Middle Ear Ventilation Research Articles

Association Between Deviated Nasal Septum and Function of Eustachian Tube among Patients Attending a Tertiary Care Center

Deviated nasal septum is the most common cause of severe and chronic nose blockage. The eustachian tube (ET) is a tube that connects the middle ear cavity and the nasopharynx and provides middle ear ventilation. The relationship between DNS and ETF is controversial in medical literature. This study tried to find the association between deviated nasal septum and function of eustachian tube. This prospective study was conducted in Nepal Medical College Teaching Hospital, Otorhinolarynology Department from November 2022 to October2023 after acquiring ethical clearance from Institutional Review Committee. All the patients presenting to the outpatient clinic over the age of 19 with deviated nasal septum (DNS) were included. Statistical analysis was done using SPSS. A p value of < 0.05 was considered statistically significant. Our study had 71 males (54.6%) and 59 females (45.4%) with mean age 37.2±15.9 years. Of 130 patients, 56 (43.1%) had DNS to right side while 74 (56.9%) to left. All patients had moderate DNS. Age group, gender, and laterality of DNS of the patient did not show any significant association with ETDQ7 score, tympanograms and middle ear pressures on either side. Moderate DNS did not affect ETF in a significant way.

Intra-operative Measurement of Eustachian Tube Orifice, and Its Correlation With Post-operative Surgical Outcome in Chronic Suppurative Otitis Media Patients.

Background Chronic suppurative otitis media (CSOM) is the inflammation of the middle ear mucosa for more than two weeks, resulting in ear discharge. It is associated with hearing loss and the presence of a perforation in the tympanic membrane. Tympanoplasty is performed to place a graft and clear the disease in the middle ear. Despite adequate disease clearance and proper graft placement, graft failure and disease persistence occur due to Eustachian tube (ET) dysfunction. The ET plays a significant role in the ventilation of the middle ear. Hence, this study was conducted to determine the significance of ET size for post-operative graft uptake. Methodology A total of 55 patients with inactive CSOM were included in the study. Their demographic data were recorded. Patients previously operated on for CSOM, cases with traumatic perforation of the tympanic membrane, congenital anomalies (e.g., cleft lip/cleft palate), and atticoantral disease were excluded. Thorough history taking and examination, including otoscopy and examination of the nose, throat, and oropharynx, were conducted. Once the patient was deemed fit for surgery, they underwent tympanoplasty. Intraoperatively, the ET size was measured using the tip of the suction cannulas. They were followed up after three months to assess graft uptake. Results Out of 55 patients included in the study, 42 (76%) had good graft uptake, while 13 (24%) had defects in graft uptake. Graft uptake failed in patients with an ET diameter of <3 mm. Post-operative graft uptake was observed in the majority of patients with a wider ET diameter, ranging between 3 mm and 6 mm, with a statistically significant p-value of 0.00 (0.05), as determined by Pearson's Chi-square test. Conclusion In our study, we found that there is an association between the ET diameter and post-operative graft uptake. Hence, a wider ET may improve middle ear ventilation and play an important role in post-operative graft uptake.

Long-Term Preclinical Evaluation of a Permanent Stent Developed for the Human Eustachian Tube.

The Eustachian tube (ET) is a bottleneck when it comes to middle ear (ME) health. If its function is impaired, this can lead to serious consequences for the patient, such as hearing problems or deafness. Therefore, this study investigated a tapered nitinol stent (3-5 mm × 14 mm) for the human ET as a potential new permanent treatment for chronic Eustachian tube dysfunction (ETD) and thus ME ventilation disorders. The self-expanding stent was inserted unilaterally into the ET of 24 sheep with observation periods of 3, 6, and 12 months. Local tissue effects and the safety of the stent insertion were analyzed based on regular endoscopic checks, weekly tympanometry measurements, final imaging, and histological examinations. The animals showed no stent-related health restrictions. However, the individual anatomy and stenting procedure had an influence on the results. The tissue reaction in the endoscopic examinations was mild even though no concomitant antibiotics were administered. After all three monitoring periods, stented ETs had a significantly larger ET lumen than the non-stented contralateral ETs. However, tissue growth was detected in the stent. Overall, the first long-term study on an ET stent showed that the tapered ET stent could be a promising treatment option for ETD.

Clinical Analysis of Repeat Balloon Eustachian Tube Dilatation

Background and Objectives Obstructive Eustachian tube dysfunction (OETD) is a complex condition in which middle ear ventilation control is impaired. OETD is often not improved by medication nor by nasal washing or nasal spray. On the other hand, balloon Eustachian tube dilatation (BETD) is an effective surgery in OETD although repeating BETD is controversial as it involves additional procedure such as ventilation tube, middle ear steroid irrigation, and trans-tympanic Eustachian tube probing in some cases. This study aims to analyze the clinical differences between patients who received single BETD and repeat BETD, and to evaluate the efficacy of repeat BETD.Subjects and Method For the study, 110 single groups, and 16 repeat groups were selected from patients who underwent BETD from Nov 2019 to Aug 2022. Age, gender, underlying diseases, history of rhinitis and smoking, and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) were analyzed for the selected groups.Results There were no significant differences in gender, underlying disease, or history of rhinitis between the two groups. However, age was significantly younger in the repeat group (45.91 vs. 33.38, &lt;i&gt;p&lt;/i&gt;=0.006), while smoking (5.64 vs. 1.66, &lt;i&gt;p&lt;/i&gt;=0.01) was significantly higher in the single group. The rate of improvement in the ETDQ-7 was 81.3% in the single group and 69.2% in both initial and repeated surgeries in the repeat group. The complete remission rate was 60% in the single group, and 38.5% in both initial and repeated surgeries of the repeat group.Conclusion For patients who are unsatisfied with the first surgery, it is meaningful enough to recommend repeat BETD, for which additional procedures are performed simultaneously.

Eustachian tube balloon dilation

Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.

Temporal bone CT-based anatomical parameters associated with the development of cholesteatoma

BackgroundCholesteatoma is caused by disorders of the middle ear ventilation that trigger a progressive series of events responsible for its formation. The aim of this study was to identify possible radiological CT-derived parameters predisposing to ventilation disorders and cholesteatoma.MethodsIn this retrospective study, patients diagnosed with cholesteatomatous chronic otitis media who underwent temporal bone CT and open tympanoplasty surgery have been included, as well as control patients with clinical examination negative for organic otological pathology who underwent temporal bone CT for other reasons. For each patient, the following parameters have been extracted from CT volumes: degree of mastoid pneumatization, prominence of the cog, patency of the Eustachian tube, antrum width, aditus width, anterior and posterior epitympanic widths, and epitympanic height.ResultsSixty patients have been included, thirty of whom belonged to the group of patients with cholesteatoma and the remaining part to the group of patients without organic otological pathology. The prevalence of a low degree of mastoid pneumatization was significantly higher among patients with cholesteatoma, as well as for the prevalence of cog prominence (p < 0.001). All the continuous variables were found to have statistical significance (p < 0.05) in the comparison between groups except for the width of the antrum.ConclusionMastoid pneumatization degree, prominence of the cog and epitympanic measures based on temporal bone CT could be good radiological correlates of the ventilatory capabilities of the epitympanum which, if compromised, can facilitate the development of cholesteatoma.

Association of various factors related to mastoid buffer and middle ear ventilation in etiopathogenesis of squamous chronic otitis media—a cross-sectional study

BackgroundActive squamous chronic otitis media (COM) is an entity with a deep retraction pocket of the pars tensa or flaccida that has retained debris of squamous epithelial where the fundus cannot be visualized involving the pars flaccida or pars tensa, associated with cholesteatoma. Eustachian tube dysfunction (ETD) is a known etiological factor for squamous COM, based on Wittmack’s theory; however, there are very few recent studies in this regard. Contracted mastoid pneumatisation (diploic or primary sclerosis) and presence of Korner’s septum have also been implicated to be associated with middle ear pathology, with conflicting results.Hence, the present study was undertaken to find out the association of three important factors, namely eustachian tube dysfunction, type of mastoid pneumatisation, and Korner’s septum related to mastoid buffer and middle ear ventilation in etiopathogenesis of active squamous chronic otitis media. The study also attempted to identify various conditions of nose and nasopharynx associated with ETD. This would enable us in appropriate surgical decision making with long term benefits in term of hearing and disease outcomes.ResultsOut of the total 37 patients, with active squamous chronic otitis media, it was observed that Eustachian tube dysfunction was found to be associated with 23 (62.16%). The majority of patients had a diploic/primary sclerosed mastoid pneumatization pattern which is 32 (86.48%) of patients. Korner’s septum was found to be associated with 13 (35.13%) patients of the total 37 patients with active squamous chronic otitis media. All these findings were found to be statistically significant.ConclusionIn this study, we found that there was a statistically significant positive association of all etiological factors namely Eustachian tube dysfunction, contracted mastoid (diploic/primary sclerotic mastoid), and the presence of Korner’s septum with causation of active squamous otitis media. Out of these factors, occurrence of diploic mastoid seemed to be the most constant association. Eustachian tube dysfunction of mechanical type, associated with various nasal pathologies, most common was, deviated nasal septum.

Delayed extensive surgical emphysema after Valsalva manoeuvre post Eustachian tuboplasty.

This paper reports a case of balloon Eustachian tuboplasty with delayed presentation of extensive surgical emphysema. This is a clinical case report with a review of literature. Eustachian tube dysfunction is a functional disorder that results in inadequate middle-ear ventilation, causing aural fullness and tinnitus. A 36-year-old male presented with the sudden onset of an isolated, painful, left-sided neck swelling. The patient underwent balloon Eustachian tuboplasty, which was uneventful, but subsequently developed a sudden onset of isolated left-sided neck swelling on the 5th post-operative day during Valsalva manoeuvre. Neck examination revealed extensive crepitus on the left side of the neck. Examination findings were confirmed by imaging. The patient was conservatively managed and subsequently discharged home. Balloon Eustachian tuboplasty is a safe procedure; however, extra care must be taken to avoid possible complications. Patients should be counselled against Valsalva manoeuvre and heavy weightlifting. They also should be instructed to sneeze with an open mouth and consider the use of stool softeners.

Classification of pathological epidermization (cholesteatoma) of the middle ear NMAO

The periodicals published over the past 5 years showed that interest in the issue of surgical treatment of chronic otitis media, including one complicated by cholesteatoma, did not wane despite the large accumulated experience of schools in otosurgery around the globe. In our opinion, there are currently some significant problems of terminology in the clinical anatomy of the ear, in particular, the nomenclature of the upper floor of tympanic cavity, which negatively affects the comparison and reproducibility of the results of surgical treatment of chronic otitis media. The critical analysis of the current classification of middle ear cholesteatoma proposed in 2017 and validated in Russia in 2021 demonstrates certain difficulties in using the pathohistological term “cholesteatoma”, as well as the basic inaccuracy in defining the concept and structure of the anterior parts of the epitympanum. The work aims to develop and present a new classification of pathological middle ear epidermization (cholesteatoma), which is based on the pathophysiology of middle ear ventilation. The modern concepts on the mechanisms of middle ear ventilation reveal its important role in developing the pathological epidermization and secondary cholesteatoma. The use of three-dimensional modelling of airway ventilation makes it substantially easier to follow the pathophysiological mechanisms of development of tympanic membrane retraction. The tympanic diaphragm consists of more than 10 composite elements. Understanding the pathophysiological principles underlies the proposed classification of pathological middle ear epidermization (cholesteatoma), which is based on the prevalence of middle ear and surrounding anatomical formation injuries. The pathological process area is coded using the abbreviation of the National Medical Association of Otorhinolaryngologists. In this abbreviation, each letter corresponds to a specific anatomical region. The tympanic diaphragm represents the boundary between the regions. Each letter is assigned an index corresponding to the degree of pathological epidermization invasion into the structures of the middle ear, temporal bone and cranial cavity. The authors provide a table, which serves as a visual aid for ease of coding the diagnosis. Examples of how to formulate a diagnosis in accordance with otoscopic illustrations are given.

Diagnostic Accuracy of Tympanogram in Pediatric patients with Otitis Media with Effusion Taking Myringotomy findings As Gold Standard

Aim: To determine the diagnostic accuracy of tympanogram for diagnosis of otitis media with effusion in patients with conductive hearing loss. Study design: Cross-sectional study Setting: Department of ENT, Benazir Bhutto Hospital Rawalpindi. Duration of study with dates: The study was carried out over six months from 24-05-2018 to 23-11-2018. Methods: The study was conducted on 150 patients. Clinical examination of all patients was done for OME, then tympanograms were recorded and all patients underwent myringotomy. OME on tympanogram and myringotomy was recorded. Results: The average age of the patients was 6.4±2.0 years. The study included 76 males (50.7%) and 74 females (49.3%). The averagelengthof disease (OME) is 18.5±10.3 months. Diagnostic accuracy of tympanogram findings taking myringotomy as the gold standard showeda sensitivity of 99.2%, specificity of 70%, a positive predictive value of 97.8%, a negative predictive value of 87.5% and an accuracy of 97.3%. Stratification with regard to age, gender and duration of disease was also carried out. This study will help to start early medication and may help us to minimize the number of surgeries for OME i.e. myringotomy. Conclusion: In conclusion, OME was frequent in the age group 6-12 years. OME in children aged 2-12 years can be diagnosed using tympanometry more accurately. However, clinical findings and other supportive audiological tests are necessary for the ultimate decision regarding the treatment of such children as chances of false positive results exist. Keywords: Middle Ear ventilation; Tympanometry; Otitis Media With Effusion

Cholesteatoma in chronic otitis media secondary to pars tensa perforation

Background Acquired cholesteatoma secondary to pars tensa perforation was rare in clinic. Objectives In this study, we explored factors related to acquired cholesteatoma in chronic otitis media patients with pars tensa perforation. Material and Methods 262 adults (296 ears) with pars tensa perforation were divided into four groups: anterior perforation group, posterior perforation group, central perforation group, and marginal perforation group. Analysis was carried out in terms of cholesteatoma formation, adhesion of perforation edges, mastoid pneumatization, and the function of eustachian tube. Results Cholesteatoma was found in 34% (18 in 53 ears) in posterior perforation group, 14.3% (14 in 98 ears) in marginal perforation group, and 2.5% (2 in 80 ears) in anterior perforation group. For subjects with adhesion in perforation edges, cholesteatoma was approved in 94% of posterior perforation, 42% of marginal perforation and 25% of anterior perforation groups. The adhesion in perforation edges and function of eustachian tube instead of mastoid pneumatization were statistically significant for cholesteatoma formation. Conclusions and Significance Acquired cholesteatoma was mostly found in patients with posterior and marginal perforation, followed by anterior perforation. Adhesion of perforation edges was another risk factor for cholesteatoma formation. Eustachian tube also functioned by influencing the ventilation of middle ear.

Unilateral hearing loss: case report on the insidious consequence of nasopharyngeal tuberculosis

BackgroundNasopharyngeal tuberculosis constitutes 1% of the head and neck manifestation of extra-pulmonary tuberculosis. The rarity of the disease along with its non-specific presentation may pose a challenge in diagnosis.Case presentationWe present a case of a 33-year-old patient who presented with a gradual onset of unilateral hearing loss. Endoscopic examination revealed leukoplakic lesions over the bilateral torus tubarius with audiological assessment revealing a mixed hearing loss in the left ear. Patient completed a 6-month course of anti-tuberculous therapy with a complete resolution of nasopharyngeal lesions and hearing loss.ConclusionWe hypothesize that tuberculosis of the nasopharynx may not only lead to impaired middle ear ventilation but also damage to the ossicular chain and inner ear structures.

Cleft lip and palate : One of the most frequent congenital malformations

With afrequency of1 per 500 live births, a cleft lip and palate is one of the most frequent congenital malformations. Untreated, it leads to disturbances in feeding, speech, hearing, tooth position and esthetics. Amultifactorial genesis is assumed. The fusion of the different facial processes takes place in the first 3 months of pregnancy and acleft can develop during this time. Surgical treatment includes the early anatomical and functional restoration of the affected structures within the first year of life in order to enable normal intake of food, articulation, nasal breathing and middle ear ventilation. Breastfeeding is possible in children with acleft formation but alternative feeding methods, such as finger feeding, often have to be used. In addition to the surgery for primary closure of the cleft, otorhinolaryngological (ENT) interventions, speech therapy, orthodontic treatment as well as other surgical interventions are part of the interdisciplinary treatment concept.

EUSTACHIAN TUBE DYSFUNCTION FOLLOWING ANTERIOR NASAL PACKING

Background: Eustachian tube maintains middle ear pressure equal to that of atmosphere and helps in ventilation of middle ear. Its function may be deranged due to adenoids, cleft palate, nasogastric tubes, allergy and by nasal packing. Objectives:To evaluate the effect of anterior nasal packing on Eustachian tube function. Methods: A cross-sectional study including 50 patients with deviated nasal septum with or without external nasal deformity and nasal polyposis. Tympanometry was performed prior to surgery, second post-operative day before pack removal and on seventh post-operative day ve days after pack removal. Results: Out of 50 patients (100 ears) who had anterior nasal packing after nasal surgeries, 40 ears had abnormal middle ear pressure after 48 hours of anterior nasal packing just before the pack removal. Middle ear pressure 5 days after the pack removal was found abnormal in 4 ears. Conclusion: This study shows that anterior nasal packing result in Eustachian tube dysfunction and negative middle ear pressure which is reversible in nature.

Middle ear effusion, ventilation tubes and neurological development in childhood.

Otitis media with middle ear effusion (MEE) can be treated with ventilation tubes (VT) insertion, and it has been speculated that prolonged MEE in childhood can affect neurological development, which in turn may be important for later academic achievements. To investigate the association between middle ear effusion (MEE), treatment with ventilation tubes (VT) and childhood neurological development. We examined 663 children from the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) unselected mother-child cohort study. Children were followed by study pediatricians with regular visits from pregnancy until 3 years of age. MEE was diagnosed using tympanometry at age 1, 2 and 3 years. Information regarding VT from age 0-3 years was obtained from national registries. We assessed age at achievement of gross motor milestones from birth, language scores at 1 and 2 years, cognitive score at 2.5 years and general development score at age 3 years using standardized quantitative tests. Children with MEE had a lower 1-year word production vs. children with no disease: (median 2, IQR [0-6] vs. 4, IQR [1-7]; p = 0.017), and a lower 1-year word comprehension (median 36; IQR [21-63] vs. 47, IQR [27-84]; p = 0.03). Children with VT had a lower 2-5-year cognitive score vs. children with no disease; estimate -2.34; 95% CI [-4.56;-0.12]; p = 0.039. No differences were found between children with vs. without middle ear disease regarding age at achievement of gross motor milestones, word production at 2 years or the general developmental score at 3 years. Our study supports the previous findings of an association between MEE and concurrent early language development, but not later neurological endpoints up to the age of 3. As VT can be a treatment of those with symptoms of delayed development, we cannot conclude whether treatment with VT had positive or negative effects on neurodevelopment.

Middle Ear Function Changes due to the Combined Effect of Pressure along with Fluid in Middle Ear Pressure Regulation- A Review

The pressure changes in Middle Ear (ME) are due to the effect of both fluid and pressure, which can be detected by tympanometry. In this review article, the mathematical and formal model of regulation of ME pressure is discussed. The air pressure in the ME chamber and the surrounding environment are the same. The auditory tube is a common connection between the ME chamber and the nasopharynx. The main functional role of the auditory tube is the ventilation of ME. When a person breathes air through an auditory tube, it enters into the ME and ventilates it. The ossicles in the ME collect sound from the tympanic membrane and transfer it to the inner ear, which requires proper ventilation of the ME. The auditory tube maintains ME pressure, the same as the external auditory canal and outside pressure. If an auditory tube is blocked, it leads to failure to ventilate ME, leading to changes in ME pressure. Swallowing and yawning allow the passive opening of the auditory tube and thus results in air flow out of the chamber. Easy and passive air exchange is allowed from the ME to the pharynx if, the pressure in the ME is higher than in the surrounding environment. ME pressure is highly variable and can change in many conditions. ME pressures increase when the body rotates from a vertical to a horizontal position because it increases the effusion of the ME mucosa due to an increase in hydrostatic pressure, which leads to an increase in the perfusion rate. Therefore, pressure increases in the case of sleeping and drowsiness. Regulation of ME pressure is a physiological process in which pressure between ME and the surrounding environment is maintained at equilibrium. The mechanism of pressure regulation is possible because of the complex sensory neural reflex pathway. A laser doppler vibrometer measures displacement of the tympanic membrane in response to sound and ME compliance is calculated by tympanometry. The movement of the tympanic membrane reduces due to the combined effect of fluid and pressure on the ME. The ME functions are altered due to the negative pressure of the fluid rather than the positive pressure.

Experience in the management of sigmoid sinus thrombophlebitis secondary to middle ear cholesteatoma

ObjectiveTo discuss the management of sigmoid sinus thrombophlebitis secondary to middle ear cholesteatoma.MethodsWe retrospectively analyzed all cases of sigmoid sinus thrombophlebitis caused by middle ear cholesteatoma over a period of 7 years. 7 male and 2 female patients, ranging in age from 9 to 66 years, were diagnosed with sigmoid sinus thrombophlebitis by clinical presentation and radiological examination. By executing a modified mastoidectomy and tympanoplasty (canal wall-down tympanoplasty) to entirely remove the cholesteatoma-like mastoid epithelium, all patients were effectively treated surgically without opening the sigmoid sinus. All patients were treated with broad-spectrum antibiotics, but no anticoagulants were used.Results9 patients had otogenic symptoms such as ear pus, tympanic membrane perforation, and hearing loss. In the initial stage of the surgery, modified mastoidectomy and tympanoplasty were performed on 8 of the 9 patients. 1 patient with a brain abscess underwent puncturing (drainage of the abscess) to relieve cranial pressure, and 4 months later, a modified mastoidectomy and tympanoplasty were carried out. Following surgery and medication, the clinical symptoms of every patient improved. After the follow-up of 6 months to 7 years, 3 patients were re-examined for MRV and showed partial sigmoid sinus recovery with recanalization. 4 months following middle ear surgery, the extent of a patient's brain abscess lesions was significantly reduced. 1 patient experienced facial paralysis after surgery and recovered in 3 months. None of the patients had a secondary illness, an infection, or an abscess in a distant organ.ConclusionThe key to a better prognosis is an adequate course of perioperative antibiotic medication coupled with surgical treatment. A stable sigmoid sinus thrombus can remain for a long time after middle ear lesions have been removed, and it is less likely to cause infection and abscesses in the distant organs. The restoration of middle ear ventilation is facilitated by tympanoplasty. It is important to work more closely with multidisciplinary teams such as neurology and neurosurgery when deciding whether to perform lateral sinusotomies to remove thrombus or whether to administer anticoagulation.Graphical abstract

Eustachian Tube Dysfunction in Children with Adenoid Hypertrophy: The Effect of Intranasal Azelastine-Fluticasone Spray Treatment on Middle Ear Ventilation and Adenoid Tissue.

Eustachian tube dysfunction (ETD) is frequent in children with adenoid hypertrophy (AH). Although the most common treatment of AH is surgical removal of adenoid tissue, numerous studies have reported the efficacy of intranasal steroids. The effects of the intranasal steroid and azelastine combination on AH and ETD have not been reported before. In this study, we tried to determine the effects of 3-month intranasal Azelastine-Fluticasone dipropionate combination (Aze-Flu) treatment in children with ETD and AH. 100 children who had open mouth sleep, snoring, and sleep apnea and were diagnosed with AH and ETD participated in this study. The mean age was 7.73 ± 2.37 (4-14 years). The rates of adenoid tissue hypertrophy and choanal occlusion were evaluated using a rigid pediatric nasal endoscope and reassessed after 3 months of Aze-Flu nasal spray treatment. The function of the Eustachian tube (ET) was evaluated before and after medical treatment using the Eustachian tube score, the Eustachian dysfunction test-7 (ETS-7) and tubomanometry (TMM). The results were evaluated in 100 patients with AH and ETD. The adenoid tissue to choana rate was 82% before treatment and decreased to 37% after treatment. The ETS-7 test score was 6.36 before treatment and increased to 9.72 at the end of 3 months. Both the regression of the adenoid tissue and the improvement in the Eustachian function scores were statistically significant (p < 0.05). AH significantly increases the frequency of ETD. In this study, it was observed that Aze-Flu treatment was significantly effective in both regression of the adenoid tissue and Eustachian tube dysfunction. We believe that it can be applied as an initial therapy in children with AH and associated ETD.

Comments on the term "drainage"

Use of the term "drainage" is inconsistent in clinical practice and the existing literature. The aim of this study was to clarify the meaning of the term and to raise awareness of its proper use. A selective literature search was performed. Drainage is the process of removing fluid but the term is often used interchangeably with the drain tube, which is often inserted at the same time, which is linguistically referred to as ametonymy. Atympanostomy tube is used for middle ear ventilation and pressure equalization. Lymphatic and abscess drainage are not objects. Standardized technical terminology serves to prevent vagueness and consecutive misunderstandings in ascientific context. This is particularly important in medicine, but is subject to acertain variability in everyday language use.

Long-Term Hearing Stability at Different Frequencies after Lower Intact Bridge Tympanomastoidectomy and Possible Theoretical Basis.

Objective: We aimed to review the long-term hearing outcomes of intact bridge tympanomastoidectomy (IBM) to discuss hearing preservation and combine the theory of "modified miniature lung," middle ear ventilation, and gas pressure balance theory to explore the possible reasons for long-term stable hearing. Study Design: We designed a collection of patients with chronic suppurative otitis media (CSOM) who underwent IBM and divided them into 2 groups to compare long-term and short-term hearing level. Setting: From April 2007 to July 2017, 102 patients received IBM for CSOM treatment in Eye & ENT Hospital of Fudan University. Methods: We divided the patients into 2 groups according to whether the follow-up period was longer than 6months. We used the numerical value of the air-bone gap difference as an index to evaluate the degree of hearing recovery. Results: We found that 99/102 (97.1%) of the hearings were improved to more than 3 frequencies. There was no significant difference between long-term hearing level and short-term hearing level, which means IBM could get long-term hearing stability. Conclusion: Intact bridge tympanomastoidectomy could provide significant hearing recovery and long-term hearing stability.