4DCT在咽鼓管功能障碍患者咽鼓管功能评估中的应用

目的 通过4DCT(four-dimensional CT)动态评估咽鼓管功能障碍(Eustachian tube dysfuction,ETD)患者Valsava动作时的咽鼓管(Eustachian tube,ET)功能.方法 2018年11月～2019年3月期间就诊于首都医科大学附属北京安贞医院的ETD患者15例,...     

咽鼓管影像学

目的探讨咽鼓管影像学检查的临床应用情况。方法回顾性分析39例咽鼓管相关病变的影像学资料,重点观察咽鼓管及其周围结构被肿瘤侵犯的程度以及中耳渗出情况。结果部分咽鼓管相关疾病的常规轴位和冠状位CT和MRI图像可以很好的显示咽鼓管咽口、圆枕、咽鼓管纤维软骨部是否受累。相关疾病(肿瘤)压迫或侵犯咽鼓管软骨部造成咽鼓管阻塞,可以导致中耳和/或乳突积液,这种阻塞解除之后,中耳积液可以消失;如果病变只压迫了咽鼓管咽口或者只侵犯了圆枕,并不引起中耳积液。部分CT和MRI图像上重点显示了肿瘤本身情况,因此咽鼓管相关部位及中耳乳突观察不理想,全部病例的咽鼓管骨部显示都不明确,从而影响临床诊断。结论咽鼓管相关疾病的影像学资料能提示咽鼓管的部分结构是否受累,并对诊断提供一定帮助。     

Eustachian tube in atrophic rhinitis

Atropic Rhinitis is a chronic non-specific disease characterised by atrophy of mucosa and turbinate bones. Maxillary antrum may sometimes be involved as result of primary disease or at time secondary to mucosal pathology or crusting. Extension of disease involving the eustachian tube is uncertain. In the present study, endoscopy of the nasopharynx was performed in 20 patients with atrophic rhinitis to find out the type, nature and site of lesion at the orifice of the eustachian tube. The lesion was found in seven cases (35%) involving the eustachian tube. The lesion occurs in form of atrophic changes with crusting granuloma and thick mucoid area. Endoscopy is also found to be therepeutic value in removing the thick discharge crust etc. at the orifice of eustachian tube to prevent the otological complications     

Eustachian tube function in tympanoplasty

This paper describes central and peripheral eustachian tube function in relation to tympanoplasty. Central obstruction of the eustachian tube at the pharyngeal orifice is frequently correctable and is not a contraindication to tympanoplasty, whereas chronic cicatricial peripheral obstruction of the eustachian tube at the isthmus is a contraindication to tympanoplasty. These findings are based on tubal patency pressure studies measured with a mercurial manometer with the patient performing the Valsalva maneuver, with catheterization of the eustachian tube, and with politzerization. If the patient can autoinflate the middle ear and if the eustachian tube will open with politzerization, then the likelihood exists that there is no peripheral obstruction of the eustachian tube and you have a good candidate for tympanoplasty. When there is a perforation of the ear drum, the best test for eustachian tube function is microscopic examination of the middle ear mucosa. If the middle ear mucosa is perfectly normal, then you know that you have good eustachian tube function and can proceed with the tympanoplasty.     

The cartilaginous Eustachian tube: Reliable CT measurement and impact of the length

Purpose

Balloon dilation of the Eustachian tube is a treatment option for obstructive Eustachian tube dysfunction. The desired balloon position is in the cartilaginous portion. However, the balloon catheter may slide into the bony portion without the surgeon's knowledge. Knowing the length of the cartilaginous portion may improve catheter positioning, but there is no published research on measuring this portion selectively or on whether the length has an impact on development of disease or treatment outcome.To evaluate whether a measurement obtained from CT images is valuable and accurate, to standardize the manner of which the length is measured, and to compare our radiologic measurements to procedural findings, we designed a combined study. Further, we tested the length's influence on development of disease and treatment outcome.

Clinical evaluation of balloon dilation Eustachian tuboplasty in the Eustachian tube dysfunction

The development of minimally invasive procedures such as the balloon dilation Eustachian tuboplasty (BET) is an alternative to the grommet tympanum membrane. BET is applied in the cases where, after elimination of all factors influencing the ET and middle ear functioning, no sufficient improvement is observed. The aim of this study was to present the therapeutic benefits of the BET method in the treatment of ETD caused by disorders in the middle ear ventilation. The BET procedure was offered to four patients (3 men and 1 woman) after subjective, physical, otorhinolaryngological and audiometric examinations including pure tone audiometry, tympanometry and pressure-swallow test. As the method was novel, preinterventional CT angiography of the carotid arteries was performed in all patients. Any complications were noticed during and after the procedure (bleeding or damage of regional mucosa) in any patients. Our clinical studies assessed the feasibility and safety of the BET during a short-term period—only a 6-week observation. Although patients revealed a significant improvement of ET score, longer long-term studies are necessary to determine whether this method will demonstrate lasting benefits and safety in the treatment of chronic Eustachian tube dysfunction. In other investigations, improvement was found to be time dependent.     

Congenital cholesteatoma involving the Eustachian tube

Cholesteatomas, classified as acquired or congenital, are non-neoplastic, keratinizing squamous epithelial lesions that can affect many different areas of the temporal bone. We present a case of a six-month-old female with chronic otorrhea who was found to have a congenital cholesteatoma originating from the Eustachian tube. Chronic pressure from cholesteatoma expansion turned the Eustachian tube into a large cavity approximately double the size of the middle ear space. This case was unusual not only in the location of the cholesteatoma but also in respect to the unusual presentation of chronic middle ear infection due to Eustachian tube obstruction.     

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.     

Dermoid cyst of the Eustachian tube

A case of congenital dermoid cyst of the Eustachian tube is reported. Only seven similar cases have been found in our review of the literature. The embryology and usual mode of presentation of these cysts are discussed. Finally, a new surgical approach using a combined retro-auricular and protympanic route is presented.     

Eustachian tube patency detected by a photoelectric method

A method was developed to observe tubal orifice movement by fiberscope and detect patency of the eustachian tube by a photoelectric device (phototubometry). A highly sensitive photodiode in the external ear canal detected tube opening as increased luminosity in the tympanic cavity from a light source placed at the pharyngeal portion of the eustachian tube. The phototubometric record was superimposed on a TV screen to compare the opening in the pharyngeal portion of the eustachian tube to the tube opening during swallowing. The phototubometric records of 21 normal subjects examined by phototubometry showed the close relationship with the opened tubal lumen at the tensor veli palatini muscle (TVP) attached portion. This method is useful for examining tubal patency and observing changes in the pharyngeal portion of the eustachian tube.     

Postnatal change on the location of Ostmann's fatty tissue in the region lateral to Eustachian tube

OBJECTIVE: To delineate a possible role of protective function by Ostmann's fatty tissue (OF) in the lateral region to Eustachian tube (ET). STUDY DESIGN: Morphometric and histopathological examination on human temporal bones. METHODS: OF in the region lateral to the cartilaginous portion of the ET between the ET lumen and the tensor veli palatini muscle (TVP) was studied histopathologically and morphometrically by analyzing a series of vertically cut histologic sections for the ET structures. Sections were obtained from 25 individuals with age ranging from 33 gestational weeks to 38 years at the time of their death. RESULTS: In fetus and neonates, the region lateral to ET was filled with mesenchyme. OF appeared first in this region at 2-3 weeks postnatally, and increased in volume with development of the ET. In the cases of older children and adults (Group-B), the ratio of the volume of OF in the region to that of ET lumen (OF/L) was significantly higher in the posterior half than in the anterior half of the cartilaginous portion of ET. However, in the cases of infants and younger children (Group-A), there was no significant difference in the ratio between the two regions. In the posterior half of the cartilaginous portion of ET, OF/L was significantly higher in Group-B than in Group-A, while in the anterior half, there was no significant difference in the ratio between two age groups (Group-A and B). CONCLUSIONS: In Group-B, the dominant OF in the area of the posterior half of the cartilaginous region, which includes the narrowest portion of ET, may be responsible for restoring the ET lumen back to its closed static condition after active tubal opening by contraction of TVP. This is thought to be important for protection of the middle ear. On the other hand, in Group-A, poor OF near the narrowest portion of ET may cause insufficient restoration of the ET lumen and increased risk of developing otitis media (OM).     

Imaging of the patulous Eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique

OBJECTIVE: To evaluate the 3D anatomy of the ET and its surrounding tissues in cases with or without patulous Eustachian tube (ET) using CT with the multiplanar reconstruction (MPR) technique. MATERIAL AND METHODS: Twenty patients with a patulous ET and 25 without middle ear problems were investigated. After performing a temporal bone CT examination, MPR images of the ET were reconstructed and measurements were made. RESULTS: The ET lumen and its surrounding tissues were clearly identified. In the patulous ET group, the ET lumen was open throughout the cartilaginous portion and the volume of the low-density area was smaller in size than in the controls. In unilateral patulous ET patients, the anatomical features were found to be similar on both sides, in spite of the fact that the non-involved side did not show symptoms associated with a patulous ET. CONCLUSION: For the first time, we were able to obtain clear reconstructed images of the patulous ET and its surrounding structure and to study its anatomical features. This method is useful for obtaining a better understanding of the ET and ET-related diseases such as patulous ET.     

Acoustic immittance testing of the Eustachian tube

The pathophysiological relationship of Eustachian tube dysfunction to middle ear effusion is widely accepted. Several techniques have been developed for utilizing the clinical measurements of acoustic immittance to assess the ventilatory status of the Eustachian tube. This article describes the array of procedures currently in use as well as a selection of procedures being developed for clinical assessment of the Eustachian tube. Most studies in this area have concentrated on measurements of normal function. Clinicians and researchers are encouraged to increase the application of these techniques in order to broaden the data base that is currently available concerning normal and pathological function.     

Isoprenaline-induced facilitation of the Eustachian tube opening

Isoprenaline was given i.v. to rats and its ability to change the air pressure necessary to open the Eustachian tube (ET) was studied. Air was injected once a minute into the middle ear via a tube glued to a hole in the tympanic bulla. The rate of pressure increase was 0.7 kPa/sec. The air pressure at which the ET opened was in 10 rats 3.4 +/- 0.3 (SE) kPa. Isoprenaline in a dose of 1 microgram/kg decreased this pressure opening level (Pol) by 0.14 +/- 0.03 kPa and with 10 micrograms/kg by 0.22 +/- 0.03 kPa. These effects were reduced by propranolol. Isoprenaline did not act via released adrenaline. A surface tension lowering substance, Tween 20, instilled into the middle ear, decreased Pol by about 0.9 kPa. It is suggested that isoprenaline evokes a decreased Pol via secretion of surface tension lowering substances.