Middle ear gas exchange via the mucosa: estimation by hyperventilation

CONCLUSION: It is thought that gas exchange via the mucosa occurred in relation to the partial pressure gradient, and it was impaired mainly by inflammatory changes in the mastoid mucosa. It was verified that gas exchange via the mucosa is less likely to be impaired than gas exchange via the eustachian tube. OBJECTIVES: To evaluate the capacity of middle ear gas exchange via the mucosa by examining the effect of hyperventilation on middle ear pressure. SUBJECTS AND METHODS: A total of 55 patients, 40 patients with a type A tympanogram and 15 with type C, were selected. Tympanometry was performed in one ear every 2 min while hyperventilation was forcibly continued for 44-6 min in the supine position. The middle ear pressure and the pressure of end-tidal carbon dioxide (PETCO2) was measured, and sonotubometry was performed. RESULTS: PETCO2 decreased gradually as hyperventilation continued in all cases. Although middle ear pressure decreased by hyperventilation in 49 of 55 patients, in 6 patients it hardly decreased despite the decrease in PETCO2. These six patients were treated for otitis media with effusion within 1 month before this examination.     

Middle ear total pressure measurement as a useful parameter for outcome prediction in pediatric otitis media with effusion

OBJECTIVE: For the effective treatment of pediatric otitis media with effusion (OME) with a ventilation tube, routine evaluation of the condition of the middle ear mucosa after tube placement is critical. For this purpose, we monitored the changes in the middle ear total pressure (METP) associated with the transmucosal gas exchanges. We also evaluated the function of the eustachian tube by sonotubometry. The present study aimed to examine the temporal changes in the maximum METP after tube placement and to assess the association between the maximum METP and subsequent outcome. We also investigated the predictive value of METP measurement and sonotubometry on tube removal. METHODS: To study the temporal changes in the maximum METP after tube placement and the association between the maximum METP and outcome after tube removal, 78 patients were enrolled, who underwent ventilation tube placement between April 1991 and May 2002 and were followed up for at least a year after tube removal. Of these 78 patients, 54 patients who underwent the METP measurement on tube removal and 39 patients who underwent sonotubometry on tube removal were included in a retrospective analysis of the predictive value of these tests. The patients were divided into 4 groups according to the outcome after tube removal, graded as "excellent", "good", "persistent perforation" and "recurrence". RESULTS: The maximum METP exhibited a tendency to increase after 18 months or longer of tube placement. The comparisons of the maximum METP across the patient groups revealed that the maximum METP in patients with "excellent" was significantly higher than that in patients with "recurrence" (Student's t-test, P<0.05). As for the prediction of outcomes on tube removal, 32.4 and 57.1% of patients were predicted to have a good outcome by sonotubometry and the METP measurement, respectively (chi2 test, P<0.05). Among patients with a maximum METP higher than 31 mm H2O, 93.3% exhibited no recurrence after tube removal. CONCLUSIONS: Favorable outcome after tube removal was associated with more active transmucosal gas exchange. The maximum METP best reflected the outcome after tube removal, indicating a superior predictive value of the METP measurement over sonotubometry.     

鼻咽癌放疗后咽鼓管功能障碍的几种类型

目的：了解鼻咽癌放疗后咽鼓管功能障碍的类型及其影响。方法：对32例(50耳)鼻咽癌放疗后有咽鼓管功能障碍的患者进行常规检查、听力计检查、鼓室导抗图法检查、咽鼓管一鼓室气流动态法(TTAG)检查、咽鼓管音响法检查和内镜检查咽鼓管咽口。结果：咽鼓管异常开放2例(4耳)，患者症状较轻。咽鼓管粘连5例(7耳)，咽鼓管完全阻塞17例(27耳)，咽鼓管不全阻塞8例(12耳)，后三者症状相似，主要导致分泌性中耳炎。结论：鼻咽癌放疗后可导致不同类型的咽鼓管功能障碍，对耳功能产生损害，对其了解将有助于针对性治疗方法的确定。     

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.     

Clinical characteristics of so called eosinophilic otitis media.

OBJECTIVE: Although "eosinophilic otitis media" is not as uncommon a condition as was previously believed, its cause and pathogenesis are not yet fully understood. The purpose of this study was to describe the clinical characteristics in patients with "eosinophilic otitis media" to clarify its pathogenesis. METHODS: Seven adult patients with persistent and intractable otitis media with viscous middle ear effusion containing many eosinophils, who were also under treatment for bronchial asthma, were studied. The following examinations were conducted: nasopharyngeal endoscopy, pure-tone audiometry, eustachian tube function test, temporal bone CT scan, blood analysis, bacterial and fungal culture of middle ear effusion, histological study of the middle ear and nasal specimens, and measurement of eosinophilic cationic protein (ECP) in middle ear effusion. RESULTS: Some patients had persistent perforation with papillomatous granulation tissue arising from the mesotympanic mucosa, and all the patients had nasal polyposis. The pure-tone audiometry showed the mixed-type of hearing loss in all the patients, and the hearing level deteriorated progressively during the course in some patients. The eustachian tube function was not always poor but was patulous in some cases. The most severely diseased areas were in the eustachian tube and mesotympanum by temporal bone CT images. All the seven patients had the high levels of total serum IgE, but the RAST scores were negative in three patients and low grade in three patients. The accumulation of eosinophils was observed in middle ear effusion, middle ear mucosa and nasal polyps, and the eosinophils were highly activated with degranulation. High level of ECP was also recovered from middle ear effusion. CONCLUSIONS: Active eosinophilic inflammation occurs in the entire respiratory tract, including the middle ear in these patients. From our present investigation, we propose the criteria and clinical characteristics of "eosinophilic otitis media".     

Technique and clinical importance of eustachian tube radiography

The intact eustachian tube is essential for a successful tympanoplasty. Since clinical function tests do not provide satisfactory results in every case, radiologic examination of the tube becomes very significant. The technique, which we have employed since 1966 in sixty-seven cases of transtympanic radiography of the eustachian tube, is described. The most important indications for this examination are discussed (cases of chronic middle ear suppuration, post-traumatic tube stenosis, and early diagnosis and clarification of tumors of the nasopharynx and middle ear). The transtympanic method is physiologic, simple to perform, and essential for hearing improvement.     

鼓膜置管治疗鼻咽癌放疗后分泌性中耳炎疗效观察

目的:探讨鼓膜置管对鼻咽癌(NPC)放疗后的分泌性中耳炎(SOM)的疗效。方法:对32例(51耳) NPC放疗后经鼓膜切开抽液冲洗治疗无效的SOM患者进行鼓膜置管和随访,对治疗耳的咽鼓管功能、听力及其 他症状的改变进行评估。结果:随访6个月～5年,治愈8耳,治愈率为15.7%,有效41耳,总有效率为96.1%。 7耳(13.7%)咽鼓管功能好转,所有重复置管耳的耳功能均得到不同程度的改善。置管后耳漏发生率为25.5%, 鼓膜穿孔发生率为9.8%。结论:鼓膜置管治疗SOM有利于咽鼓管功能的恢复,对于咽鼓管功能已经严重损害 的患耳,重复鼓膜置管是维持耳功能的可靠手段;鼓膜置管的并发症利大于弊。     

Theoretic analysis of middle ear gas composition under conditions of nonphysiologic ventilation.

As gas flows in and out of the nasopharynx, the pressure in that region fluctuates. It drops below or rises above atmospheric pressure, which is itself not constant but is subject to changes in altitude and weather. Such pressure changes in the nasopharynx produce a pumping of gas into and out of the middle ear. The net amount of middle ear gas transferred from or to the nasopharynx will, component for component, in steady state exactly equal the amount of middle ear gas transferred to or from the microcirculation by means of diffusional absorption by (or release from) the mucosa. In the case of a permanently patulous eustachian tube, a single parameter, characteristic of the rate of ventilation through the open eustachian tube, is found to determine the gas composition in the middle ear, whereas in the case of a middle ear ventilated by tympanostomy, two rate-of-ventilation parameters, one for gas flow through the ventilation tube and one for flow through a periodically open eustachian tube, determine the steady state gas composition. A high rate of ventilation favors absorption of oxygen and venting of carbon dioxide from the middle ear in both cases.     

鼻咽癌放疗后咽鼓管功能障碍的评估

目的 通过综合的检测方法对鼻咽癌放疗后的咽鼓管功能障碍进行评估。方法 用鼓室导抗图法、咽鼓管一鼓室气流动态法(TTAG)、咽鼓管音响法、正-负压平衡试验法和内镜检查咽鼓管口两端等综合方法，对23例(35耳)鼻咽癌放疗后有咽鼓管功能障碍的病人进行检查和评估。结果 23例35耳中，21例3l耳表现为咽鼓管阻塞，其中完全阻塞15例21耳，不完全阻塞6例10耳；2例4耳为咽鼓管异常开放。结论 简单的检查不足以了解鼻咽癌放疗后所导致的咽鼓管功能障碍，采取多种方法的综合检查才能对咽鼓管功能障碍的性质和程度进行准确的评估。     

局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎

目的：探讨局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎的临床疗效。方法收集顽固性分泌性中耳炎患者20例（24耳）,于门诊局麻下,结合鼻内镜经鼻腔径路行咽鼓管咽口球囊扩张,并行鼓膜置管。所有患者均于术后3个月拔出T型管。结果术后随访6个月,18例患者耳闷塞感、听物朦胧感症状明显减轻,未再出现鼓室内积液。2例术后仍有耳内闷胀及听力下降,耳内镜检查示鼓室积液未吸收,再次置入T型通气管后症状改善。结论局麻下行咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎疗效显著,对于改善咽鼓管功能方法安全可行,并发症极小,是一种微创的新方法。     

95例镫骨畸形及耳硬化症的手术体会

目的:探讨鼓膜完整、咽鼓管通畅的传导性聋患者之镫骨手术的疗效。方法:回顾性分析95例鼓膜 完整、咽鼓管通畅的传导性聋的镫骨手术资料,比较耳硬化症、单纯中耳畸形、外耳道狭窄畸形之镫骨 卵圆窗外 科治疗的效果。结果:术后4周听阈均值显示:利用砧骨的卵圆窗开窗术优于砧骨 镫骨底板连接术(P<0.05); 3组中外耳道狭窄畸形优于耳硬化症及单纯中耳畸形组(P<0.05);生理性镫骨底板切除术与利用砧骨的卵圆 窗开窗术差异无统计学意义。随访1～3年,除镫骨撼动术(8/14)的听阈均值又同于术前水平外,其余均保持术 后近期听力水平。结论:镫骨手术应用于镫骨 卵圆窗畸形病例时有别于耳硬化症而有其特殊性     

The Silverstein permanent aeration tube in tympanoplasty

Hearing improvement for cases of chronic ear disease has become one of the goals of tympanoplasty. Although great strides continue to be made toward this goal, one enigma which frustrates even the most carefully performed tympanoplasty is the blocked or non-functioning eustachian tube. Early attempts to overcome this problem consisted of passing polyethylene tubing through the eustachian tube and out the nose, Zoller, or drilling out the tubal orifice, Wullstein. Other articles recommended rerouting the eustachian tube through the maxillary sinus or reconstructing its normal course by a middle fossa approach. Herbert Silverstein first introduced the idea of a permanent indwelling silastic aeration tube for treatment of chronic serous otitis media in 1970; he also described its use in ears with ossicular problems and poor eustachian tube function. He places this tube by drilling a hole through the posterior inferior bony annulus of the middle ear or directly into the mastoid antrum. The Silverstein permanent silastic aeration tube has been found to be a valuable adjunct in tympanoplasty. This tube may be utilized at the time of the initial surgery or as a secondary procedure. It may be placed through the bony annulus of the middle ear or into a hole drilled to the mastoid antrum as described by Silverstein; however, in ears where the incus must be removed, the fossa incudis becomes the preferred location. Sixteen cases are reported in which the Silverstein permanent aeration tube was utilized in conjunction with tympanoplasty. The concept for use of this permanent silastic tube arose out of the frustrating experience of producing recurrent perforations in grafted tympanic membranes by the use of conventional aeration tubes; therefore, the following technique was adopted: a diagnostic myringotomy was performed and a polyethylene tube placed temporarily through the grafted tympanic membrane. If the hearing improved following the procedure the patient was scheduled for insertion of a permanent aeration tube. In selected cases the aerating device was used in conjunction with the original tympanoplasty. Postoperative care is simple and consists of cleaning crusts from within and around the tube. Although infections through the tube are infrequent, if they occur the tube may be removed as an office procedure. Overall hearing results have been gratifying. Six months following surgery 81 percent of the patients had closed the air bone gap to within 10 decibels or less and another 12 percent to within 20 decibels of the preoperative bone conduction. There was more loss of hearing in two of the 16 ears following this procedure, but in none was there a significant change in the discrimination score or the development of an unserviceable ear. Truly this is a detour and bypass procedure, and it would be much more physiologic and desirable to restore middle ear aeration through the normal eustachian tube; however, until a reliable, simple and consistent procedure can be devised, the Silverstein permanent aeration tube appears to fulfill the requirements of maintaining middle ear aeration with good hearing and function.     

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.     

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.     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的探究咽鼓管功能障碍的慢性化脓性中耳炎治疗效果。方法2016年12月~2020年2月,从本院收治的咽鼓管功能障碍的慢性化脓性中耳炎患者中选择50例进行研究,回顾患者病例,以不同的治疗方案作为分组标准,将50例患者分为对照组、实验组,各25例。对照组只开展中耳乳突手术,实验组同期开展中耳乳突手术与咽鼓管球囊扩张术,对比两组听力改善效果、治疗效果、并发症发生率。结果实验组听力改善效果明显高于对照组,P<0.05;术后3个月、6个月实验组患者的EDTQ-7评分、听阈值均低于对照组,P<0.05;实验组并发症发生率低于对照组,P<0.05。结论在咽鼓管功能障碍的慢性化脓性中耳炎患者行中耳乳突手术时,同期开展咽鼓管球囊扩张术,既能改善患者的听力状态,又能提升治疗效果,减少并发症,值得推荐。     

试析Toynbee现象与中耳压力的关系

采用声管测定法，声阻抗测定法和鼻咽压力测定法，研究在Ｔｏｙｎｂｅｅ试验时叶耳压力，咽鼓管开放时程和鼻咽和时程三者间的关系，同时，测定 腔填塞前后鼓室 力的变化，并用糖精法测定鼓膜穿孔者于鼻腔填塞前后的粘膜纤毛运动情况。     

Sonotubometry: eustachian tube ventilatory function test: a state-of-the-art review.

OBJECTIVE: Disturbance of any of the ET functions may contribute to the development of otitis media. Sonotubometry measures the ventilatory function using sound. The qualities of sonotubometry as a test for eustachian tube ventilatory function have been studied by various investigators. The development of the method is described in the review, and a summary of the study results is provided to make an estimate of the diagnostic potential of this eustachian tube function test. DATA SOURCES: The English-language literature on the topic was searched systematically by Medline and Pubmed using the following key words: ventilatory function, eustachian tube, sonotubometry, and function test. There were no limits for the year of publication. STUDY SELECTION: Articles that described the method itself (validity, reproducibility, diagnostic value) were studied in detail. DATA EXTRACTION: All the articles described in study selection were used for this review. CONCLUSIONS: The technique of sonotubometry has been improved gradually over the years. The results of sonotubometry are at least as good as those of other function tests. However, because the results still tend to be ambiguous in children and otitis media is most common in this population, the reproducibility and application of sonotubometry must be evaluated further. Sonotubometry has great advantages over other function tests, but it is not used routinely to assess eustachian tube ventilatory function because its value for clinical practice has not yet been adequately demonstrated. The review showed that sonotubometry can be improved further and that efforts to do so seem justified because it forms a particularly promising method to assess eustachian tube function in children with suspected eustachian tube disease.     

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.     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的：探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法：对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者（128耳）行有针对性的治疗。结果：鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义（P＜0.01）。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义（P＜0.05）。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论：儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。     

鼻咽癌放化疗后近期听力学改变

目的 研究鼻咽癌患者放化疗后近期的听力学改变.方法 根据鼻咽癌的治疗方式,将64例(128耳)鼻咽癌患者分为单纯放疗组(45例,90耳)和放化疗联合治疗组(简称联合治疗组,19例,38耳),同时选取25例(50耳)无明显耳鼻疾病患者为对照组.在鼻咽癌患者放化疗前及结束后2～3个月进行耳镜检查、纯音测听、鼓室导抗图及咽鼓管功能测试,分析鼻咽癌放化疗后近期的听力学改变.结果 鼻咽癌患者放疗后近期多有鼓膜性状的改变,联合治疗组和单纯放疗组患者均呈现听力下降,其中单纯放疗组以传导性听力下降多见(24%,22/90),而联合治疗组以感音神经性(29%,11/38)及混合性听力下降为主(24%,9/38).两组患者中多存在咽鼓管功能障碍.结论 鼻咽癌放化疗后近期听力损害中,放射治疗主要影响中耳及咽鼓管功能,化学治疗以内耳毒性为主,放化疗联合治疗加重听力损害.