Negative Middle Ear Pressure Research Articles

Smoking Pack Years and Eustachian Tube Dysfunction.

To determine the effect of smoking history on the risk of developing obstructive eustachian tube dysfunction (OETD). Cross-sectional review. National database. Data from the National Health and Nutrition Examination Survey (1999 to present) was analyzed. OETD was defined as middle ear pressure less than -100 decapascals (daPa). Nonsmokers, current smokers, with tympanometry data were analyzed. Patients under the age of 18, with myringotomy tubes, or with a sinus problem/earache/cold in the past 24hours were excluded. The relative risks (RRs) for developing OETD were calculated for nonsmokers versus smokers and those with greater versus less than 10, 20, and 30 pack years (py). A total of 9472 patients met inclusion criteria (54.1% female, 75.9% non-Hispanic, mean age 43, 20.3% smokers). The RR of having OETD for smokers versus nonsmokers was 1.75 [95% confidence interval, CI: 1.45-2.11]. The RR of having OETD for patients with a 10+ py was 1.97 [95% CI 1.57-2.47], 20+ py was 2.29 [95% CI 1.76-2.95], and 30 py or greater was 2.08 [95% CI 1.49-2.90]. In this study, smoking roughly doubled the risk of developing OETD, as represented by a single measurement of negative middle ear pressure less than -100 daPa. The definition of OETD used in this study was limited, as it did not include symptomology, and more work is needed to examine additional covariates. However, these results may guide future research to better counsel and screen patients for OETD.

NLRP3 Inflammasome Activation During Acute Negative Pressure Injury in the Middle Ear of Mice.

The present study was conducted to explore the role of the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome in mouse otic barotrauma models. Previous studies suggest that the NLRP3 inflammasome plays an important role in the pathogenesis of middle ear disease. However, whether middle ear negative pressure injury underlies NLRP3 inflammasome activation remains unclear. Wild-type and Nlrp3 -/- mice were randomly assigned to control and pressure injury groups, respectively. Pressure loading was performed using a pressure cabin with the pressure level set to 20 kPa higher than that of the ambient atmosphere. This was achieved in approximately 15 seconds and maintained for 10 minutes. Hematoxylin and eosin staining was performed to detect morphological changes of the middle ear mucosa, tissue IL-1β was measured via an enzyme-linked immunosorbent assay, and cleaved caspase-1 was detected by Western blot. We found that the maturation of caspase-1 and IL-1β production in the middle ear significantly increased after otic barotrauma. In Nlrp3 -/- mice, inflammasome activation is downregulated and mucosal hyperplasia is reduced compared with those of wild-type mice during recovery. The NLRP3 inflammasome likely plays an important role in the pathogenesis of otic barotrauma. Controlling activation of the NLRP3 inflammasome may promote middle ear recovery after negative pressure injury.

Evaluation of Hearing Status in Various Type of Cerebral Palsy Children in a Tertiary Hospital

Background: Cerebral palsy (CP) in children are frequently associated with sensorineural pathology.
 Objectives: To assess the severity of hearing impairment in children with CP and correlate the auditory impairment with different types of CP.
 Materials & Methods: This cross-sectional study was conducted in the Department of Pediatric neurology and Autolaryngiology- Head and Neck Surgery BSMMU, during March to September 2011. Diagnosed CP patients were included consecutively. After taking informed written consent, proper history and clinical examinations was done and severity of hearing loss was assessed.
 Results: Among the 50 children with CP, Tympanometry result revealed that negative middle ear pressure was present in 32% in spastic quadriplegia(SQ), 24% in spastic hemiplegia (SH), 16% in spastic diplegia (SD) and 24% in mixed type. Eustachian tube dysfunction was present in 62.5% in spastic hemiplegia. In TOAE result 52% were pass and 48% were referred and ABR were suggested. On the basis of result of TOAE, those were referred, initially they were encountered as hearing impairment in this study. Among them, in SQ were 18%, SH were 12% and mixed. Follow up auditory brain stem response revealed mild, moderate and severe sensorineural hearing loss were 8% in spastic quadriplegic type and the spastic diplegia and athetoid group were 2% only mild, Moderate sensorineural hearing were 2% in spastic hemiplegia group.
 Conclusion: Spastic Quadriplegic cerebral palsy patients had the maximum incidence of hearing impairment. Perinatal asphyxia and prematurity were the main risk factor of hearing impairment.
 BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 19-22

Correlation between chronic suppurative otitis media and deviated nasal septum of the ipsilateral side

Background: Chronic suppurative otitis media (CSOM) is a long standing infection of middle ear with permanent defect in tympanic membrane with or without ear discharge, frequently have an underlying nasal pathology, which can worsen the middle ear disease secondary to Eustachian tube dysfunction, leading to negative middle ear pressure, tympanic membrane retraction, chronic otitis media with effusion and/or cholesteatoma. Present study was conducted to study the correlation of a etiopathogenesis, bacteriology of CSOM with the deviation of the nasal septum (DNS) of the ipsilateral side. Methods: Study was conducted in ENT department, AJ institute of medical science, Mangalore, Karnataka. Study group included 120 patients having CSOM, selected randomly from outpatient department (Time bound cross-sectional study). Predesigned proforma was used. Detailed history taken, followed by a thorough ENT examination. Relevant investigations were performed. Results: In this study, the prevalence of nasal disease (DNS) in patients with CSOM was 73.33%. Out of 120 CSOM patients, 88 patients had co-existent nasal disease (DNS). Among the 88 cases; 71 (59.2%) patients showed direct correlation with CSOM. Culture swabs showed similar bacterial isolates in aural and nasal swabs indicating, there may be retrograde spread of pathogens from nasopharynx to middle ear via Eustachian tube. Conclusions: A significant correlation was established between CSOM and DNS of the ipsilateral side. DNS played a key role in persistence of CSOM. A conscientious evaluation of nose and paranasal sinuses diseases is essential and we thus endorse management of nasal disease prior to the surgical treatment of ear disease, for meritful postoperative results.

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.

Wideband Acoustic Immittance in Children.

As wideband absorbance (WBA) gains popularity, it is essential to understand the impact of different middle ear pathologies on the absorbance patterns as a function of frequency in children with various middle ear pathologies. More recently, the use of wideband tympanometry has enabled clinicians to conduct WBA at ambient pressure (WBA amb ) as well as the pressurized mode (WBA TPP ). This article reviews evidence for the ability of WBA measurements to accurately characterize the normal middle ear function across a wide range of frequencies and to aid in differential diagnosis of common middle ear disorders in children. Absorbance results in cases of otitis media with effusion, negative middle ear pressure, Eustachian tube malfunction, middle ear tumors, and pressure equalization tubes will be compared to age-appropriate normative data. Where applicable, WBA amb as well as WBA TPP will be reviewed in these conditions. The main objectives of this article are to identify, assess, and interpret WBA amb and WBA TPP outcomes from various middle ear conditions in children between the ages of 3 and 12 years.

A COMPARATIVE STUDY OF MICROSCOPIC TYMPANOPLASTY VERSUS ENDOSCOPIC TYMPANOPLASTY IN MANAGEMENT OF INACTIVE MUCOSAL VARIETY OF CHRONIC OTITIS MEDIA

Chronic Otitis Media (COM) is defined as the chronic inflammation of the middle ear cleft including the middle ear, mastoid air cell system and the eustachian tube in presence of a permanent abnormality of the pars tensa or flaccida, most likely as a result of earlier acute otitis media, negative middle ear pressure or otitis media with effusion. As COM is not necessarily a result of the gathering of pus, the classic term chronic suppurative otitis media (CSOM) is no longer advocated.

Predictive Value of Adenoid-Nasopharyngeal Ratio in the Diagnosis of Secretory Otitis Media.

To explore the associated factors of otitis media with effusion (OME) and analyze the diagnostic value of the adenoid-nasopharyngeal (A/N) ratio to OME. Patients with adenoid hypertrophy (AH) recently in 2years were collected, including sex, age, duration, with/without rhinosinusitis, and examination results, including Cone Beam Computerized Tomography (CBCT) sinus imaging, tympanometry, pure tone audiometry (PTA), blood test, and allergen detection. According to Liden/Jerger's classification, the patients were divided into two groups: Type B and type C, which were defined as the tympanometry abnormal group (TAG), and the rest were classified as the tympanometry normal group (TNG). A total of 316 children were included in this study. Age and duration were significantly younger and shorter in TAG (6.0(4.0-9.0) vs.5.0(4.0-7.0)); 12.0(4.0-24.0) vs.6.0(2.0-12.0)). Compared to TNG, the allergen test results of fx5 (protein, milk, cod, wheat, peanut, and soybean) in TAG were higher (0.09(0.04-0.25) vs.0.14(0.05-0.45)), but eosinophilia in blood was lower (count: 0.21(0.13-0.35) vs. 0.18(0.12-0.27); ratio: 3.10 (1.90-4.70) vs. 2.50 (1.65-3.80)). A/N ratio and Visual obstruction ratio had a statistical difference (Z = -3.770, P < .01) but the two ratios didn't have too much disparity (0.82(0.74-0.88) VS 0.80(0.75-0.80)), and they had a positive correlation (r = 0.345, P < .01). A/N ratio of TAG was higher than TNG (0.78(0.70-0.85) vs. 0.86(0.82-0.90)) and had a positive correlation with increasing negative middle ear pressure (r = -3.777, P < .01). A/N ratio was an associated factor of OME (OR:1355.611, P = .006), the cut-off value of A/N ratio was 0.815(sensitivity: 75.3%, specificity: 64.3%, area under the curve (AUC): 0.747). A/N ratio indirectly reflected the abnormality of tympanometry in this study. When A/N ratio reaches 0.815, patients are at a higher risk of having OME so it could be a predictor of OME in patients with adenoid hypertrophy.

Allergic rhinitis: An indicator of otitis media with effusion in children seen at aminu kano teaching hospital, Kano.

Allergic rhinitis (AR) is a multifocal IgE-mediated type I hypersensitivity reaction involving nasal mucosa characterized by excessive sneezing, watery rhinorrhea, nasal itching, nasal stuffiness, and eyes itching. Tympanometry is a simple, rapid, and objective test that can be easily carried out. The use of tympanometry in clinical setting can improve detection of middle ear effusion and other middle ear abnormalities. AR has been found to be one of the predisposing factors to developing Otitis Media with Effusion (OME) in children. A case-control study was used to determine the prevalence of OME among children with AR as cases and those without allergy as controls. The study participants were children aged 4-12 years with clinical diagnosis of AR attending ENT clinics of Aminu Kano Teaching Hospital, whereas controls were children age 4-12 years without history of AR, ear diseases, or other respiratory system related ailments attending general outpatient clinics in Aminu Kano Teaching Hospital. An interviewer-administered score for AR (SFAR) questionnaire was filled out for all the participants, those with score of 6 and above were selected as cases. The two groups had complete ENT examination and tympanometry done, findings were recorded, and analyzed using SPSS version 21. The mean age of the cases was 6.8 ± 2.1 years, whereas it was 7.5 ± 2.6 years for the controls. The mean difference was 0.7 and was not statistically significant (t = 2.35, df = 258, P value = 0.20). Type B tympanogram suggesting OME was found in 7.3% of subjects and in 2.8% of controls. Type C tympanogram suggesting negative middle ear pressure was found in 15.5% of subjects and in 4.6% of controls. Type A tympanogram suggesting normal middle ear pressure was found in 75% of subjects and in 90% of controls. Acoustic reflex was found to be absent in 29.6% of subjects and in 15.4% of controls and this found to be statistically significant (χ2 = 7.77, df = 1, P value = 0.001). The difference between type A, B, and C tympanograms of subjects and that of controls was found to be statistically significant (Type A χ2 = 14.62, df = 4, P value = 0.01, Type B χ2 = 14.06, df = 4, P value = 0.01, Type C χ2 = 17.01, df = 6, P value = 0.01). Type B tympanogram was used as an indicator to suggest OME for the purpose of this study. Participants with AR were found to have more abnormalities of tympanometric parameters and higher prevalence of type B tympanogram suggesting OME than controls.

Vibration Measurements of the Gerbil Eardrum Under Quasi-static Pressure Sweeps.

Tympanometry provides an objective measurement of the status of the middle ear. During tympanometry, the ear-canal pressure is varied, while the response of the ear to sound pressure is measured. The effects of the pressure on the mechanics of the middle ear are not well understood. This study is a continuation of our previous work in which the vibration response of the gerbil eardrum was measured in vivo under quasi-static pressure steps. In this study, we delivered a continuous pressure sweep to the middle ear and measured the vibration response at four locations for six gerbils. Vibrations were recorded using a single-point laser Doppler vibrometer and glass-coated reflective beads (diameter ~ 40µm) at the umbo and on the mid-manubrium, posterior pars tensa and anterior pars tensa.The vibration magnitudes were similar to those in the previous step-wise pressurization experiments. Most gerbils showed repeatability within less than 10dB for consecutive cycles. As described in the previous study, as the frequency was increased at ambient pressure, the vibration magnitude on the manubrium increased slightly to a broad peak (referred to as R1) and then decreased until a small peak appeared (referred to as R2), followed by multiple peaks and troughs as the magnitude decreased further. The low-frequency vibration magnitude (at 1kHz) decreased monotonically as the pressure became more negative except for a dip (about 500Pa wide) that occurred between - 700 and - 1800Pa. The lowest overall magnitude was recorded in the dip at mid-manubrium. The vibration magnitudes also decreased as the middle-ear pressure was made more positive and were larger than those at negative pressures. R1 was only visible at negative and small positive middle-ear pressures, while R2 was visible for both positive and negative pressures. R2 split into multiple branches after the middle-ear pressure became slightly positive. No magnitude dip was visible for positive middle-ear pressures.The low-frequency vibration magnitudes at negative middle-ear pressures on the pars tensa were higher than those on the manubrium. R1 was not visible for large negative middle-ear pressures on the pars tensa. R2 appeared as a multi-peak feature on the pars tensa as well, and a higher-frequency branch on the posterior pars tensa appeared as a trough on the anterior pars tensa. The magnitude dip was not present on the pars tensa. The largest overall magnitude was recorded at the R2 peak on the posterior pars tensa.The results of this study expand on the findings of the step-wise pressurization experiments and provide further insight into the evolution of the vibration response of the eardrum under quasi-static pressures.

Wideband Tympanometry in Adults with Severe to Profound Hearing Loss with and without Cochlear Implants

Objectives—Cochlear implantation has been suggested to be associated with an air-bone gap, possibly secondary to increased middle- and inner-ear stiffness. To explore the effect of possible changes in mechanics due to cochlear implantation, we measured wideband tympanometry (WBT) in individuals with normal hearing and individuals with severe to profound sensorineural hearing loss who underwent unilateral or bilateral cochlear implantation. Our goal was to characterize differences in WBT patterns associated with severe to profound sensorineural hearing loss and with cochlear implantation. Design—The study participants were 24 individuals with normal hearing (48 ears) and 17 with cochlear implants, of which 15 were unilaterally implanted and two were implanted bilaterally. All the participants had normal otoscopy. In the implanted group, inner-ear anatomy was normal according to preoperative imaging. All participants underwent pure-tone audiometric assessment, standard tympanometry (226 Hz probe tone), and WBT to a click stimulus (analyzed from 226 to 8000 Hz). WBT was recorded at ambient and peak pressures. To elucidate the effect of sensorineural hearing loss on WBT, we compared normal-hearing ears with impaired non-implanted ears. The impact of cochlear implantation was assessed by comparing the WBT of the implanted and non-implanted ears of the same participants. Moreover, the effect of the ear (right vs. left) and test–retest reproducibility were evaluated. Results—WBT results for right and left ears showed no statistically significant differences in the normal hearing participants. There were no statistical differences shown between repeated measurements of WBT with removal and re-insertion of the probe in any of the groups—the normal ears, the implanted ears, and the non-implanted ears with hearing impairment. Peak compensated admittance (Ytm) in standard tympanometry was normal in 32 out of 34 (94%) ears with sensorineural hearing loss, with one CI user having bilateral negative middle-ear pressure. Compared to normal-hearing ears, ears with severe to profound SNHL, with or without cochlear implantation, showed a significant decrease in absorbance at high frequencies (4000–5000 Hz). Implanted ears, compared both to normal-hearing and contralateral-non-implanted ears, showed a significant decrease in absorbance at low frequencies (400–800 Hz) and an increase in absorbance around 1600 Hz. Conclusions—WBT analysis revealed that the implanted ears showed a significant decrease in absorbance at low frequencies (400–800 Hz) and an increase at 1600 Hz. This finding is likely a result of an increased stiffness due to the implantation surgery and the presence of the implant in the inner ear. In contrast, the specific decrease in absorbance around 4000–5000 Hz in the implanted and non-implanted ears compared to the normal ears is likely either due to aging or the impact of the severe-to-profound SNHL on the input impedance of the cochlea. The structural and functional changes of both the conductive system and the cochlea associated with aging and SNHL may change the wideband acoustic immittance of the ear and these alterations might be correlated with the hearing loss severity. Additional research is needed to determine how much hearing loss and age influence wideband acoustic immittance of the ear.

Middle Ear Pressure Changes after Adenotonsillectomy and Myringotomy in Patients with Otitis Media with Effusion

Background: Otitis media with effusion(OME) is a common ear problem among children characterized by accumulation of secretion in the middle ear. The pathophysiology of OME is negative pressure due to eustachian tube dysfunction. In children adenoid enlargement is associated with enlargement of the tonsils. Surgical treatment is advocated when conservative treatment fails. Surgical treatment consists of adenotonsillectomy with myringotomy. Negative middle ear pressure is expected to improve after surgical intervention.&#x0D; Objectives: To see the pressure changes after surgical treatment of OME.&#x0D; Methods: Among 68 subjects with OME, 88 ears were operated. Adenotonsillectomy was done in all subjects. In addition myringotomy was done in 65 ears and myringotomy with grommet insertion was done in 23 ears. In post-operative period all patient were followed up at end of 1 month, 3 month and 6 month with tympanometry.&#x0D; Results: Pre operatively type B tympanogram was 67(76.13%) whereas type Atympanogram was 0(0%). At end of 6 month type A curve was 49(61.27%) and type B tympanogram was 9(11.25%) that indicates improvement of middle ear function after operation.&#x0D; Conclusion: Tympanometric improvement was significant after 6 month of surgery.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 22-28

Pneumatization Pattern and Status of the Mastoid Antrum in Chronic Otitis Media: A Review.

Chronic otitis media is generally more prevalent in individuals with a weakly pneumatized temporal bone, whereas acute otitis media has a propensity for pneumatized temporal bone. Antimicrobial drugs are thought to have influenced the incidence and progression of middle ear infections. The mastoid air cell system, a part of the middle ear cleft, has recently been recognized as a crucial factor in the genesis, behaviour, course, and outcome of middle ear inflammatory conditions. Epithelium infiltrates the growing bone and produces epithelium-lined air cell chambers, a process known as pneumatization.Conventional temporal bone radiography, i.e. X-ray mastoid, has not kept up with recent otology breakthroughs. Detailed visualization of the aural structures has advanced significantly with the introduction of high-resolution computed tomography (HRCT). HRCT has a clear edge in the assessment of the temporal bone, especially when thin-section, high-resolution methods are used, resulting in a more precise description of the pneumatization pattern and the anatomical extent of middle ear pathology.Our results of the review indicated that persistent inflammation of the middle ear in children inhibits pneumatization of the temporal bone. Due to its potential to exert a greater negative middle ear pressure, the middle ear volume is insufficient to generate a retraction pocket; thus, the size and state of the antrum is also a significant factor in the establishment of a COM-like retraction pocket in inactive squamosal disease. Numerous factors, including the number of patients, regional, genetic, ethnic and hereditary characteristics, as well as the cellularity of the mastoid, which is impacted by a multitude of factors, may account for the variable reports and inter-study variation in this regard.

Frequency and Severity of Auditory Impairment in Children with Cerebral Palsy in a Selected Tertiary Health Care Centre

Cerebral palsy is the most common chronic motor disorder in children and frequently associated with sensorineural pathology. Deafness is very important public health concern. Because it determines long-term life span disability in individuals, decrease their quality of life. To observe the rate of occurrence of hearing impairment in children with cerebral palsy (CP) and to assess the severity of hearing impairment children with CP and correlate the auditory impairment with different types of CP were aim of the study. Total 50 children with Cerebral Palsy were taken. A structured questionnaire was filled up including history of patient and important variables related to hearing status like family history of deafness, consanguinity, antenatal history, preterm LBW, perinatal asphyxia, kernicterus, neonatal septicemia, neonatal seizure and meningitis were included in study. Physical examination and neurological examination like hearing, vision, motor, cognitive, speech delay were assessed. In this study, among the 50 children with CP, Tympanometry showed that negative middle ear pressure was 32% in spastic quadriplegia (SQ), 24% in spastic hemiplegia (SH), 16% in spastic diplegia (SD) and 24% in mixed type. Eustachian tube dysfunction was 62.5% in spastic hemiplegia. Secretory otitis media was 36.4% in spastic quadriplegia. Auditory brain stem response revealed severe sensorineural hearing loss was 8% in spastic quadriplegic type. Moderate sensorineural hearing loss was 2% in spastic hemiplegia group. Hearing loss was frequent in children with Cerebral Palsy. Spastic Quadriplegic cerebral palsy patients had the maximum incidence of hearing impairment.

Prevalence of middle ear effusion (MEE) and other middle ear problems among apparently healthy children in some selected primary schools in Kano Metropolis, Nigeria

Middle ear effusion (MEE) is the commonest ear problem affecting children less than 6 years and is a threat to deafness which is common in our environment. Tympanometry is used to determine MEE and other problems of the middle ear. This study was aimed at determining the prevalence of middle ear effusion and other middle ear problems among apparently healthy school children in some selected schools in Kano Metropolis. The study was in four primary schools located in Kano metropolis where socio-demographic characteristics of the participants (whose parents consented) were recorded, and pneumatic tympanometry was conducted. The participants were 150 school children (78 males and 72 females) aged 4-12 years and were selected using stratified sampling technique, with mean age of 9.8 ± 2.2 years. Results showed that Cronbach’s alpha was &gt; 85% for both intra and inter-observer error estimate. In all the measured parameters, significant sexual dimorphism was only found in the right ear cavity volume (Rt ECV) with males having higher values (p&lt;0.05). Majority of the pupils (82%) had normal (type A) tympanogram, 6% had flat (type B) which signifies middle ear effusion, 5.4% had type C tympanogram which signifies negative middle ear pressure and clinically eustachian tube dysfunction, 5.6% had type As (osteosclerosis of the middle ear), and 1% has Ad type (ossicular discontinuity). Age, height &amp; weight correlated significantly with one or more of the measured ear parameters of the left or right in both sexes. The prevalence of MEE among school-aged children in Kano metropolis is alarming and is a threat to deafness. Therefore, clinicians should be more suspicious and include routine ear examination for children in their practice to detect uncomplicated MEE.

Oral Submucous Fibrosis: Association of Clinical and Histological Severity with Hearing Loss and Middle Ear Function.

OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in OSMF patients by audiometry and tympanometry. Two Hundred patients of < 40years of age with OSMF were examined and followed by PTA and impedance audiometry. Impaired mobility was seen in 20(10%) ears, and retraction of tympanic membrane was found in 36(18%) ears. Clinical staging was done in four stages. Majority of the patients were males (58%) in the age group of 21-30years belonging to stage III (38%) and IV (26%) respectively. PTA showed varying degrees of hearing loss in 73 (36.5%) ears. In Grade I, mild hearing loss was seen in 10 (35.71%) ears and moderately severe hearing loss was in 5 (11.36%) ears whereas in Grade II mild hearing loss in 11(25%) ears. Grade III and IV showed mild hearing loss in 11(14.47%) and 12 (23.07%) respectively. Tympanometry revealed type A curve in 126 (63%) ears followed by C curve in 50 (25%) and B curve in 24 (12%) ears. In patients of OSMF, there is involvement of palatal/paratubal muscles in the fibrosis process, which causes eustachian tube malfunction leading to disturbed middle ear functions and negative middle ear pressure. Most patients of oral submucous fibrosis showed direct association with grade of hearing impairment and eustachian tube dysfunction. Higher clinical grades, both clinically and histologically showed similar findings thereby we concluded that if the disease is treated early, preventing patients from having higher grades of disease, involvement of ear can be avoided, and patients can be saved from hearing impairment.

A STUDY ON OSSICULOPLASTY

The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or acida, most likely a result of earlier acute otitis media, negative middle ear pressure or otitis media with 1 2 effusion . Ossiculoplasty is a micro surgical operative procedure, performed to repair or reconstruct the ossicular chain . Present study was done to nd out the epidemiology and hearing result after ossiculoplasty. Materials and methods Study design –Retrospective study Study setting – Tertiary care hospitals in south India. Study period - Over a period of 3 years (from July 2017 to June 2020) Sample size – 55 Methodology - All the patient with COM and ossicular chain damage were considered for study. Data was collected from the medical record department and analyzed. Results - Study was to be done to nd out the natural behavior of the disease, COM with ossicular damage and how it can be managed effectively. In our study of 55 cases of ossiculoplasty, followings are nding1. 52.72% are male and 47.27% are female. And the male to female ratio is 1.11:1. 2. Mean age of the patient is 27.63. 3. Most common ossicle involved was incus. 4. Mean improvement in ABG is 15.49 and in 87.2% of patients ABG closure was with in 20dB.

In vivo study measuring middle ear pressure during various stages of Eustachian tube balloon dilation.

ObjectiveDocumentation of middle ear pressure at different stages of balloon Eustachian tuboplasty and assessing risk of barotrauma with this procedure.Main outcome measuresMiddle ear pressure measurements in patients undergoing balloon Eustachian tuboplasty at the time of pre‐insertion, catheter insertion, inflation, one minute post inflation, deflation, and catheter withdrawal, as well as documentation of pressure change in the middle ear between different stages.ResultsA total of 24 patients and 45 Eustachian tubes, 11 females and 13 males, with an average age of 55.6 years were included in this study. Middle ear pressure values during the active stages of the procedure varied from −356 to +159 daPa. The overall greatest negative pressure change measured was −515 daPa from catheter insertion to immediately post balloon inflation. The overall greatest positive pressure change measured was +418 daPa from immediate catheter inflation to one minute post inflation.ConclusionsThere was no consistent pattern of middle ear pressure change noted during the different stages of balloon Eustachian tuboplasty as both positive and negative middle ear pressure changes were noted at the time of balloon dilation. Dangerous levels of middle ear pressure raising concern for barotrauma were not identified during the procedure.Level of evidenceLevel IV.

THE CURIOUS ‘TYPE C’ TYMPANOGRAM: CONTRACTION OF THE TENSOR TYMPANI MASQUERADES AS NEGATIVE MIDDLE EAR PRESSURE

Negative middle ear pressure presents something of a paradox. The ‘Type C’ tympanogram, in which the peak of the tympanogram occurs below zero pressure, seems to indicate that the air pressure in the middle ear is actually below atmospheric pressure – that there is a degree of suction – and yet the peak can remain persistently in place even if the subject swallows and opens their Eustachian tube. Negative middle ear pressure can even be measured when a subject has a permanently open (patulous) Eustachian tube, a situation that seems physically impossible. This paper reviews the paradox and concludes that in many cases of “negative middle ear pressure” the actual pressure inside the middle ear is in fact zero, but the tympanometric offset comes about because of the unappreciated action of the tensor tympani: when this muscle contracts, it pulls the eardrum inwards, and this inwards force is registered as negative middle ear pressure during tympanometry. That is, the force exerted by the muscle needs to be countered by a negative pressure in the ear canal in order to bring the eardrum back to its equilibrium position. This interpretation is reinforced by a number of findings in the literature, which are reviewed. A proposal for how tensor tympani effects might be separated from actual middle ear pressure offsets is made.

Effects of Enlarged Adenoids on Middle Ear Pressure and Hearing

Background: Adenoids are common childhood upper respiratory tract problem which frequently obstruct the nasopharyngeal opening with tubal occlusion causes reduction in middle ear pressure with conductive hearing loss.&#x0D; Objective: To observe middle ear pressure and level of hearing in children with enlarged adenoids.&#x0D; Methods: This cross sectional observational study conducted among 72 children of enlarged adenoids admitted or attended in Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University Dhaka.&#x0D; Results: 72 children of enlarged adenoids of age ranges between 5-12 years with male female ratio was 1.25:1. Mouth breathing (65.27%), hearing impairment (59.72%), nasal obstruction (55.55%) and snoring (56.94%) were the presenting symptoms of the patients. Majority of the patients of this study came from middle class (52.77%). Most of the patients with enlarged adenoids were grossly enlarged (51.38%). 43.05% grossly enlarged adenoids had significant hearing loss . In this series 65 ears (45.13%) had type A Tympanogram. 58 ears (40.27%) has Type B Tympanogram and 21 ears (14.58%) has Type C Tympanogram.&#x0D; Conclusion: This study revealed significant association between enlarged adenoids and conductive hearing loss of variable degree and negative middle ear pressure.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 73-80