The atelectatic ear

Direct measurements of middle ear pressure were performed in 14 children with recurrent middle ear effusion and deep retraction of the tympanic membrane. In 12 of the 22 ears studied, measurements showed that a high negative pressure in the middle ear space had been induced by sniffing. Results suggest that a combination of closing failure of the Eustachian tube and sniffing is the cause of effusion and progressive retraction of the tympanic membrane in these patients. It is further suggested that cholesteatoma, which was present in three of the patients, was also a result of sniff-induced negative pressure in the middle ear space.     

Eustachian tube function following adenoidectomy: an evaluation by sniffing

Recent investigations have demonstrated an association between sniff-induced negative middle ear pressure and otitis media with effusion. This is taken as evidence of Eustachian tube malfunction. Adenoidectomy is frequently performed as part of the surgical management for otitis media with effusion, but whether this affects Eustachian tube function is uncertain. The aim of this study was to investigate the hypothesis that if adenoidectomy improved Eustachian tube function, children who had undergone adenoidectomy would show less tendency to generate a high negative intratympanic pressure by sniffing. Eustachian tube function was studied actively in 40 children with otitis media with effusion. Twenty children, selected at random, underwent adenoidectomy and all 40 had a unilateral grommet inserted. Eighty-five percent of the children could create a negative middle ear pressure by sniffing, but there was no difference in the number of 'sniff + ve' children between the adenoidectomy and control groups (P greater than 0.5), or in the magnitude of the negative pressure induced. It is concluded that a high percentage of children with otitis media with effusion are capable of inducing a negative middle ear pressure by sniffing, but this parameter of Eustachian tube function is not affected by adenoidectomy.     

Eustachian tube malfunction and middle ear disease in new perspective

Our traditional concepts relating to the development of middle ear disease are based on the assumption that obstruction of the Eustachian tube with reduced ventilation of the middle ear space leads to the development of high negative pressure in the middle ear and, ultimately, to the development of middle ear disease. This hypothesis, which focuses on Eustachian tube opening failure, has not been verified satisfactorily. Results of recent studies indicate that another approach to the problem can lead to a better understanding of the Eustachian tube pathophysiology leading to the development of ear disease. Direct measurements of middle ear pressure in patients with manifest ear disease have revealed that high negative intratympanic pressure is generated by the voluntary act of sniffing. This type of Eustachian tube malfunction is thus characterized by Eustachian tube closing failure. The repetitive barotrauma induced by sniffing or reverse Valsalva maneuvers seems to be a basic predisposing factor in the development of recurrent middle ear effusion and chronic middle ear disease, including adhesive otitis and cholesteatoma.     

Test-retest variability of eustachian tube responses in children with persistent middle ear effusion

In our previous studies on eustachian tube function in children with middle ear effusion, we found that many ears were evacuated by the act of sniffing. When subjects were tested repeatedly, however, responses to sniffing were very variable. In order to study the spontaneous variability, a total of 51 subjects (81 ears) were retested. The results of the retest were very similar to those of the first test when all the ears were considered as a group. However, in individual ears pronounced variability was seen. In the sniff test, responses changed qualitatively in 30% of the ears, and in 27% of the ears there was a change in the ability to equalize pressure by swallowing. Thus, the results of the group were highly reproducible, while at the same time individual results were highly variable with time.     

Test-retest variability of eustachian tube responses in children with persistent middle ear effusion

Summary In our previous studies on eustachian tube function in children with middle ear effusion, we found that many ears were evacuated by the act of sniffing. When subjects were tested repeatedly, however, responses to sniffing were very variable. In order to study the spontaneous variability, a total of 51 subjects (81 ears) were retested. The results of the retest were very similar to those of the first test when all the ears were considered as a group. However, in individual ears pronounced variability was seen. In the sniff test, responses changed qualitatively in 30% of the ears, and in 27% of the ears there was a change in the ability to equalize pressure by swallowing. Thus, the results of the group were highly reproducible, while at the same time individual results were highly variable with time.     

Abnormal middle ear pressures during experimental influenza A virus infection--role of Eustachian tube function

Introduction: Experimental infection of adults with influenza A virus, rhinovirus or RSV causes abnormal ME pressure in some, but not all subjects. The hypothesis tested in this study is that the response variability is caused by constitutional differences in the functioning of the Eustachian tube. Methods: 18 adult subjects were experimentally infected with influenza A virus. On five occasions before virus exposure, middle ear pressure (by tympanometry) and Eustachian tube function (by sonotubometry) were recorded bilaterally. Tests were repeated on days 1 through 8 and 10 after infection. Individual ears were classified with respect to the number of pre-exposure, positive sonotubometric testings and the middle ear pressure response to infection was compared between ears with Eustachian tube openings at all pre-infection test sessions (GR-A) and those with at least one negative test (GR-B). Results: Pre-exposure, 19, six, four, four, one and two ears had tubal openings on five, four, three, two, one and zero sessions, respectively. For that period, GR-A had significantly lesser average intra-ear and intra-group middle ear pressure variances compared to GR-B, but there were no between-group differences in the average middle ear pressure or in the number of observations of abnormal middle ear pressure. After virus exposure, middle ear pressure variances and the number of abnormal observations increased and the average pressure decreased in both groups, but the effects were more pronounced for GR-B ears. Conclusions: These results support the hypothesis that pre-existing good Eustachian tube function reduces the otological complications of viral upper respiratory tract infection.     

Eustachian tube function varies over time in children with secretory otitis media

Impaired opening and closing functions of the Eustachian tube are considered to be pathogenic factors in secretory otitis media (SOM). As the clinical course of SOM is variable, the variability of tubal function is of interest. We aimed to explore the short- and long-term variability of tubal opening and closing functions in SOM. The study comprised 42 ears in 21 children (13 males and 8 females) with tympanostomy tubes due to SOM. The middle ear pressure was recorded during repeated passive forced openings, equalization of + 100 daPa and - 100 daPa by swallowing, Valsalva inflation and forceful sniffing. Test sessions were performed twice (separated by 30 min) on each of 2 days, with a mean interval of 3.7 months in between. In the forced opening test there was a considerable intra-individual variability over time. Expressed as SD of the mean, the variability of the forced opening and closing pressures in individual ears was on average 15% and 23%, respectively, between sessions and 20% and 30% respectively, between test days. In the equalization, Valsalva and sniff tests the rates of responses that changed from positive to negative between sessions and test days ranged from 12% to 33%. Female gender and retraction pockets were related to poorer opening function in the forced opening test. Ears with serous effusion (in contrast to mucoid) showed a similar trend and also a lower occurrence of positive equalization, Valsalva and sniff tests. It was concluded that Eustachian tube opening and closing functions are highly variable in ears with SOM. Consequently, single tubal function tests have low value when used as a prognostic tool in individual ears.     

儿童分泌性中耳炎鼓膜置管后中耳功能的综合评价

目的:探讨儿童分泌性中耳炎(SOM)鼓膜置管后中耳功能综合评价的方法和临床意义。方法:选择31例(43耳)临床诊断为SOM的患儿,分别在鼓膜置管术前及术后1个月,进行纯音听阈测试、畸变产物耳声发射(DPOAE)、鼓室导抗图(记录外耳道容积,ECV)测试;术后1个月加咽鼓管功能正负压平衡测试,并在显微镜下观察置管情况。结果:置管后1个月,39耳置管通畅者ECV>2.0ml,听力比置管前明显提高;DPOAE引出率及部分频率幅值提高,与置管前比较,差异有统计学意义(P<0.01或P<0.05);咽鼓管功能尚无完全正常。结论:应用ECV、纯音听阈测试、DPOAE以及咽鼓管功能测试对患儿鼓膜置管术后中耳功能的恢复情况进行综合评价,具有临床指导意义。     

Does the silastic eustachian tube prosthesis improve eustachian tube function?

This clinical study attempts to evaluate the effectiveness of Eustachian tube function in 30 ears, 11–29 months after insertion of the Silastic® Eustachian tube prosthesis (SETP). Indications for the SETP were limited to persistent Eustachian tube dysfunction. Preoperatively, 13 patients had intact tympanic membranes with persistent serous otitis media. Seventeen patients underwent tympanoplasty and demonstrated persistent serous otitis media in the opposite ear. Postoperatively, aeration of the middle ear was evaluated by tympanometry, microscopic examination, and myringostomy. Microphotographs demonstrate the state of the middle ear. Histology of the middle ear mucosa was obtained in a few cases. Ninety-six percent of the ears with an SETP demonstrated confirmed persistent Eustachian tube dysfunction beginning an average of six months after insertion. Complications were common.     

Effect of inflammation on the ventilatory function of the eustachian tube

In an attempt to determine the effect of an upper respiratory tract infection on the ventilatory function of the Eustachian tube, 20 children who had recurrent acute or chronic middle ear effusions were studied. Baseline Eustachian tube function testing was obtained when there were no signs or symptoms of upper respiratory infection. These tests were repeated at six-week intervals and whenever an upper respiratory tract infection supervened. The results of this study were the following:

• 1 In the absence of an upper respiratory tract infection, the Eustachian tube function tests indicated that all 20 children had a persistent function al obstruction of the Eustachian tube, which was attributed to an inefficient active tubal opening mechanism or increased tubal compliance, or both.
• 3 During periods of upper respiratory tract infection, Eustachian tube function became worse, which was attributed to intrinsic mechanical obstruction.
• 3 During the course of the study, middle ear effusion or atelectasis recurred in some of the children, which was not necessarily in association with an upper respiratory tract infection.

The basic problem in all of the children was functional obstruction of the Eustachian tube that could result in a middle ear effusion; however, in the absence of an effusion, their poor Eustachian tube function would place them at particularly high risk for developing one, especially during periods of upper respiratory infection. Since management of the functional Eustachian tube obstruction remains obscure at present, therapy should be directed toward alleviating the transient or persistent middle ear negative pressure or the intrinsic mechanical Eustachian tube obstruction when an upper respiratory infection is present     

Pressure chamber tests for selection of aircrew

The Eustachian tube function requested from flying personnel today is generally regarded as acceptable if hearing and otoscopic findings are normal and there is no history of ear disease. Since increasing performance of modern aircrafts place more rigorous demands on the equilibrating capacity of the Eustachian tube and difficulty to clear the ears already is the most common cause of temporary grounding among flying personnel, the present requirements for tubal function might gradually get more and more inefficient. Inability to equilibrate in flight may lead to temporarily reduced hearing, acute ear pain and alternobaric vertigo that will affect the pilot's capacity and thus constitute a problem of flight safety. A testing procedure that makes it possible to continuously measure the middle ear pressure in subjects with intact eardrums during simulated flights in a pressure chamber would introduce a possibility to find basic medical standards of Eustachian tube function to be used in the selection of flying personnel. Student pilots, accepted for primary flight training, were examined in the present study by such a method. A comparison is made with the results of other tests of the Eustachian tube function in order to find out the relevance of the latter tests in the selection of flying personnel. The results are presented and discussed.     

Eustachian tube function in children.

Eustachian tube function of children with bilateral serous otitis media was studied in 14 ears following myringotomy and pressure equalizing tube insertion. Cases with non-Eustachian tube pathology potentially contributing to Eustachian tube dysfunction were excluded from the study. Eustachian tube function was evaluated utilizing an impedance audiometer to document neutralization of positive and negative middle ear pressures. All cases showed persistent tubal dysfunction for up to six months. Partial incomplete neutralization of positive pressure occurred in 64 per cent, but in no case could negative pressure be partially neutralized even when "locking" was relieved with valsalva. Continuous ventilation of the middle ear for up to six months did not allow a return to normal Eustachian tube function. This is extremely effective palliation, and should be recognized as such.     

Der Einfluß der Lachgas-Inhalationsnarkose auf das Sero-Muko-Tympanon

Summary It is known that nitrose oxide anaesthesia results in an increase of the middle ear pressure. The aim of this project was to find out if such an increase of the middle ear pressure could lead to evacuation of the sero-mucoid secretion through the Eustachian tube as stated in the literature. In a group of children (60 ears) scheduled for surgery (myringotomy and, if neccessary, adenoidectomy) tympanograms were performed immediately before and during the anaesthesia, the middle ear fluid was confirmed by myringotomy and, if any, succeed out. Both the comparison of the tympanograms prior and during the anaesthesia and the results of myringotomy led to the conclusion, that in general, nitrose oxide anaesthesia induces no evacuation of middle ear fluid via the Eustachian tube. The factors preventing fluid evacuation (fluid viscosity etc.) are discussed.     

Pressure opening and closing functions of the Eustachian tube by inflation and deflation in children and adults with normal ears

Different inflationary (e.g. Valsalva's) and deflationary (e.g. sniffing) manoeuvres were studied in 58 children and 61 adults, all otologically healthy, in order to evaluate qualitatively and quantitatively the pressure opening and closing functions of the Eustachian tube. Only 71% of the normal children could voluntarily increase the middle ear pressure compared with 100% of the adults. The corresponding figures for evacuating the middle ear by deflation were 24% and 34%, respectively. The rhinopharyngeal pressure levels during the manoeuvres were age-dependent and decided the response rate in children. Tubal factors also determined the response rate since low pressure opening and closing levels were related to successful deflation. Negative middle ear pressures found in the normal children were due to poor muscular opening function of the tube rather than successful deflation. The pressure closing level seems to be a reliable tool in grading tubal closing ability.     

Left-right differences in Eustachian tube function in children with ventilation tubes

OBJECTIVE: To study the intraindividual variation in Eustachian tube (ET) function in children with ventilation tubes. METHODS: The forced response test, the pressure equilibration test and the sniff test were performed on both ears of 148 children. The results of both ears were compared. RESULTS: No systematic differences were found between the left and the right ears. However, the intraindividual variation was very pronounced. The variation in passive ET function within children was of similar magnitude as the variation in passive ET function between children. Twenty-eight percent of the children had different active ET function in both ears and 15% had an opposite result in each ear with respect to the sniff test. CONCLUSIONS: This study shows that ET function is much more a characteristic of the individual ear than of the individual child. These findings also question the validity of trials on ET function or middle ear disease that use the opposite ear as a control (split level design).     

Otitis media with effusion: treatment by autoinflammation using a balloon

Resolution of negative middle ear pressure is important in treating otitis media with effusion (OME). We treated 34 children and 21 adults with OME by autoinflammation using a nose tube and balloon in the 16 months from June 2001 to September 2002. Of these, 7 children and 5 adults had been treated for 3 years or longer, and had had grommets inserted. In 49 ears of 27 early cases of children, 34 ears (69%) improved in tympanometric findings converting to type A from type B, C2 and C5, and 9 ears (18%) of type B converted to type C1. In 23 ears of 16 early cases of adults, 12 ears (52%) improved converting to type A from type B, C2, C5 and C1, and 3 ears (13%) to type C1 from type B. However, 4 ears of 4 children and 5 ears of 5 adults did not recover by autoinflammation. In 7 children with prolonged OME in whom grommets had been inserted, 5 recovered due to autoinflammation, whereas only one of 5 adults recovered. Of 6 patients who had not recovered, 2 were associated with asthma and nasal polyposis and eosinophils infiltrated into the middle ear effusion. In other 2 patients, even when the middle ear effusion disappeared by grommets insertion, they had still dysfunction of the Eustachian tubes confirmed by sonotubometric examination. It seems no beneficial effects of autoinflammation were maintained if patients had tubal dysfunction due to intensive inflammatory changes of the middle ear and tubal mucosa or other unknown origin. Two patients used the device irregularly and rarely. There is a theoretical risk associated with this maneuver of causing baroinjury and forcing infected nasopharyngeal secretions into the middle ear, but we found no complications.     

279例耳闷胀感的病因分析

目的 探讨产生耳闷胀感的部位和原因。方法 收集耳闷胀感为主诉的279例362耳,对患耳的临床表现、鼓室导抗图、纯音测听和咽鼓管功能进行分析。结果 362耳中鼓室导抗图A型203耳、B型111耳、C型33耳以及鼓膜穿孔15耳。纯音测听表现为传导性聋、感音神经性聋、混合性聋以及正常者分别是83耳、8l耳、105耳和93耳。在362耳中,咽鼓管功能异常208耳,在A型鼓室导抗图203耳中,咽鼓管功能异常67耳。结论 产生耳闷胀感的病变部位包括外、中、内耳和面神经的病变,其中以分泌性中耳炎、各种原因引起的感音神经性聋和“咽鼓管狭窄症”为多。     

Electron microscopic observations of the porcine middle ear--inflammatory changes]

In previous studies, the morphology of the mucoepithelial cells of the middle ear of normal pigs has been found to be similar to that of humans. In this study, otitis media was induced in 18 ears by transcanal injection of glycerin into the middle ear cleft and morphological changes were investigated by scanning and transmission electron microscopy. The mucoepithelial cells of the inflamed porcine middle ear consisted of ciliated cells, non-ciliated cells, secretory cells and basal cells, and the distribution of these cells was similar to that of normal cases. In the inflamed Eustachian tube and middle ear cleft, the epithelial cells were detached, the intracellular junctions ruptured and there was subepithelial thickening in some places. In addition, the cilia were detached or deformed irregularly. On the other hand, ciliated cells, bulging non-ciliated cells, secretory cells and columnar cells were increased in numbers. These features suggested that the muco-ciliary system of the inflamed ears had been stimulated. In the air cell system, however, there were signs of mucoepithelial cell injury, but no evidence suggesting that the muco-ciliary system had been stimulated as in the Eustachian tube or middle ear cleft. The inflammatory changes in the mucoepithelial cells in the Eustachian tube and middle ear cleft gradually returned to normal but in the air cell system, the changes were persistent. Moreover, the signs of mucoepithelial cell injury remained longer when inflammation occurred at a younger age.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evolution of the epidermoid formation and its role in the development of the middle ear and tympanic membrane during the first trimester

In a study of 20 ears from embryos and early fetuses, 16 contained structures recognizable as precursors of the epidermoid formation (EF). The earliest were small, but later they took the form of a long epithelial bud which emanated from the tip of the tubotympanic recess or Eustachian tube. At a later stage still the EF protruded into the lumen of the Eustachian tube. The early formation of the tympanic membrane, the middle ear cavity and the osseous tympanic ring all take place in the vicinity of the EF precursor. It is possible that the EF precursor may act as an organizer, playing a prominent part in the migration of the first pharyngeal pouch towards the first branchial groove and the development of the middle ear and tympanic membrane.