Variability of Eustachian tube function: comparison of ears with retraction disease and normal middle ears

OBJECTIVE: To explore the short-term and longterm variability of tubal opening and closing in ears with advanced retractions and in healthy ears. STUDY DESIGN/METHODS: Twenty ears with retraction type middle ear disease (R-MED) and 20 normal ears underwent direct recording of the middle ear pressure during repeated forced openings, equalization of +100 daPa and -100 daPa by swallowing, Valsalva inflation, and forceful sniffing. Tests were performed twice (separated by 30 min) on each of 2 days separated by 3 to 4 months. RESULTS: There was considerable intraindividual variability of the forced opening pressure and the closing pressure in both groups, within as well as between sessions and test days. Although the variability was 1.5 to 2 times higher in ears with retraction than in the normal group, mean Po and Pc did not differ between the groups. Compared with normal ears, ears with retraction changed more frequently from a positive to negative test response, or vice versa, when re-tested after 30 minutes. Rates of positive response in the equalization and Valsalva tests were significantly lower in diseased ears compared with normal ears. CONCLUSIONS: Eustachian tube opening and closing functions vary more in ears with retraction disease than in normal ears, which is consistent with the variable clinical course of R-MED and implies that single tubal function tests have little prognostic value on the individual level.     

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。     

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.     

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.     

Eustachian tube closing failure in children with persistent middle ear effusion

One important role of the Eustachian tube is to protect the middle ear from the extensive physiological pressure variations that take place in the nasopharynx, for example on sniffing. In a previous investigation in 50 children with persistent middle ear effusion a surprisingly high percentage of ears were evacuated by sniffing. The present study was undertaken in a second series of children, and results were found to be reproducible. In total 156 ears in 100 children have been investigated. In 63% of ears (73% of subjects) evacuation of the middle ear took place on sniffing. Results show that Eustachian tube malfunction in these subjects is characterized by a reduced protective function; a condition denoted "Eustachian tube closing failure".     

Nasal Gas Composition in Humans and its Implication on Middle Ear Pressure

The amount and composition of gas that enters the middle ear by the Eustachian tube is of interest in the study of middle ear pressure regulation. We have studied the gas composition in the nasal cavity through the respiratory cycle in humans by mass spectrometry. The findings were correlated to earlier findings regarding synchronization of swallowing and breathing. The composition of the gas that may pass the Eustachian tube at openings during swallowing seems to be very close to expiratory values: nitrogen 79.19%, oxygen 14.69%, argon 1.00% and carbon dioxide 5.10%.     

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.     

慢性鼻窦炎对中耳功能的影响

目的：研究慢性鼻窦炎的病变范围、病程长短对中耳功能的影响。方法：利用纯音测听及声阻抗检测５６例慢性鼻窦炎患者的纯音听力,鼓室导抗图和咽鼓管功能。结果：慢性鼻窦炎虱咽鼓管功能异常４８．３％,鼓室导抗图异常４２．０％,气导听阈提高３３．９％,前组鼻窦炎和中耳功能比较有级性差异（Ｐ〈０．０１）,病程〉５年和≤５年比较,有极显著性差异（Ｐ〈０．０１）。结论：慢性鼻窦炎对中耳功能的影响,随着病变范围的扩大,     

表面活性物质在分泌性中耳炎咽鼓管开放功能中的作用

目的　探讨外源性的表面活性物质在分泌性中耳炎咽鼓管开放功能中的作用。方法　通过鼓室内注入灭活的肺炎链球菌悬液 ,建立分泌性中耳炎动物模型 ,测试咽鼓管的被动开放压。结果　测试了中耳有渗液者 2 7耳和正常者 2 1耳的咽鼓管被动开放压 ,有渗液耳的被动开放压高于正常耳的被动开放压 ,分别注入外源性的表面活性剂后 ,被动开放压均降低 (P <0 .0 1)。结论　外源性的表面活性剂可以降低咽鼓管的表面张力 ,有利于咽鼓管的开放     

The effects of grommet insertion on Eustachian tube function

A prospective study on the effect of grommet insertion on the passive Eustachian tube opening pressure was undertaken in children's ears with otitis media with effusion. After an initial immediate improvement following aspiration of the middle ear no further change in Eustachian tube function occurred over 4 subsequent weeks. Grommet insertion probably has no effect on Eustachian tube function.     

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     

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。     

Tympano-nasopharyngeal shunt operation. A new method of middle ear ventilation.

The tympano-nasopharyngeal shunt operation is recommended as a "substitute" Eustachian tube. An experimental study regarding the efficacy of tympano-nasopharyngeal shunt operation was conducted in two dogs. Finally, four patients with complete tubal stenosis were operated on by this new method within a period of one year, with no postoperative complications. The hearing improved and patients were able to inflate their middle ears. The method is claimed to have the following advantages: permanent ventilation of the middle ear with preservation of an intact drum; the middle-ear pressure can be increased by Valsalva or Politzer manoeuvres; moderate technical difficulties; no risk of postoperative complications; and suitable in children as well as adults. The disadvantages seem to be: drainage not ensured; minor risk of ascending infection.     

The influence of upper respiratory tract inflammation upon tubal function

Eustachian tube function was examined in four patients (four ears) with a traumatic perforation of the tympanic membrane when they suffered from an upper respiratory tract (URT) infection or seasonal nasal allergy and after they had recovered. Although the tubal opening pressure did not show a distinct difference on the two occasions, the active ventilatory function was apparently impaired during the upper respiratory tract inflammation; particularly the negative middle ear pressure equalizing function, and was still impaired 2-3 weeks later after recovery from the upper respiratory tract inflammation. It is concluded that URT inflammation can affect tubal ventilatory function even in normal individuals.     

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.     

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 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.     

Evaluation of predive parameters related to eustachian tube dysfunction for symptomatic middle ear barotrauma in divers.

OBJECTIVE: Eustachian tube dysfunction plays an important role in the pathogenesis of middle ear barotrauma. This investigation evaluates the predictive value of several parameters related to tubal dysfunction, in relation to symptomatic middle ear barotrauma in divers. STUDY DESIGN: Prospective and blinded. PATIENTS: Thirty-one sport scuba divers with normal predive audiometry, tympanometry, and general and otorhinolaryngologic examination. METHODS: After an occurrence of middle ear barotrauma, the individual diver predive data on smoking, mild septal deviation, otitis media history, rhinosinusitis history, Valsalva, Toynbee, and nine-step inflation/deflation tympanometric test, as well as degree of mastoid pneumatization were registered for calculation of predictive value in relation to the barotrauma. All symptomatic ears were examined within 24 hours of diving by the investigator, who was blinded to the predive findings. Barotraumas that occurred during an upper respiratory tract infection were excluded. RESULTS: Divers completed a total of 774 dives (median, 25; range, 3-100). Symptomatic middle ear barotrauma occurred in 19 ears (31%) of 14 divers (45%) at one time or another. The rate of tubal dysfunction measured by the nine-step test and a mastoid pneumatization below average were significantly higher in divers (p <0.05) as well as in ears (p <0.005) with barotrauma. Positive and negative predictive values of both parameters for subsequent barotrauma were between 69% and 76%. Combining the results into a two-test battery in a strict approach (positive on both) increased the positive predictive value to 86%. CONCLUSION: Eustachian tube dysfunction measured by the nine-step test and a small size of the mastoid cell system seem to be risk factors for symptomatic middle ear barotrauma in otherwise healthy sport scuba divers. Evaluation of these factors in the predive examination of diving candidates may be useful in the determination of fitness to dive.