Impaired Eustachian Tube Function Research Articles

Association of Pre-operative Eustachian Tube Function with the Graft Uptake After Tympanoplasty.

To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results-i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery.

Evaluation of eustachian tube function in chronic suppurative otitis media with reference to its treatment outcome

<p class="abstract"><strong>Background:</strong> The study was undertaken to find out Eustachian tube function in safe type of chronic suppurative otitis media and to study the comparison of graft uptake in normal, partially impaired and grossly impaired Eustachian tube function in safe type of chronic suppurative otitis media.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was conducted in the Department of Otorhinolaryngology and Head and Neck surgery, Sri Maharaja Gulab Singh Hospital, Jammu during the period from November 2016 to October 2017. Patients were diagnosed clinically and also audiometrically by pure tone audiometry and impedance audiometry. Eustachian tube function test- Toynbee test was done in all the patients. </p><p class="abstract"><strong>Results:</strong> Out of 20 patients with normal Eustachian tube function, 19(95%) showed graft uptake. Out of 20 patients with partially impaired Eustachian tube function, 18 (90%) showed graft uptake. Out of 20 patients with grossly impaired Eustachian tube functions 13 (65%) showed graft uptake. Comparison of mean values of pre and post- operative air-bone (AB) gap with respect to normal, partially impaired and grossly impaired Eustachian tube functions is highly significant statistically with (p<0.001).</p><p class="abstract"><strong>Conclusions:</strong> As seen in our study, functioning Eustachian tube is an important requirement for optimum outcome of myringoplasty. Testing the functions of Eustachian tube before surgery provides a possibility of predicting the possible outcome of myringoplasty or tymapanoplasty. This is also concluded that a partially functioning Eustachian tube should not be considered to be a contraindication to these surgeries as in many of these cases graft uptake and AB gap closure was good (90%).</p>

Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media.

To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016-July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation.

Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.

Eustachian tube function in patients with inner ear disorders

The influence of Eustachian tube (ET) dysfunction on the inner ear fluid pressure and thus on the inner ear function in Meniere's disease has been discussed controversially. So far, most of the studies examining ET function in inner ear disorders indirectly analyzed ET function by tympanometric methods. The present study directly studied ET function in inner ear disorders by sonotubometry. Healthy subjects and patients with Meniere's disease, sudden sensorineural hearing loss, cholesteatoma and chronic suppurative otitis media were examined by sonotubometry. Mean increase of sound pressure intensity (dB) and mean duration of sound pressure increase (s) were analyzed. Highest mean increase of sound pressure intensity was seen in healthy subjects when using >5 dB peaks (11.6 ± 0.7 dB) and >0 dB peaks (9.6 ± 0.6 dB). Comparative analysis including bilateral ears showed decreased ET function in patients with cholesteatoma (p = 0.002) and in patients with Meniere's disease (p = 0.003) when using >0 dB peaks. Examination of each specific ET opening maneuver showed impaired ET function in pathological ears of patients with cholesteatoma and with Meniere's disease, during yawning (p = 0.001; p < 0.001), dry swallowing (p = 0.010; p = 0.049), Toynbee maneuver (p = 0.033; p = 0.032) and drinking (p = 0.044; p = 0.027). Mild ET dysfunction is detected in patients with Meniere's disease by direct sonotubometric assessment of ET function.

Laser Eustachian Tuboplasty

Laser Eustachian tuboplasty (LETP) with ablation of the epipharyngeal orifice of the Eustachian tube (ET) shows good results in clinical observation. However, to this day, there are no reports evaluating the surgical procedure with valid test methods. The purpose of this study was to test the effect of minimally invasive LETP by means of a pressure chamber ET function test. Prospective surgical trial. Tertiary and university hospital. Thirty patients with a history of ET dysfunction during pressure changes were examined. Minimally invasive LETP was performed with an 812-nm diode laser under local anesthesia as an outpatient procedure. The ET function was tested preoperatively and postoperatively by pressure chamber ET function test. Eustachian tube closing pressure (ETCP) was evaluated as a measure of the tissue pressure of the ET. In cases of a severely impaired ET function, a "blocked" pattern was evident, and no measurement of ETCP was possible. Before minimally invasive LETP, 17 patients showed a completely blocked pattern. Postoperatively, 13 patients of this group showed an improved ET function with a restored normal opening pattern (p < 0.001). The ETCP was reduced from 6.24 ± 3.46 mbar preoperatively to 4.06 ± 2.36 mbar postoperatively (p < 0.013). The results strongly indicate that the effect of minimally invasive LETP can be proven by measuring the ET function in a pressure chamber. Results must be interpreted in combination with clinical methods like Valsalva maneuver and tympanometry. Patients with ET dysfunction during pressure changes seem to benefit from the minimally invasive LETP.

Sonotubometry with perfect sequences: First results in pathological ears

Conclusion: Sonotubometry with perfect sequences (PSEQ) was able to detect eustachian tube (ET) openings in both normal and pathological ears. Impaired ears showed ET openings in almost all cases; however, these proved to be not only less frequent, but also with lower amplitude and shorter duration. Objectives: To investigate the function of impaired ET under physiological conditions, using a novel kind of sound stimulus for sonotubometry – the PSEQ. Methods: Twenty otologically healthy subjects (40 normal ears) and 32 patients with ear diseases (40 pathological ears) were examined sonotubometrically using noise signals with an ideally flat spectrum (PSEQ). Dry swallowing, water swallowing, and Toynbee maneuver were used to induce ET openings. Analysis was performed regarding the frequency of occurrence, duration, amplitude, and form of the ET openings. Results: PSEQ allowed the detection of an ET opening in all 40 normal ears (91% of the performed maneuvers) and in 87.5% of the ears with impaired ET function (but only 47% of the maneuvers). The average amplitude of the openings in healthy ears was 16.86 dB, the average duration was 363 ms. In diseased ears these values were significantly lower: 9.73 dB, p < 0.001 and 280 ms, p < 0.05.

Results of Sonotubometry in Testing Eustachian Tube Ventilatory Function in Children with Cleft Palate

In previous studies, an updated sonotubometry setup was tested in healthy adults and children to test its validity and reproducibility in the assessment of the ventilatory function of the eustachian tube (ET). The results were promising, but further investigations were needed to confirm the discriminative potential of this sonotubometry setup. Our objective in the present study was to test the discriminative potential of an updated sonotubometry setup in children with cleft palate. The ET ventilatory function was tested in 56 children with cleft palate, ie, children with impaired ET function, and compared to the outcomes in 61 healthy children who served as a control group. All of the children were between 5 and 9 years of age. To test the reproducibility, we performed the sonotubometric testing in 2 sessions of 10 acts of swallowing each. Spearman's coefficient was used to test the correlation between the 2 sets of measurements. The results of measurements in the cleft palate group were compared with those in the otologically healthy control group and analyzed by means of a Mann-Whitney U test. Opening of the ET was recorded in at least 1 of the 2 measurement sessions in 57% of the children with cleft palate, as compared to 82% in the control group. The mean number of openings was lower in the cleft palate group than in the control group (respectively, 2.3 versus 3.7 out of 10; p < .01). The first and second sessions were highly correlated in both the cleft palate group and the control group, with Spearman's coefficients of, respectively, 0.96 and 0.89. The results of this study show that this updated sonotubometry setup has the potential to discriminate between these groups of children with various states of ET ventilatory function. Furthermore, the results of this study once again show that this updated sonotubometry setup is capable of assessing ET ventilatory function in both healthy children and children with cleft palate and that the measurements are highly reproducible. A persistent disadvantage remains that in 18% of the 61 healthy children there was no ET opening that could be registered, which still prohibits a definite assessment at the individual level.

High-resolution gas volume change measurements bring new insights in pressure regulation of the middle ear

in this issue, the paper by Kania et al. ([7][1]) presents measurements and modeling results on the role of nitrogen in the gas exchange processes in the middle ear. The middle ear is a semirigid biological gas pocket that is closed most of the time. External influences, such as changing weather

EVIDENCE IN INFANTS WITH CLEFT PALATE THAT BREAST MILK PROTECTS AGAINST OTITIS MEDIA

Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. The findings also suggest that, in infants with cleft palate, impaired eustachian tube function is not the only pathogenic factor in the development of MEE.

Evidence in infants with cleft palate that breast milk protects against otitis media: Paradise J.L.; Elster B.A.; Tan L.Pediatrics (USA) (1994) 94/6 I (853–860)

Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusion-free on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media.We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first.Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P < .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable.Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.

Evidence in Infants With Cleft Palate That Breast Milk Protects Against Otitis Media

Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusion-free on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media. We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first. Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P < .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable. Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.

EVIDENCE THAT BREAST MILK PROTECTS AGAINST OTITIS PAMEDIA WITH EFFUSION (OME) IN INFANTS WITH CLEFT PALATE

In a prospective study of nutrition and middle-ear disease in 252 infants with cleft palate, entailing frequent standardized pneumatic otoscopic examination, we encountered sporadic infants with one or both ears effusion-free on one or more occasions. Each was additionally unusual in having been fed breast milk. We therefore reviewed the prospectively obtained feeding histories of all subjects in relation to the recorded presence or absence of OME at each examination, excepting examinations subsequent to myringotomy if performed.Of the 252 infants enrolled in an 8-yr. period, 231 (91.7%) were ≤ 2 mos. of age at entry. Two hundred twenty-two (88.1%) received cow milk or soy formulas with no reported admixture of breast milk; 30 (11.9%) received breast milk exclusively or in part for varying periods, in virtually all instances expressed by the mother and provided via artificial feeder. In none of the 222 infants fed only formula was either ear effusion-free at any examination during the first 18 mos. of life, whereas in 11 (37%) of the 30 infants fed breast milk, one or both ears were effusion-free at one or more examinations (P < 0.0001). Freedom from OME was found across categories of cleft type, race, sex, SES, and birth order.These findings provide evidence (1) that in infants with cleft palate, impaired Eustachian tube function is not the sole factor in the pathogenesis of OME, and (2) that breast milk protects against the development of otitis media in infancy.

Appearance of effusion material in the attic space correlated to an impaired Eustachian tube function.

In adult Sprague-Dawley rats a dysfunction or a total blockade of the Eustachian tube was established by various experimental procedures. The appearance of effusion material in the attic was subsequently considered to be evidence of incomplete ventilation of the middle ear cavity. Though the salpingopharyngeus muscle (SPM) seemed to be the muscle which could open the Eustachian tube maximally, splitting of the soft palate and consequent interference with the tensor veli palatini muscle (TVPM) and the levator veli palatini muscle (LVPM)--but obviously not with the salpingopharyngeus muscle (SPM)--caused the effusion material to be produced in the middle ear cavity. Neither blockade by about 80% of the tympanal orifice nor severing of the tendon of the tensor tympani muscle (TTM) close to the malleus produced any signs of effusion material whatsoever. Our findings strongly suggest that the most important part of the Eustachian tube, as regards ventilation, is the nasopharyngeal portion, as a normally functioning TVPM and LVPM seems to be an absolute prerequisite to prevent effusion material from developing in the attic.

Middle ear ventilation tubes.

AbstractTwenty years have now passed since the first tube was placed through the tympanic membrane for middle ear ventilation. In this relatively short period of time, many different ideas for tube design have emerged and are presented. The types of middle ear fluid formation and the relationship of this formation to impaired eustachian tube function are discussed. The main indication for indwelling tubes is chronic secretory otitis media with effusion which fails to respond to conservative treatment; however, indications have been expanded with continued experience. The complications associated with the use of middle ear ventilation tubes are presented. Five years' experience using ventilation tubes in 1,460 ears is reported. Conclusions are based on data compiled from this study.