Functional evaluation of paratubal muscles using electromyography in patients with chronic unilateral tubal dysfunction

Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.     

阻塞性睡眠呼吸暂停低通气综合征上气道开大肌凋亡现象研究

目的:观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者腭帆张肌中Bax、Bcl-2的表达水平,探讨OSAHS患者上气道开大肌肌纤维是否存在凋亡现象。方法:选取30例OSAHS患者作为实验组,10例已排除OSAHS的慢性扁桃体炎患者作为对照组。采用免疫组织化学Elivison二步法和计算机图像分析系统检测两组腭帆张肌中Bax、Bcl-2的表达水平并进行对比分析。结果:①实验组Bax的表达水平和Bax/Bcl-2的比值明显高于对照组,差异有统计学意义(P<0.05);②Bax的表达水平与呼吸紊乱指数呈正相关(r=0.697,P<0.01)。结论:OSAHS患者上气道开大肌存在凋亡现象,且病情越重凋亡的程度也越严重。     

Clinical applications of pharyngeal electroneurography

Electroneurography of soft palate, Eustachian tube and pharynx was carried out in 60 normal adults and 187 patients. This test was performed on the 2-channel Schwarzer 2,000 electromyograph. The 2 cm long concentric needle electrodes were used for recording and were inserted into muscles of glossopalatinus, pharyngopalatinus, tensor veli palatini and levator veli palatini. Four cm long stimulating electrodes were used to stimulate the mandibular branch of trigeminal nerve and pharyngeal branch of vagus nerve. Stimuli of 100 voltage were delivered as rectangular pulses of 0.1-0.2 ms duration at a rate of 1-2 Hz. In normal subjects, the latency of the evoked wave induced from tensor veli palatini by stimulating the mandibular branch of trigeminal nerve was 1.8 +/- 0.6 ms. The latency of the evoked wave induced from levator veli palatini, glossopalatinus, pharyngopalatinus were 1.9 +/- 0.6, 2.0 +/- 0.4, 1.9 +/- 0.7 ms respectively. In 35 patients with paralysis of soft palate and pharynx, no evoked potential could be recorded in 18 cases, meaning complete nerve injury, latency delayed in 10 cases, indicating partial nerve injury, normal latency of evoked potential in 7 cases. One hundred and twenty-four cases of otitis media, 20 cases of myoclonus of soft palate and pharynx and 8 cases of cleft palate were also studied. Their electrogroms were normal. This technique may be used not only to measure nerve conductivity directly but also to make correct diagnosis of neuromuscular disorders of these structures without serious complications.     

阻塞性睡眠呼吸暂停低通气综合征腭帆张肌失神经变化

目的通过研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者腭帆张肌中钙蛋白酶-1（calpain 1）和神经细胞黏附分子（neural cell adhesion molecule,NCAM）的表达以及运动终板形态改变,探讨OSAHS患者上气道扩张肌失神经变化。方法选取30例OSAHS患者作为实验组,10例排除OSAHS的慢性扁桃体炎患者作为对照组。通过乙酰胆碱脂酶（acetylchelin esterase,AchE）染色法显示运动终板形态变化,免疫组化Elivison二步法检测腭帆张肌中calpain 1和NCAM的表达。结果①OSAHS组运动终板数量明显减少甚至消失：②calpain-1和NCAM的表达水平明显高于对照组,差异有显著性意义（P〈0．05）;③calpain1和NCAM的表达水平均与呼吸紊乱指数呈正相关（r=0．811,P=O．000：r=0．692,P=0．000）。结论OSAHS患者上气道扩张肌存在失神经支配病变,且病情越重失神经的程度也越严重。     

咽鼓管薄层断面与磁共振成像对照研究

目的研究咽鼓管和毗邻结构的断面形态及相互解剖关系,为临床影像学诊断提供解剖学依据.方法利用生物塑化技术,将9侧咽鼓管区及相邻结构制成三个平面(横断、冠状位及矢状位)的薄层断层标本,并与磁共振成像(MRI)对照,观察咽鼓管及毗邻结构在各方位的走行与解剖关系.结果在横断、冠状断面上可较好显示咽鼓管的正常解剖结构及毗邻关系,咽鼓管纤维软骨位于咽鼓管后内侧,其上缘向外弯曲形成软骨部的顶.咽鼓管咽筋膜封闭咽鼓管前外侧并向下延伸构成咽鼓管的下壁.腭帆张肌位于咽鼓管前外侧,腭帆提肌位于其外后下方.粘膜下筋膜位于腭帆提肌的内侧,咽颅底筋膜走行于腭帆张肌和腭帆提肌之间,Weber-Liel筋膜位于腭帆张肌外侧.结论MRI可较好显示咽鼓管软骨部及其肌肉、筋膜;应用塑化薄层断面可直接与MRI扫描图像进行对照研究,对鼻咽区病变的影像诊断具有重要参考价值.     

Role of the tensor veli palatini muscle in movement of the soft palate.

To examine the role of the tensor veli palatini muscle in palatal movement, we conducted 1) quantitative measurement of palatal movement by selective stimulation of the tensor and levator muscles, and 2) EMG recording of the two muscles during phonation. The results were: 1) negligible palatal movement upon tensor stimulation, despite a marked velar elevation by levator stimulation; and 2) little EMG activity of the tensor and marked EMG activity of the levator during phonation. It was concluded that the tensor plays no role in the palatal function.     

Reproducibility of acoustic rhinometry and rhinomanometry in normal subjects

The reproducibility of nasal patency measurements was assessed by acoustic rhinometry and active rhinomanometry using previously described Toronto methodologies. Six subjects with normal upper airways were tested with both procedures on six separate occasions within a 2-month period. Topical decongestant was applied to minimize the effects of mucosal variation on the nasal airway. The mean coefficients of variation (mean +/- s.d; %) over time of the measurements were 8.1 +/- 4.1 and 9.7 +/- 5.2 for minimal unilateral cross-sectional area and 4.8 +/- 1.8 and 5.5 +/- 3.5 for nasal volume (0-5 cm) of the right and left sides, respectively. For active rhinomanometry, the mean coefficients of variation (mean +/- s.d.; %) over time of the measurements were 15.9 +/- 7.3, 12.9 +/- 4.6, and 8.5 +/- 2.8 for right, left and combined nasal airflow resistance. The intraclass correlation coefficient was 0.76, 0.70, and 0.96 for right, left, and combined nasal resistance, 0.91 and 0.87 for right and left minimal cross sectional area, and 0.86 and 0.69 for right and left nasal volumes, respectively, also confirming a high level of reproducibility for both methods. In conclusion, performed by an experienced operator under controlled circumstances, the reproducibility of both methods of nasal patency assessment compared favorably with many widely accepted clinical tests.     

Effects of size of the nasal airway on nasal airflow rate

The controversy concerning the effects of nasal airway impairment on facial growth has stimulated renewed interest in upper airway respiratory function. We assessed the relationship between nasal airway patency and nasal airflow rate, using the pressure-flow technique to estimate nasal cross-sectional size and nasal airflow rate in 30 normal and 82 nasally impaired adults. Groups were categorized according to otolaryngologic examination results and pressure-flow measurements. The results clearly demonstrate that size of the airway influences airflow rate when the smallest nasal cross-sectional area is under 0.4 cm2. The data suggest that the nose becomes flow-limiting when it is less than 0.18 cm2. These data support our contention that nasal airway impairment in adults occurs when the airway is less than 0.4 cm2 in size.     

Muscle spindles in the velopharyngeal musculature of humans

Seven muscles in the velopharyngeal region of humans were studied histologically to determine the presence of muscle spindles. Typical spindles were found in palatoglossus and tensor veli palatini with a greater number in the latter. Spindles were not found in levator veli palatini, palatopharyngeus, musculus uvulae, salpingopharyngeus, or the superior pharyngeal constrictor.     

Do the tensor tympani and tensor veli palatini muscles of man form a functional unit? A histochemical investigation of their putative connections

The discussion among anatomists and otolaryngologists about the muscles originating from the Eustachian tube and the connections between the tensor tympani and tensor veli palatini muscles started in the 1860s. From then on, a considerable number of contradictory hypotheses and data have been presented. However, before discussing whether or not these two muscles form a functional unit, interest should focus on the question of whether it is even possible. The cartilaginous portion of the Eustachian tube with all muscles originating from it, including the whole tensor tympani muscle, was dissected from five perfusion-fixed cadavers and removed in toto. Complete longitudinal serial sections of 10 microm were made in the axis of the tensor tympani muscle. Sections were alternatingly stained according to Cason's and Maskar's techniques. The macroscopic aspect (under the operating microscope) of a tendinous connection between the two muscles under consideration could be proven by the histochemical methods used in all cases. Based on our findings and the literature reviewed we are convinced that the tensor tympani and tensor veli palatini muscles of man constitute a functional unit. This represents an important step forward towards the understanding of the possible functions the tensor tympani muscle serve in man.     

Palatal aponeurosis and the insertion of the tensor muscle of the soft palate. An anatomic study and clinical applications

INTRODUCTION: Knowledge of the anatomy of soft palate muscles is of great interest in cleft palate surgery, in surgical correction of obstructive sleep apnea syndrome and in excision of maxillo-facial carcinomas. Some authors described the palatal aponeurosis as the expansion of the tendon of the two tensor veli palatini muscles, others stated that the palatal aponeurosis is a distinct anatomic entity. METHOD: Ten dissections of the soft palate have been performed to improve our knowledge of its anatomy. RESULTS: The palatal aponeurosis is a distinct anatomic entity continuous with the periosteum of the nasal cavity. The tendon of the tensor veli palatini terminated on the inferior side of the aponeurosis. One fifth of the tensor's tendinous fibers terminated on the posterior border of the palatine bone and the others are spreading on the anterior and inferior side of the palatal aponeurosis. DISCUSSION: In cleft palate patients, this aponeurosis is absent, the palatal muscles are attached to the posterior border of the palatine bones. So it seems to be logical to recommend a soft-palate "pushback" to create a new space between the posterior border of the palatine bones and the soft-palate muscles.     

Motor innervation of the eustachian tube muscles in the guinea pig

The brainstem location of motoneurons innervating eustachian tube-associated muscles in the adult guinea pig was determined using intramuscular injections of the neural tracer horseradish peroxidase (HRP). Following HRP injections into the tensor veli palatini and the eustachian tube belly of the medial pterygoid muscle, an ipsilateral column of HRP-labeled motoneurons was present medial to the dorsolateral division of the trigeminal motor nucleus. Following HRP injection into the levator veli palatini, labeled motoneurons were present in the ipsilateral dorsal division of nucleus ambiguus. The locations of the tensor veli palatini and levator veli palatini motoneurons are similar to those found in studies of other animals. A distinct eustachian tube belly of the medial pterygoid muscle was also identified. This sub-belly had a motoneuron pool distinct from the main medial pterygoid muscle group. The authors have provided the gross anatomical and neuroanatomical substrates upon which future studies of eustachian tube function in the guinea pig may be based.     

应用肉毒毒素A治疗腭肌阵挛性耳鸣临床分析

目的探讨肉毒毒素A对腭肌阵挛源性耳鸣的治疗作用。方法在鼻内窥镜下,将20U肉毒毒素A注射到4例腭肌阵挛性耳鸣患者患侧腭部肌肉内(腭帆张肌、腭帆提肌等),观察患者耳鸣的变化以及是否有并发症出现。同时回顾相关文献,对该病的病因、诊断及治疗加以分析。结果用药后第三天,患者腭部肌肉阵挛和耳鸣均消失,疗效持续约3个月。耳鸣消失的同时出现轻度鼻咽部返流或发声困难,约一周后逐渐消失。结论阵挛的腭部肌肉内注射肉毒毒素A是治疗腭肌阵挛性耳鸣的有效方法。     

Eustachian tube-Tensor veli palatini muscle-cranial base relationships in children and adults: An osteological study

Objective

The vector relationships between the Eustachian tube, Tensor veli palatini muscle and cranial base constrain the efficiency of middle ear pressure-regulation and are required parameters for computational modeling of Eustachian tube function. Here, those relationships were reconstructed from skulls and compared between children and adults.

Method

Reconstructions were made using modifications of previously described techniques for 18 child skulls aged 3-4 years and 20 adult skulls (10 females, 10 males; >18 years). Measured and calculated variables were compared between groups using a Student's t-test.

Results

Consistent with previous reports, certain variables for adult skulls exhibited sexual dimorphism. Between children and adults, significant differences were documented for measures of cranial base length and width; hard palate width; nasopharyngeal height, width and depth; Eustachian tube length; the maximum and minimum Tensor veli palatini muscle lengths; the angles of deviation of the Tensor veli palatini muscle from the Eustachian tube, and the surface area of the Tensor veli palatini muscle. There were no between-group differences in the angle of Eustachian tube decent from the cranial base, Eustachian tube deviation from the parasagittal plane or the lateral component of the Tensor veli palatine muscle-Eustachian tube angle.

Conclusions

The differences between children and adults that could account for the observed poorer Eustachian tube function in children include their shorter Eustachian tube, lesser Tensor veli palatine muscle-Eustachian tube vectors, and the lesser Tensor veli palatine muscle surface area. Other observed differences are attributable to growth and development of the craniofacial complex.     

The extended bundle of the tensor veli palatini: Anatomic consideration of the dilating mechanism of the Eustachian tube

Objective

The aim of this study was to analyze the topographical structures of the muscles surrounding the Eustachian tube.

Age-related morphologic differences in the components of the eustachian tube/middle ear system

The current study utilized a three-dimensional computer graphics technique to analyze the size, shape, and positional associations of the eustachian tube (ET) cartilage and lumen, the levator veli palatini (LVP) muscle, and the tensor veli palatini (TVP) muscle. Older specimens 7 years and above (n = 13) were compared to young specimens less than 7 years (n = 4). Our results suggest that changes in ET function associated with age could result from size and shape differences in the ET cartilage and changes in the position of the LVP and TVP muscles.     

Clinical study of otological manifestations in cases of cleft palate

Cleft palate (with or without cleft lip) occurs in about 1: 750–1: 2000 births in different societies in the world. Cleft palate individuals have a greater incidence of hearing loss than the general population. The primary cause of the ear problem in cleft patients is eustachian tube dysfunction. The cause for which is abnormal insertion of levator veli palatini and tensor veli palatini muscles into the posterior margin of the hard palate and the palatal aponeurosis and associated muscular hypoplasia.     

鼻咽癌初诊患者中耳功能的相关多因素量化分析

目的：探索量化和客观评价鼻咽癌初诊患者的中耳功能的方法,采用多因素及量化的方法分析其影响因素。方法：对320例（320耳）鼻咽癌初诊患者行电耳镜、声导抗检测、纯音听阈测试、鼻咽部及中耳CT或MRI扫描、咽鼓管功能检查、电子鼻咽镜检查,量化评估中耳功能;采用SPSS13．0进行单因素及多因素分析。结果：T分期、临床分期、肿物部位、扩散类型、形态、咽鼓管功能及咽口形态、影像学侵犯范围（鼻腔、颅底、咽隐窝、咽旁间隙、腭帆张肌、腭帆提肌）是影响鼻咽癌初诊患者的中耳功能单因素,而性别、年龄、病理类型、N分期、M分期对鼻咽癌初诊患者中耳功能无影响;多因素分析显示：T分期、肿物部位、咽鼓管功能、腭帆张肌侵犯、颅底侵犯是影响鼻咽癌初诊患者中耳功能的独立因素。结论：鼻咽癌初诊患者的中耳功能受T分期、肿物部位、咽鼓管功能、腭帆张肌侵犯、颅底侵犯等相关因素影响,本研究探讨的中耳量化标准能较为客观地评估鼻咽癌初诊患者的中耳功能。     

Muscle spindles in the human levator veli palatini and palatoglossus muscles

Muscle spindles are present in many muscles of the speech mechanism including those of the jaw, tongue, larynx, and respiratory system. Past investigations that have examined muscles of the velopharynx for the presence of muscle spindles have reported their existence only in the tensor veli palatini and palatoglossus muscles. The present investigation has demonstrated the existence of muscle spindles in two muscles of the human velopharynx--the levator veli palatini (LVP) and palatoglossus muscles. Seven LVP and two palatoglossus muscles were embedded in paraffin blocks, serially sectioned at 8 microns, and selected slides were stained by a modified Gomori trichrome technique. Scanning by light microscopy at 40x revealed spindles in all of the muscles examined. This positive finding likely reflects the use of a more chromatically distinctive staining procedure and a higher scanning magnification than were used in prior investigations. The potential roles of muscle spindles in velopharyngeal function are addressed.     

睡眠状态下阻塞性睡眠呼吸暂停低通气综合征患者上气道扩张肌肌电活性的变化

目的：观察睡眠状态下阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者上气道扩张肌肌电活性的变化,探讨其在OSAHS中的作用及意义。方法：对中、重度OSAHS患者69例（OSAHS组）及健康志愿者20例（对照组）于诱导睡眠后分别行颏舌肌、腭帆张肌和腭帆提肌等上气道扩张肌肌电图的检测并与诱导睡眠前比较。结果：（1）清醒状态下OSAHS组上气道扩张肌肌电水平较对照组高（均P〈0．01）;②与清醒状态比较,睡眠状态下OSAHS组上气道扩张肌肌电水平显著下降（均P〈0．01）;③从清醒状态到睡眠状态,OSAHS组上气道扩张肌肌电水平下降幅度明显大于对照组（均P〈0．01）。结论：OSAHS患者清醒状态下上气道扩张肌肌电活性代偿性升高及睡眠状态下失代偿是该病发生的重要病理生理机制。