting ratio [PRR] 23.6, 95% confidence interval [CI]: 18.1-30.8) increased likelihood of any hearing disorder ( p value <0.0001). The association was specifically elevated for a variety of deafness conditions (e.g., bilateral deafness [PRR: 41.9; 95% CI: 12.8-136.9]), Eustachian tube disorders (PRR: 34.9; 95% CI: 4.9-247.4), hypoacusis (PRR: 10.1; 95% CI: 7.6-13.3), and tinnitus (PRR: 8.7; 95% CI: 6.2-12.1). Patients treated with teprotumumab should receive warnings regarding the increased risk of hearing-related impairments and receive audiometry before, during, and after treatment.

Serum Aspergillus fumigatus-Specific IgG as a Complementary Biomarker in Differentiating Endotypes of Chronic Rhinosinusitis: A Study on Its Role and Diagnostic Efficacy in Type 2 Inflammation.

Aspergillus is one of the most common pathogens causing fungal allergy in the respiratory tract. Serum Aspergillus fumigatus-specific immunoglobulin G (Af-sIgG) levels have been used as a biomarker for the diagnosis and treatment response monitoring in airway allergic diseases such as allergic bronchopulmonary aspergillosis and allergic fungal rhinosinusitis. However, its role in common primary chronic rhinosinusitis (CRS) was unclear. This study aims to evaluate whether serum Af-sIgG level could serve as a biomarker for the disease presentation of primary CRS. We obtained serum Af-sIgG levels from patients diagnosed as bilateral primary CRS refractory to medical treatment and evaluated the correlations between serum Af-sIgG levels and disease severity in patients with type 2 (T2) and non-T2 CRS. Patients with T2 CRS exhibited significantly higher serum Af-sIgG levels than non-T2 CRS patients. The cut-off value of serum Af-sIgG in T2 CRS was 20.9 mg/L, with an odds ratio of 3.8 (95% CI 1.17-12.20, P = .026). Furthermore, serum Af-sIgG levels were positively correlated with symptom scores evaluated by the Sino-Nasal Outcome Test-22 (SNOT-22) scores in T2 patients (P = .009). While stratified by SNOT-22 total scores, patients with severe disease had higher serum Af-sIgG levels only in T2 CRS (P = .034). In individual domains of SNOT-22 analysis, serum Af-sIgG levels showed a significant correlation with "ear/facial" symptom scores in the T2 group (P < .001). Serum Af-sIgG levels may serve as a supplementary objective biomarker that correlates with identification and subjective measurements of T2 CRS, and may be associated with symptoms arising from Eustachian tube dysfunction.

Age-related morphological change in bony segment and cartilage segment of Eustachian tube.

Eustachian tube dysfunction (ETD) is the predominant cause of otitis media with effusion in children and adults. Balloon dilatation of the Eustachian tube (BDET) provides a new method for restoring the ventilatory function of Eustachian tube (ET). However, the differences in age-related morphological changes in the dimensions and positions of ET in children and adults are unclear. This study aimed to examine age-related morphological changes in bony and cartilage segments of the ET in a three-dimensional space in normal population. A total of 71 randomly selected computed tomography (CT) images of the temporal bones of 46 people were retrospectively studied in four age groups: A (0-3 years old); B (4-8 years old), C (9-18 years old), and D (19-65 years old). Space analytic geometry was assessed to calculate the dimensions and positions of ET. The bony segment of ET lengthened from infancy to adulthood with age in groups A, B and C (r = 0.562**/0.000). The cartilage segment of ET mostly extended with age from infancy to 8 years old in children (r = 0.633**/0.000), but with bending close to the sagittal plane and away from the horizontal plane with age in groups A, B and C (P < .05), and with a constant angle to the coronal plane among the four groups (P > .05). The bony and cartilaginous segments of ET exhibit distinct morphological changes in space with age. The bony segment of ET extends in a constant position from infancy to adulthood. In contrast, the cartilaginous segment of the ET indicates multidimensional positional changes until adulthood, in addition to the elongation from infancy to children. This may provide an accurate morphological basis for comparing the differences in ETD pathogenesis and surgical treatment between children and adults.

Sound and Noise Sources in Sonotubometry: An Investigation of Eustachian Tube Assessment

This research aims to enhance the understanding of the acoustic processes occurring during sonotubometry, a method used to assess the Eustachian tube (ET) function. Recent advancements in digital signal processing enable a more comprehensive data analysis. In this project, a silicone model of the ET was developed to systematically study the existing noise and sound sources. These measurements were then compared with recordings from human subjects. Three distinct ’noise sources’ were identified, which can influence the assessment of the ET opening using transmission measurements of the imposed signal: sound leakage from the speaker, a clicking noise at the initiation of ET opening, and rumbling/swallowing noise. Through spectral analysis, it was also possible to ascertain the spectral and temporal occurrence of these sound and noise types. The silicone model exhibited remarkable similarity to the healthy human ET, making it a robust experimental model for investigating the acoustics of sonotubometry. The findings underscore the significance of delving deeper into the analysed sound, as the noise occurring during sonotubometry can be easily misconstrued as an actual ET opening. Particularly, careful consideration is warranted when evaluating data involving clicking and swallowing noise.

Optimized Management of Patulous Eustachian Tube: Shim Size Modifications to Minimize Middle Ear Effusion and Enhancing Treatment Outcomes.

Objective: In this retrospective case series, we reported 4 patients presenting with a patulous Eustachian tube (PET) to highlight our institutional management approach to PET with shim insertion and a modified shim with hydroxyapatite injection. Methods: A single institution retrospective review. Results: One case was complicated by otitis media effusion; thus, the shim was downsized under local anesthesia with an immediately improved effusion. Another patient managed with a bilateral shim of the same size but is still symptomatic on one side; therefore, we upsized it, and the symptoms disappeared. The last one developed biofilm formation and thick secretion even after downsizing. Hydroxyapatite injection was performed under local anesthesia using the same shim insertion protocol. Conclusion: Shim insertion for the treatment of PET is considered a safe, reversible, and adjustable technique, giving satisfactory results while avoiding middle ear effusion. It can be performed under local or topical anesthesia in the clinic, and size adjustment can be considered to get maximum relief without middle ear effusion. This case series highlights that adjusting the size of the shim is a suggested method to eliminate symptoms and avoid complications of shim without the need for myringotomy and ventilation tube.

Interpretation of the nine-step test for Eustachian tube function should consider mastoid cavity volume.

The modified nine-step test is a classical method for evaluating Eustachian tube function. However, clinical interpretation of the increased maximal difference in middle ear pressure (mdMEP) in the modified nine-step test is unknown. We hypothesised that the different reservoir effects of the mastoid cavity can bias the results of the modified nine-step test. A total of 108 consecutive participants (216 ears) were retrospectively screened. Of these, 55 participants (82 ears) who met the inclusion/exclusion criteria were enrolled. The volumetric results of the mastoid cavity, parameters of the modified nine-step test (mdMEP, middle ear pressure, tympanic membrane compliance), and demographic data were analysed. A significant negative correlation was found between mdMEP and mastoid cavity volume (R = .467, p < .001). Ears with mdMEP >70 daPa showed poor pneumatization in the mastoid cavity, with volumes less than 3000 mm3 (10th percentile of all ears analysed). Ears with mastoid cavity volumes lower than the 25th percentile showed a significantly higher mdMEP (p < .001). Patients with mastoid cavity volumes higher than the 75th percentile were significantly younger (p < .001). Multivariate regression analysis for mdMEP showed a good fit (R = .854) using factors including middle ear pressure, admittance and, most importantly, the reciprocal of mastoid volume (Beta = 0.752, p < .001). The mdMEP, the main parameter of the modified nine-step test, was negatively correlated with the mastoid cavity volume. Therefore, the results of the modified nine-step test should be interpreted with consideration of mastoid cavity volume.

Ayurvedic Management of Traumatic tympanic membrane perforation

Traumatic tympanic membrane perforations are common in Otolaryngological practice. These perforations can be due to direct penetrating trauma, infections or due to eustachian tube disorders. These perforations can lead to reversible high frequency deafness, tinnitus and vertigo. Small perforations heal spontaneously within three months after the injury while large perforations are treated with myringoplasty. This is a case report of 35year old female patient who presented to Shalakya OPD with complaints of sudden onset of earache and reduced clarity of hearing in left ear, since 7 days. The tympanic membrane was ruptured. While compairing the size of perforation relative to circumference of the tympamic membrane, it was observed to be a large sized perforation affecting 50% of tympamic membrane. Large sized perforations are usually considered non healing as it exert influence on the malleus and umbo at tympanic membrane insertion and would interrupt the sound conducting mechanism. She was managed conservatively with Ayurveda treatment. Karnalepa applied over the pre auricular and mastoid region makes the healing fast and effective. Karnapichu, the modified form of karnapoorana provides a much larger skin contact time with controlled release of drugs.The case report shows the effect of local and systemic medication in the form of Murivenna karnapichu. The healing of tympanic membrane occurred within one month of follow up.

Objective Measurements of Nasal Obstruction and Eustachian Tube Function in Pregnant Women.

Background: Hormonal changes during pregnancy have a substantial effect on the swelling of the mucous membrane in the nasal cavity, resulting in rhinitis and Eustachian tube dysfunction. The aim of the study was to assess subjective and objective changes in nasal cavity and Eustachian tube patency in the third trimester of pregnancy. Materials and Methods: The study group included fifty 18-41 year-old women in the third trimester of pregnancy. The control group consisted of 25 females aged 25 to 31 who were not pregnant. The Eustachian tube and nasal cavity patency examination was carried out using a rhinomanometer, a tympanometer and a SNOT-22 Questionnaire. Results: The SNOT-22 showed that subjective nasal obstruction was assessed as strong or worse by 42% of the study group, which was significantly higher than in the control group and confirmed with rhinomanometry. A total of 68% of the study group reported a subjective ear fullness which correlated with the week of pregnancy. The tympanometry showed that all pregnant women exhibited a type A tympanogram, but tympanometry values decreased at higher weeks of pregnancy, and statistical analysis confirmed a significant difference between the study group and the control group in tympanometry for both ears. Conclusions: The results highlight the substantial impact on both subjective and objective measurements of nasal and Eustachian tube patency. Almost every woman in the third trimester of pregnancy experiences nasal obstruction, and nearly 70% struggle with ear fullness. Recognizing and addressing these challenges are pivotal for ensuring the well-being of pregnant individuals and enhancing the quality of antenatal care.

A Deep Learning Framework for Analysis of the Eustachian Tube and the Internal Carotid Artery.

Obtaining automated, objective3-dimensional(3D) models of the Eustachian tube (ET) and the internal carotid artery (ICA) from computed tomography (CT) scans could provide useful navigational and diagnostic information for ET pathologies and interventions. We aim to develop a deep learning (DL) pipeline to automatically segment the ET and ICA and use these segmentations to compute distances between these structures. Retrospective cohort. Tertiary referral center. From a database of 30 CT scans, 60 ET and ICA pairs were manually segmented and used to train an nnU-Net model, a DL segmentation framework. These segmentations were also used to develop a quantitative tool to capture the magnitude and location of the minimum distance point (MDP) between ET and ICA. Performance metrics for the nnU-Net automated segmentations were calculated via the average Hausdorff distance (AHD) and dice similarity coefficient (DSC). The AHD for the ET and ICA were 0.922 and 0.246 mm, respectively. Similarly, the DSC values for the ET and ICA were 0.578 and 0.884. The mean MDP from ET to ICA in the cartilaginous region was 2.6 mm (0.7-5.3 mm)and was located on average 1.9 mm caudal from the bony cartilaginous junction. This study describes the first end-to-end DL pipeline for automated ET and ICA segmentation and analyzes distances between these structures. In addition to helping to ensure the safe selection of patients for ET dilation, this method can facilitate large-scale studies exploring the relationship between ET pathologies and the 3D shape of the ET.

Efficacy of Intranasal Corticosteroid Sprays in Relieving Clinical Signs of Eustachian Tube Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Efficacy of Intranasal Corticosteroid Sprays in Relieving Clinical Signs of Eustachian Tube Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Sirolimus-coated Eustachian tube balloon dilatation for treating Eustachian tube dysfunction in a rat model

Eustachian tube balloon dilatation (ETBD) has shown promising results in the treatment of ET dysfunction (ETD); however, recurrent symptoms after ETBD frequently occur in patients with refractory ETD. The excessive pressure of balloon catheter during ETBD may induce the tissue hyperplasia and fibrotic changes around the injured mucosa. Sirolimus (SRL), an antiproliferative agent, inhibits tissue proliferation. An SRL-coated balloon catheter was fabricated using an ultrasonic spray coating technique with a coating solution composed of SRL, purified shellac, and vitamin E. This study aimed to investigate effectiveness of ETBD with a SRL-coated balloon catheter to prevent tissue proliferation in the rat ET after ETBD. In 21 Sprague–Dawley rats, the left ET was randomly divided into the control (drug-free ETBD; n = 9) and the SRL (n = 9) groups. All rats were sacrificed for histological examination immediately after and at 1 and 4 weeks after ETBD. Three rats were used to represent the normal ET. The SRL-coated ETBD significantly suppressed tissue proliferation caused by mechanical injuries compared with the control group. ETBD with SRL-coated balloon catheter was effective and safe to maintain ET luminal patency without tissue proliferation at the site of mechanical injuries for 4 weeks in a rat ET model.

Efficacy of balloon Eustachian tuboplasty plus tympanostomy tube insertion in postirradiation otitis media with effusion

ObjectiveThis study aimed to compare the efficacy of balloon Eustachian tuboplasty (BET) plus tympanostomy tube insertion (TTI) and simple TTI for postirradiation otitis media with effusion (OME) in patients with nasopharyngeal carcinoma. MethodThis study included 36 patients (51 ears) with OME after the first radiotherapy course for nasopharyngeal carcinoma and categorized them into the BET + TTI and simple TTI groups. Effective rates, pure tone hearing threshold, Eustachian tube function score, and complication incidences were compared. ResultsThe effective rates of the BET+TTI and TTI groups were 93.75 % and 75 %, respectively, with no statistically significant difference (P = 0.29). The pure tone hearing threshold examination at 9 months postoperatively revealed significantly lower mean air-pure tone and air-bone gap in both the BET + TTI and TTI groups than preoperatively. Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores at every postoperative visit were significantly higher than preoperative scores in the two groups (all P < 0.05); ETDQ-7 score reduction in the BET + TTI group at 3, 9, and 12 months postoperatively was significantly higher than that in the TTI group. Otorrhea and recurrence both occurred in the BET+TTI and TTI groups, but the BET+TTI group demonstrated a lower incidence. ConclusionBET + TTI is an effective treatment method for postirradiation OME.

Validation of Biomarkers and Patient-Reported Outcome Measures to Improve the Diagnosis and Treatment of Eustachian Tube Dysfunction

Patients who suffer from Eustachian tube dysfunction (ETD) experience a significant decline in quality of life. To enhance patient outcomes, it is crucial to establish an accurate diagnosis, assess treatment effectiveness, and evaluate the severity of the condition. Substantial progress has recently been made in identifying biomarkers (BMs) and developing ETD clinical outcome assessments (COAs). This study examines the current state of BMs and COAs in ETD, including the methods evaluated historically and their potential clinical applications. The research in this area emphasizes the importance of using objective measures, such as middle ear pressure (MEP) and patient-reported outcome measures (PROMs), for diagnosing and evaluating ETD. Further, I discuss how electronic PROMs (ePROMs) and other digital health technologies can guide the development of innovative PROMs that ETD. Despite significant advances in COAs for ETD, much work remains to validate and improve them before their implementation in clinical practice. There has been less focus on vertigo as a symptom in recent assessments of ETD, suggesting that further examination of this aspect is needed. By validating BMs and COAs for ETD, we could enhance long-term patient outcomes and quality of life through improved diagnostic accuracy and evaluation of treatment efficacy.

Rate and management of tympanic membrane perforations in children with Down syndrome and middle ear disorder

ObjectiveTo characterize the management and outcomes of observation versus surgical intervention of tympanic membrane (TM) perforations in children with Down syndrome (DS). In addition, to estimate the prevalence of TM perforations in children with DS. MethodsRetrospective case review analysis of TM perforation rate in children with DS with history of tympanostomy tube (TT) insertion at a tertiary pediatric referral center. Patients were divided into observation or surgical intervention groups and then further evaluated for the type of intervention, the number of required procedures, and success rate of hearing improvement. Risk factors contributing to perforations were analyzed, including TT type, number of TT surgeries, and perforation size. ResultsThe TM perforation rate in children with DS with TT history was 7.0 %. Tympanoplasty was performed in 41.5 % of perforated ears with a success rate of 53.1 %. There was no statistical difference between the surgical intervention and observation groups regarding perforation characteristics or TT number and type, but the surgical intervention cohort was older. Hearing improvement based on postoperative pure tone average (PTA) threshold was noted in the successful surgical intervention group. ConclusionThe rate of TM perforations in children with DS after TTs is comparable to the general population. Improved PTA thresholds were noted in the surgical success group influencing speech development. The overall lower success rate of tympanoplasty in patients with DS emphasizes the need to factor in the timing of surgical intervention based on the predicted age of Eustachian tube maturation.