Caliber of the lumen of the eustachian tube pre-isthmus in infants and children

We measured the eustachian tubes in temporal bones taken from infants and children. These specimens included eustachian tubes from 35 normal temporal bones and 13 temporal bones containing acute and secretory otitis media. All temporal bones were serially sectioned for histological studies. The lumen of the third portion of each eustachian tube (i.e., the pre-isthmus or the physiological isthmus) was measured with the aid of a grid mounted on a microscope. These measurements showed: (1) the eustachian tube lumen grows and enlarges to a small degree with age; (2) each age group has a considerable variation in the size of the lumen which is compatible with natural biological distribution; (3) no statistical differences were found in the size of the pre-isthmus lumina of those eustachian tubes from temporal bones showing acute or secretory otitis media when compared with the lumina of eustachian tubes in non-pathological ears.     

Caliber of the lumen of the eustachian tube pre-isthmus in infants and children

Summary We measured the eustachian tubes in temporal bones taken from infants and children. These specimens included eustachian tubes from 35 normal temporal bones and 13 temporal bones containing acute and secretory otitis media. All temporal bones were serially sectioned for histological studies. The lumen of the third portion of each eustachian tube (i.e., the pre-isthmus or the physiological isthmus) was measured with the aid of a grid mounted on a microscope. These measurements showed: (1) the eustachian tube lumen grows and enlarges to a small degree with age; (2) each age group has a considerable variation in the size of the lumen which is compatible with natural biological distribution; (3) no statistical differences were found in the sizes of the pre-isthmus lumina of those eustachian tubes from temporal bones showing acute or secretory otitis media when compared with the lumina of eustachian tubes in non-pathological ears.     

The infant''s pre-tympanic region of the eustachian tube in health and disease

The size of the eustachian tube lumen of the pre-tympanic segment in infants and children from birth up to two years is presented. The material consisted of serially sectioned 28 eustachian tubes of normal temporal bones and 13 eustachian tubes of temporal bones harboring acute and secretory otitis media. The size of the eustachian tube lumen was measured with the aid of a millimetric grid mounted on a microscope. These measurements have shown that: (a) there is no increase in the lumen size of the pre-tympanic region of the auditory tube from birth to two years of age. (b) Each age group presents a considerable range in luminal size, compatible with a natural biological distribution. (c) No obstruction of the eustachian tube lumen was encountered in any of the pathological specimens. (d) There is no significant statistical difference between the lumen size of the pre-tympanic region coming from normal temporal bones as compared to those from temporal bones with acute or secretory otitis media.     

The infant's "post-isthmus" region of the eustachian tube in health and disease

The size of the eustachian tube post-isthmic lumen in infants and children less than 2 years old is discussed. The material in our study consisted of serially sectioned eustachian tubes of twenty-six normal temporal bones and fourteen temporal bones harboring acute and secretory otitis media. The size of the eustachian tube lumen was measured with the aid of a millimetric grid mounted on a microscope. These measurements have shown that: There is no increase in the lumen size of the post-isthmic region of the eustachian tube from birth to 2 years of age. Each age group presents a considerable range in luminal area, compatible with the natural biologic distribution. No obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens. There is no significant statistical difference between the lumen size of the post-isthmic region coming from normal temporal bones as compared with those from temporal bones with acute or secretory otitis media.     

The eustachian tube lumen in chronic otitis media

The measurements of the size of the eustachian tube lumen, in its various regions, in adults are presented. The material consisted of serially sectioned eustachian tubes of 26 normal temporal bones and four pathologic temporal bones, three of them with simple chronic otitis media and one with cholesteatoma. These measurements reveal: (1) in adults (as in children) that there is a considerable variance of the eustachian tube lumen sizes corresponding to other variations in sizes of other organs; (2) no obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens; and (3) there was no significant statistical difference between the lumen size of the eustachian tube retrieved from normal temporal bones compared with those from temporal bones with chronic otitis media.     

Growth of the eustachian tube lumen with age

We undertook measurements of the lumina of 115 eustachian tubes of various ages. Our results showed that, like any other body organ, the eustachian tube lumen grows with age. The cartilaginous part of the eustachian tube was found to grow considerably more than the bony part. These findings, which were statistically confirmed, appear to contradict the theory ascribing the high incidence of acute otitis media in children to an enhanced susceptibility to infection due to their having a wider eustachian tube than adults.     

The human Eustachian tube lumen in children. I. The isthmus

A study of Eustachian tube measurement in infants and children is presented. The study comprised 53 Eustachian tubes from normal temporal bones and 17 Eustachian tubes from temporal bones harbouring acute and secretory otitis media. The temporal bones underwent histologic serial sectioning. The lumen of the Eustachian tube isthmus was measured with the aid of a grid mounted on a microscope. These measurements show: A) the Eustachian tube isthmus lumen does grow and enlarge slightly with age; B) each age group presents a considerable range in area, compatible with a natural biological distribution; C) no statistical difference was found in the size of isthmus lumens obtained from temporal bones which had been affected by acute or secretory otitis media, when compared with lumens of Eustachian tubes coming from non-pathological ears. This comparison took into consideration both age and physiological distribution.     

中耳炎颞骨咽鼓管峡部粘-软骨膜的组织病理学观察

目的：了解中耳炎性病咽鼓管峡部粘－软骨膜的影响。方法：用光镜对３２耳各型中耳炎颞骨（中耳炎组）与５０耳正常颞骨（正常组）标本连续切片的咽这峡部粘－软骨膜，中耳腔鼓岬粘骨组织病理学比较观察。结果：中耳炎组和正常组颞骨标本咽鼓管峡部均无病理性阻塞；中耳炎组峡部粘－软骨膜厚度测量和病理观察，未见有明显炎症改变，与正常组比较无明显差异；而其中耳腔粘骨膜均明显炎症病变。这种炎症截然不同反应的界限恰好在咽这的     

The infant's eustachian tube lumen: the pharyngeal part

A study of Eustachian tube measurements in infants and children is presented. The study included 33 Eustachian tubes from normal temporal bones and 10 Eustachian tubes from temporal bones harbouring acute otitis media. The temporal bones underwent histologic serial sectioning. The lumen of the Eustachian tube's first portion, i.e. the pharyngeal part, was measured with the aid of a grid mounted on a microscope. These measurements show: A. The Eustachian tube lumen grows and enlarges to a small extent with age. B. Each age group presents a considerable variation in the range of area of the lumen comparable with the natural biological distribution. C. No statistical difference was found between the size of the pharyngeal portion of the lumen of the Eustachian tube from temporal bones which had acute otitis media and those coming from non-pathological ears. This comparison took into consideration age and physiological distribution. These findings are similar to our earlier findings regarding the isthmic region.     

Expression of glycoconjugates in human eustachian tubes with otitis media

Objectives: To characterize glycoconjugate expression in normal human eustachian tubes and study the alterations in glycoconjugate expression found in eustachian tubes with otitis media. Study Design: Using lectin histochemistry, alterations in glycoconjugates were studied in three normal temporal bones, in four temporal bones with mucoid otitis media (MOM), and in five with serous otitis media (SOM). Methods: Sections of previously processed temporal bones were decelloidinized, and then incubated with seven biotinylated lectins-WGA, SNA, MAA, BPA, PNA, UEA-I, and LcH–that reflect seven carbohydrate residues of glycoconjugates, respectively: GlcNAc/NeuNAc, Ne-uNAcα(2–6)GalNAc, NeuNAcα(2–3)GalNAc, Galβ(1–3) GalNAc, l -fucose, and α-mannose residues. Control sections were incubated with inhibitory carbohydrates or without biotinylated lectins. Results: In the normal temporal bones, five carbohydrate residues in goblet cells and cilia of the eustachian tube demonstrated moderate to strong activity—NeuNAcα(2–6)GalNAc, NeuNAcα(2–3)GalNAc, GalNAc, Galβ(1–3)GalNAc, and l -fucose. Two residues demonstrated weak activity—GlcNAc/NeuNAc and α-mannose. Temporal bones with MOM revealed increases in sialic acid and α-mannose, and a decrease in l -fucose. Residues of carbohydrates in the cilia of bones with SOM were notably decreased, especially for GalNAc, Galβ(1–3)GalNAc, and Neu-NAcα(2–6)GalNAc. Conclusions: Glycoconjugates in the normal human eustachian tube are rich in GalNAc, Galβ(1–3)GalNAc, l -fucose, and NeuNAcα(2–3/2–6) GalNAc, but low in α-mannose and sialic acid. Eustachian tubes from cases with SOM or MOM demonstrated alterations in glycoconjugate expression in cilia and goblet cells, which may reflect disorder of the carbohydrate metabolism during otitis media, especially in SOM. Laryngoscope, 108:1474–1479, 1998     

Patulous eustachian tube following otitis media

Loss of weight, dehydration, pregnancy, fatigue, and otitis media are among the factors proposed as causes of a patulous eustachian tube, but true details remain obscure. We studied patients who developed a patulous eustachian tube following otitis media and discuss the relationship between these 2 conditions. Subjects were 12 patients diagnosed with otitis media at our department who later developed a patulous eustachian tube. The initial middle ear disease progressed from acute otitis media to otitis media with effusion in 2, acute otitis media in or acute mastoiditis in 1 each, and otitis media with effusion in the remaining 8 patients. Seven patients evidenced a low body mass index (BMI), weight loss, and underlying disease, but 5 with a patulous eustachian tube following otitis media did not. We retrospectively analyzed 119 patients diagnosed with a patulous eustachian tube in our department for whether they had been diagnosed by an ENT physician as having otitis media, i.e., acute otitis media or otitis media with effusion. Some 42 (35.3%) had a history of otitis media. At acute otitis media or otitis media with effusion, the tympanic cavity becomes inflamed, accompanied by inflammation of the eustachian tube mucosa and a stenotic tendency. Healing from otitis media is accompanied by decreased eustachian tube mucosa inflammation. We surmise that, depending on how inflammation disappears, fibrosis of the eustachian tube mucosa occurs, leading to a pathologically patulous eustachian tube. Many aspects of the causation of this condition remain unclear, but we surmised that in patients with earlier otitis media, a pathological patulous eustachian tube develops during resolution of inflammation. Our findings indicate the involvement of otitis media as a causative factors in a patulous eustacian tube.     

Thickness of the human round window membrane in different forms of otitis media

The thickness and morphologic characteristics of the round window membrane were evaluated in temporal bones from normal subjects as well as those with serous otitis media, purulent otitis media, and chronic otitis media. Temporal bones were studied in chronological order in six age ranges to determine the possibility of age-related differences. No significant difference in the mean thickness of the round window membrane was observed in terms of age groups in normal temporal bones or temporal bones from patients with otitis media; however, a significant difference in the mean thickness was observed in the various forms of otitis media compared with the normal round window membrane in all age groups. The membrane was thickest in patients with chronic otitis media when compared with that in normal subjects or those with serous or purulent otitis media. The epithelial layer (including the subepithelial space) and the fibrous layer were measured individually to determine in which layer the change in mean thickness occurred. These measurements showed an involvement of all layers of the round window membrane in those groups with otitis media, with maximal involvement of the combined epithelial layer and subepithelial space.     

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.     

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.     

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.     

Otitis Media Following Tympanostomy Tube Placement in Children With IgG2 Deficiency

Children with IgG₂ deficiency commonly develop recurrent acute otitis media. It is believed that these infections are secondary to impaired antibody response rather than eustachian tube dysfunction and are therefore less responsive to treatment with tympanostomy tubes. The authors compared the incidence of acute otitis media in IgG₂-deficient patients following tympanostomy tube placement with controls in a retrospective cohort study. The charts of 20 patients (10 with IgG₂ deficiency and 10 controls) were reviewed. Episodes of otitis media were recorded for 12 months. IgG₂-deficient patients experienced three times as many occurrences of otitis media as did controls. This suggests that otitis media is much more common in these patients following tympanostomy tube placement. We believe that an immunodeficiency workup should be considered in patients with multiple episodes of otitis media following placement of tympanostomy tubes.     

Congenital cardiac outflow tract anomalies and otitis media

The neural crest is involved in the differentiation of the cardiac outflow tract and branchial arches. Branchial arches one and two give rise to the eustachian tubes. Anatomically different eustachian tubes (e.g., short length) are found in persons prone to otitis media. We hypothesized a relationship between outflow tract anomalies and eustachian tube anomalies. The medical records of 238 children with a catheterization diagnosis of congenital heart disease were reviewed for otitis diagnoses. Children with syndromes known to be associated with recurring otitis media were excluded. Recurrent otitis media was recorded in 32.2% of those with outflow tract anomaly, significantly (P less than 0.03) higher than the 18.9% rate in children with a cardiac anomaly not involving the outflow tract. Neither race, sex, nor cyanosis seemed to account for the differing rates of otitis. These data may support the concept of a field defect arising from neural crest cells that influences the development of the cardiac outflow tract and eustachian tubes.     

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.     

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。     

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。