Eustachian tube function in patients with eosinophilic otitis media associated with bronchial asthma evaluated by sonotubometry

OBJECTIVE: To determine eustachian tube function in patients with asthma and with or without eosinophilic otitis media (EOM), a new middle ear disease entity with a highly viscous middle ear effusion containing many eosinophils and usually associated with bronchial asthma. One of the most important causes of otitis media (OM) is eustachian tube dysfunction. DESIGN: Retrospective case review. SETTING: A referral center. PATIENTS: Twenty patients with EOM and patients with asthma but without OM. MAIN OUTCOME MEASURES: We studied eustachian tube function using sonotubometry and a questionnaire. Sonotubometry was also performed on 13 control patients with chronic otitis media (COM) and 7 normal controls. RESULTS: The tubal opening duration was significantly longer in patients with EOM than in patients with asthma but without OM, controls with COM, and normal controls, indicating the presence of patulous eustachian tubes in patients with EOM. Responses to the questionnaire also supported the presence of patulous eustachian tubes in the patients with EOM. CONCLUSIONS: The presence of a patulous eustachian tube may be a major cause of EOM in patients with bronchial asthma. In patients with asthma who have a helper T-cell 2-dominant predisposition, a patulous eustachian tube easily allows the entry of antigenic materials into the middle ear, causing eosinophil-dominant inflammation.     

Patulous eustachian tube in long-term survivors of nasopharyngeal carcinoma

This article reports on 21 long-term (10 years) survivors of nasopharyngeal carcinoma, divided into 2 groups: those subjected to an inflation-deflation test and a clearance function test in a longitudinal study, and those receiving sonotubometry in a cross-sectional study. On the inflation-deflation test, 12 (55%) out of 22 ears had a patulous eustachian tube, and on sonotubometry, 10 (50%) out of 20 ears also revealed a patulous eustachian tube. Except for 4 ears with chronic otitis media, the ears had resolved to a normal eardrum appearance at 10 years postirradiation. The phenomenon might be attributed to both restoration of the impaired tubal function and the development of a patulous tube.     

No effect of a nasal decongestant on eustachian tube function in children with ventilation tubes

OBJECTIVE: The aim of the study was to assess the effect of a topical decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion. STUDY DESIGN: A randomized, double-blinded, placebo-controlled study. METHODS: At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion. RESULTS: Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube. CONCLUSIONS: Topical decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of topical decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged.     

鼓室成形术后的咽鼓管功能检测及意义

目的探讨咽鼓管功能对慢性化脓性中耳炎鼓室成形术后疗效的影响。方法用咽鼓管鼓室-气流动态图(tube-tympanoaerodynamicgraphy,TTAG)法及音响法对53耳鼓室成形术后的咽鼓管功能进行检测,并分析鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况;并用鼻窦镜观察咽鼓管咽口,分析咽鼓管咽口与咽鼓管功能的关系。结果53耳鼓室成形术后咽鼓管功能正常37耳,其中29耳鼓膜生长良好;咽鼓管功能异常16耳中,有4耳鼓膜生长良好,比较咽鼓管功能正常耳与异常耳鼓膜生长良好耳数,两者有显著性差异(P<0.05);53耳术后有9耳咽鼓管咽口充血肿胀,其中2耳咽鼓管功能正常,7耳咽鼓管功能不良,提示术后咽鼓管功能障碍与咽鼓管咽口病变有关。结论慢性化脓性中耳炎鼓室成形术后咽鼓管功能与疗效关系密切,术后咽鼓管功能障碍可能是导致手术失败的原因之一。     

慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

目的探讨慢性化脓性中耳炎咽鼓管功能改变对手术疗效的影响.方法分析40耳行鼓室成形术的慢性化脓性中耳炎的咽鼓管功能与手术疗效的关系.咽鼓管功能检查用正-负压试验、TTAG法及音响法,咽鼓管鼓室口及咽口的观察分别用鼓室镜及鼻窦镜,对比分析咽鼓管功能改变与病变部位的关系,并比较鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况.结果慢性化脓性中耳炎的咽鼓管功能与鼓室口病变程度相关,鼓室口病变轻者,咽鼓管功能良好;而鼓室口病变重者咽鼓管功能不良.40耳鼓室成形术后咽鼓管功能良好耳鼓膜生长良好,咽鼓管功能不良耳鼓膜生长欠佳;两者均有统计学意义.结论慢性化脓性中耳炎咽鼓管功能与鼓室成形术效果关系密切,咽鼓管功能障碍可能是导致手术失败的重要因素之一.     

Sonotubometry findings in children at high risk from middle ear effusion.

The functioning of the eustachian tube has an important role to play in the development of middle ear disease. It would be useful if a clinical test could assist in the identification of eustachian tube dysfunction, particularly if this is shown to be an indicator of persistent middle ear effusion. The aim of this study was to compare the results of sonotubometry using the MMS-10 instrument in children at high risk from middle ear effusion with a group of normal subjects. Forty-one subjects (age range 5-6 years) were allocated to one of two groups (experimental group, 21 subjects; control group 20 subjects) based on a questionnaire designed to identify subjects at high risk from middle ear effusion. The test protocol allowed each subject to swallow three times for each of two pure-tones (7 and 8 kHz) delivered by the nasal probe. Sonotubometry indicated opening of the eustachian tube on swallowing in around 80% of subjects. The incidence of positive findings varied greatly amongst subjects across both groups. In the control group, the mean increase in sound pressure level on swallowing was 11.5 dB (+/- 4.3) and 9.8 dB (+/- 2.5) for 7 and 8 kHz, respectively. The corresponding means for duration were 118 ms (+/- 47.9) and 137 ms (+/- 61.8). Sonotubometry failed to demonstrate a difference between the two groups of subjects. Hence, the clinical application of sonotubometry to identify subjects at high risk from middle ear effusion is not supported.     

Mechanical obstruction of the eustachian tube by the benign tumor of the parapharyngeal space does not cause otitis media with effusion.

OBJECTIVE: We are reporting on eustachian tube and middle ear pathologic findings in patients with parapharyngeal tumors. PATIENTS: Eleven cases of eustachian tube involvement as indicated by obstruction due to compression of the tumor were assessed in this study. MAIN OUTCOME MEASURES: Each patient underwent otoscopy, nasopharyngoscopy, a pure-tone hearing test, impedance audiometry, and sonotubometry. RESULTS: All of the tumors were diagnosed benign according to the histologic examination. In 9 of the 11 patients, the pharyngeal opening of the eustachian tube narrowed or was blocked by the tumor. None of the patients showed any response on the tumor side in the sonotubometry. Therefore, gas exchange was prevented through the eustachian tube by the tumor; however, they also showed an intact tympanic membrane and normal hearing tests. CONCLUSION: According to our data, if there is drainage of middle ear fluid through the eustachian tube and the exchange of gas in the middle ear is preserved, otitis media with effusion will not occur even in cases such as these.     

Evaluation of noninvasive eustachian tube function tests in normal adults

A causal association between eustachian tube (ET) dysfunction and otitis media (OM) has been documented. We present normative data for eustachian tube function (ETF) in an otologically normal population of 107 college-age subjects using two noninvasive methods: nine-step tympanometric testing and sonotubometry. The results show a 78% agreement between the two methods when one test session was performed. The nine-step test showed a 52% repeatability rate on three sequential test sessions while the sonotubometry test showed a 34% repeatability rate. The combined tests showed a 34% agreement for the three sequential tests. The findings reveal that the combination of the two tests identify 96% of normal subjects as having at least some tubal function present. Although both tests provide similar information regarding the presence of tubal opening, the sonotubometry method is more physiologic. Additional information shows that the average category of the nine-step test in a normal population was category 2, the mean duration of tubal dilation was 0.40 seconds, and the mean middle-ear pressure was -12 mm H₂O.     

Reproducibility of sonotubometry as Eustachian tube ventilatory function test in healthy children

OBJECTIVES: To devise a simple and reliable diagnostic procedure to test Eustachian tube function routinely in an ENT outpatient setting. One method to measure ET ventilatory function is sonotubometry. The reproducibility of a recently updated sonotubometry set-up was tested in healthy children. METHODS: The test population comprised 61 school children aged from 6 to 8 years. Only otologically healthy children were included. Health state was established by means of a 12-item questionnaire. To test reproducibility, sonotubometric testing took place in two sessions of 10 acts of swallowing each. Spearman's coefficient was used to test the correlation between the two sets of measurements. All testing took place at a primary school in a nearby village. RESULTS: Opening of the ET was recorded in at least one of the two measurement sessions in 82% of the children. The first and second sessions were highly correlated, with a Spearman's coefficient of 0.89. CONCLUSIONS: In otologically healthy children, opening of the ET was recorded frequently using the updated sonotubometry set-up. Measurement results had high reproducibility. Therefore, the test forms a useful method to assess ET ventilatory function in otologically healthy children. The performance of this updated version needs to be established in children with otological diseases.     

Results of sonotubometry in testing eustachian tube ventilatory function in children with cleft palate

OBJECTIVES: In previous studies, an updated sonotubometry setup was tested in healthy adults and children to test its validity and reproducibility in the assessment of the ventilatory function of the eustachian tube (ET). The results were promising, but further investigations were needed to confirm the discriminative potential of this sonotubometry setup. Our objective in the present study was to test the discriminative potential of an updated sonotubometry setup in children with cleft palate. METHODS: The ET ventilatory function was tested in 56 children with cleft palate, ie, children with impaired ET function, and compared to the outcomes in 61 healthy children who served as a control group. All of the children were between 5 and 9 years of age. To test the reproducibility, we performed the sonotubometric testing in 2 sessions of 10 acts of swallowing each. Spearman's coefficient was used to test the correlation between the 2 sets of measurements. The results of measurements in the cleft palate group were compared with those in the otologically healthy control group and analyzed by means of a Mann-Whitney U test. RESULTS: Opening of the ET was recorded in at least 1 of the 2 measurement sessions in 57% of the children with cleft palate, as compared to 82% in the control group. The mean number of openings was lower in the cleft palate group than in the control group (respectively, 2.3 versus 3.7 out of 10; p < .01). The first and second sessions were highly correlated in both the cleft palate group and the control group, with Spearman's coefficients of, respectively, 0.96 and 0.89. CONCLUSIONS: The results of this study show that this updated sonotubometry setup has the potential to discriminate between these groups of children with various states of ET ventilatory function. Furthermore, the results of this study once again show that this updated sonotubometry setup is capable of assessing ET ventilatory function in both healthy children and children with cleft palate and that the measurements are highly reproducible. A persistent disadvantage remains that in 18% of the 61 healthy children there was no ET opening that could be registered, which still prohibits a definite assessment at the individual level.     

Update on eustachian tube dysfunction and the patulous eustachian tube

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent knowledge on eustachian tube dysfunction and the patulous eustachian tube. RECENT FINDINGS: A clinically useful test for eustachian tube function is still lacking. Narrowing of the isthmus alone was demonstrated to be an insufficient cause of otitis media. Inflammatory mediators identified within the eustachian tube and middle ear cells were causally linked with otitis media with effusion. Increasing evidence was found that allergic disease and reflux may be two of the most important contributors of tubal inflammation causing otitis media with effusion. The adenoid size and proximity to the torus tubaris may also be important in considering which patients with persistent otitis media with effusion may benefit from adenoidectomy. Computed tomography scan has documented loss of soft tissue within the cartilaginous eustachian tube in patients with patulous eustachian tubes. An endoscopic approach to seal the tubal lumen has been found to be effective in relieving patulous symptoms. SUMMARY: These studies suggest that allergic rhinitis and gastroesophageal reflux should be investigated in patients with eustachian tube dysfunction. Adenoidectomy should also be considered in patients who have adenoids that obstruct the torus tubaris. Patients with a patulous eustachian tube may benefit from an endoscopic closure. Further research is needed to identify a clinically useful test for eustachian tube dysfunction.     

颞骨CT和咽鼓管功能检查对胆脂瘤型中耳炎咽鼓管鼓室口病变的诊断意义

目的：探讨颞骨高分辨率CT（HRCT）和咽鼓管功能检查对胆脂瘤型中耳炎患者术前咽鼓管鼓室口病变的诊断价值。方法：回顾性分析38例（41耳）胆脂瘤型中耳炎患者术前颞骨HRCT扫描和咽鼓管功能综合测试仪检查结果，并与术中显微镜下探查咽鼓管鼓室口处病变情况进行对比分析。结果：颞骨HRCT发现咽鼓管鼓室口软组织占位影34耳；术中发现鼓室口病变32耳，其中为肉芽组织22耳和胆脂瘤4耳，脓团堵塞3耳，鼓室口周围黏膜肥厚肿胀2耳，黏膜粘连闭锁1耳。咽鼓管功能障碍37耳，其中为阻塞型32耳，闭锁不全型5耳。结论：对胆脂瘤型中耳炎患者术前进行颞骨HRCT扫描和咽鼓管功能检查，对术中有目的地处理咽鼓管鼓室口的病变，制定手术方案和预估治疗效果具有重要意义。     

漂浮导管扩张咽鼓管治疗放疗后分泌性中耳炎

目的：了解鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)咽鼓管功能，以及漂浮导管扩张咽鼓管治疗该病的临床价值。方法：使用咽鼓管功能综合检查仪检测21例(37耳)NPC放疗后SOM患者的咽鼓管功能；在鼻内镜直视下将漂浮导管导入咽鼓管内扩张咽鼓管，治疗NPC放疗后咽鼓管阻塞引起的SOM。结果：21例NPC放疗后SOM中，咽鼓管功能为正常型2耳，阻塞型21耳，闭锁不全型8耳，开放型6耳。漂浮导管扩张咽鼓管治疗NPC放疗后SOM，有效率为43．2％(16／37)。结论：NPC放疗后SOM的咽鼓管功能障碍，多以阻塞型为主，应用漂浮导管扩张咽鼓管是一种有效的治疗方法。     

Sonotubometry findings in children at high risk from middle ear effusion

The functioning of the eustachian tube has an important role to play in the development of middle ear disease. It would be useful if a clinical test could assist in the identification of eustachian tube dysfunction, particularly if this is shown to be an indicator of persistent middle ear effusion. The aim of this study was to compare the results of sonotubometry using the MMS-10 instrument in children at high risk from middle ear effusion with a group of normal subjects. Forty-one subjects (age range 5–6 years) were allocated to one of two groups (experimental group, 21 subjects; control group 20 subjects) based on a questionnaire designed to identify subjects at high risk from middle ear effusion. The test protocol allowed each subject to swallow three times for each of two pure-tones (7 and 8 kHz) delivered by the nasal probe. Sonotubometry indicated opening of the eustachian tube on swallowing in around 80% of subjects. The incidence of positive findings varied greatly amongst subjects across both groups. In the control group, the mean increase in sound pressure level on swallowing was 11.5 dB (± 4.3) and 9.8 dB (± 2.5) for 7 and 8 kHz, respectively. The corresponding means for duration were 118 ms (± 47.9) and 137 ms (± 61.8). Sonotubometry failed to demonstrate a difference between the two groups of subjects. Hence, the clinical application of sonotubometry to identify subjects at high risk from middle ear effusion is not supported.     

Sonotubometry: its role in childhood glue ear

Sonotubometry is a relatively new technique for the measurement of Eustachian tube function. Two groups of children were studied: an abnormal group with a diagnosis of glue ear, and a control group of normal children. Sonotubometry testing showed tubal function to be normal in 80% of the control group compared with only 29% in the abnormal group. This difference is statistically significant. Furthermore, the reliability of sonotubometry testing as a predictor of glue ear was assessed and compared with the current methods of pre-operative assessment (pure tone audiometry, tympanometry, and otoscopy). Sonotubometry compares well, giving a correct prediction rate of 85%. In addition it has been shown that, unlike the other tests, sonotubometry testing was possible on all children studied.     

Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report

Pharyngeal orifice of the eustachian tube was ligated on ten patients, 15 ears with intractable patulous eustachian tube. While the eustachian tube orifice was observed by an endoscope inserted through the contralateral nostril, the orifice was ligated transnasally and/or transorally using instruments usually used in the endoscopic nasal surgery. Now 13–27 months after the surgery, the outcome was excellent (both symptoms and sonotubometry were normalized) in two ears, good (either symptoms or sonotubometry was improved) in seven ears, and unchanged in the remaining six ears. In one of the ears with an outcome of unchanged, the ligation was found to be spontaneously released soon after surgery, but the symptom was improved after the second operation 2.5 months after the first operation. Temporary otitis media with effusion was seen in one ear, mild inflammation around the ligated site also in one ear, but no other serious complication has been observed. Although further improvement in the surgical procedure and further discussion about its long-term outcome should be required, this procedure appeared to be one of the therapeutic options for intractable patulous eustachian tube.     

Chronische Tubendysfunktion und ihre Folgeerkrankungen bei Erwachsenen mit einseitiger Lippen-Kiefer-Gaumen-Spalte

BACKGROUND: While almost all children with cleft palate develop eustachian tube dysfunction, this tends to normalize with age although it remains impaired in a number of patients. METHODS: Eustachian tube function was evaluated by tympanometry in 40 patients with an average age of 19.9 years. The number of patients with chronic otitis media, a sequelae of chronic eustachian tube dysfunction, was determined microscopically and from the patient's history. Hearing was assessed by pure tone RESULTS: Eustachian tube dysfunction was found bilaterally in 25% of the patients and unilaterally in 6%, while chronic otitis media was found in 32.5% and 12.5%, respectively. The hearing level did not differ between the side of the cleft and the opposite side (P=0.562). CONCLUSION: Nearly a third of the adult patients still suffered from eustachian tube dysfunction. Pathological tympanograms and chronic otitis media usually occurred bilaterally. A relationship between the side of the cleft and the side on which the eustachian tube dysfunction or its sequelae occurred was not apparent. The main reason seems to be the continuing bilateral muscular insufficiency in opening the eustachian tube.     

Hyperbaric oxygen therapy: effect on middle ear and eustachian tube function.

Hyperbaric oxygen therapy (HBO) involves intermittent inhalation of 100% oxygen under a pressure greater than 1 atm. It is an important mode of adjuvant therapy for disease processes such as decompression sickness, osteomyelitis, carbon monoxide poisoning, and poorly healing wounds. Patients undergoing this therapy often complain of ear pain and/or fullness which can be transient or long standing. This prospective study objectively measured the changes in eustachian tube function before and after HBO treatment in 33 adult patients by the 9-step inflation-deflation test described by Bluestone. The results show 15 of the 33 patients (45%) had evidence of eustachian tube dysfunction after treatment was initiated. Of these, 15 (100%) developed the sensation of fullness, 13 (87%) developed serous otitis media, and 7 (47%) required tympanostomy tubes. The overall incidence of middle ear problems was 27 patients (82%) experiencing a sensation of fullness, 17 (52%) developing serous otitis media, and 8 (24%) requiring tympanostomy tubes. The middle ear complications reported in this study are much higher than those in previous reports in the literature. Twelve of 33 patients presented with a subjective history of eustachian tube dysfunction, and all 12 (100%) developed fullness in their ears and serous otitis media during the course of the treatment. The findings reveal that patients manifesting eustachian tube dysfunction after their first HBO treatment were at significantly greater risk toward developing symptoms of fullness and serous otitis media, often requiring tympanostomy tube placement. In addition, a history of eustachian tube dysfunction accurately predicted the development of fullness and serous otitis media.     

Laser eustachian tuboplasty: a preliminary report

OBJECTIVES/HYPOTHESIS: Surgical correction of eustachian tube dysfunction remains an elusive challenge. Repeat ventilation tube placement is often inadequate to prevent tympanic membrane and middle ear complications. Endoscopic analyses of eustachian tube dynamics have localized the site of primary pathophysiology to within the cartilaginous tube. The study investigated the feasibility, safety, and efficacy of a new endoluminal eustachian tube operation for the treatment of eustachian tube dysfunction. STUDY DESIGN: Prospective, institutional review board-approved surgical trial in a tertiary-care medical center. METHODS: Ten patients with more than 5 consecutive years of intractable otitis media with effusion recurring after two or more tympanostomy tube placements were treated with unilateral laser eustachian tuboplasty. Surgery was performed on an outpatient basis with the use of general anesthesia and combined both transnasal and transoral approaches. A 980-nm diode or argon laser was used to vaporize an appropriate amount of mucosa and cartilage on the posterior wall of the tubal lumen. Preoperative and postoperative dynamic video eustachian tube function analyses were compared. Outcome measures were presence or absence of middle ear effusion and impedance tympanograms. RESULTS: Five patients had at least 12 months of follow-up, and three of them had absence of any effusion (60%). Two patients had recurrence of their otitis media with effusion and required tympanostomy tubes again. Five patients had at least 6 months of follow-up, and four of them had absence of any effusion. The remaining patient had recurrence of otitis media with effusion and received a tympanostomy tube again. Overall results for all 10 patients after 6 months were 7 free of effusion (70%). There were no intraoperative complications. Postoperative complications were limited to minimal peritubal adhesions and one intranasal synechia. CONCLUSIONS: Preliminary results suggest that laser eustachian tuboplasty is safe and efficacious in the treatment of intractable eustachian tube dysfunction. Further study will be necessary to determine whether laser eustachian tuboplasty is a suitable alternative to repeated tympanostomy tube placement in selected patients.     

鼻内镜下导管法咽鼓管吹张及鼓室给药治疗非化脓性中耳炎

目的 观察鼻内镜下导管法咽鼓管吹张及鼓室给药治疗非化脓性中耳炎的疗效。方法 30例由咽鼓管功能不良引起的、以鼓膜内陷为主要表现的慢性分泌性中耳炎患者，在鼻内镜引导下行导管法咽鼓管吹张，并经导管吹人泼尼松龙和玻璃酸钠混合液体2ml，隔日1次，共7～lO次，检查咽鼓管功能及鼓膜形态，检测听力．评估耳鸣及耳闭塞感变化。结果30例咽鼓管功能明显改善或恢复正常，鼓膜内陷不同程度缓解，无粘连发生。纯音听阈（0．5，1．0，2．0，4．0kHz平均听阈）下降10-30dB28例，无变化2例；耳鸣消失19例，减轻7例，无效4例：耳闭塞感消失26例，明显减轻4例。结论 鼻内镜下导管法咽鼓管吹张及鼓室给药治疗由咽鼓管功能不良引起的、以鼓膜内陷为主要表现的慢性分泌性中耳炎，能改善听力，缓解耳鸣及耳闭塞感症状。其操作简单，患者痛苦小，易于接受。