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Toivonen J, Poe D. The case for balloon eustachian tuboplasty in children. Curr Opin Otolaryngol Head Neck Surg 2024:00020840-990000000-00136. [PMID: 39146019 DOI: 10.1097/moo.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Balloon dilation of the cartilaginous portion of the Eustachian tube has increasingly gained acceptance among otolaryngologists in the treatment of obstructive Eustachian tube dysfunction. There is however little data on the procedure performed in children. The purpose of this study is to review the recent developments regarding balloon dilation in pediatric patients. RECENT FINDINGS Balloon dilation of the Eustachian tube is safe in pediatric patients. The effects of the procedure are durable during long term follow-up. Diagnosing obstructive dysfunction remains challenging. There is no single test or questionnaire for diagnosing the condition; instead a series of appropriate tests should be used. The pediatric Eustachian tube is very responsive to the effects of balloon dilation. While the treatment is effective, overtreatment can have unwanted results such as patulous symptoms. Reducing the time of dilation should therefore be considered. SUMMARY Otolaryngologists performing the procedure should be familiar with the effects of balloon dilation on the pediatric Eustachian tube and consider altering the duration of dilation accordingly. Further studies are needed especially regarding patient selection, optimal age for dilation and balloon parameters for pediatrics (e.g. dimensions, inflation duration, inflation pressure).
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Affiliation(s)
- Joonas Toivonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Dennis Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Anastasiadou S, Bountzis P, Gkogkos DE, Karkos P, Constantinidis J, Triaridis S, Psillas G. Eustachian Tube Dysfunction Diagnostic Pathway-What Is the Current State of the Art and How Relevant Is Chronic Nasal Disease? J Clin Med 2024; 13:3700. [PMID: 38999265 PMCID: PMC11242287 DOI: 10.3390/jcm13133700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/06/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Eustachian tube dysfunction (ETD) presents a complex diagnostic challenge in otolaryngology, compounded by its multifaceted nature and overlapping symptoms with chronic nasal disease. This article examines the intricacies of ETD diagnosis, emphasising the necessity for a consensus on diagnostic procedures. Methods: A review of the literature was performed through the OVID research tool in the Pubmed/Medline databases to identify relevant articles that discuss eustachian tube dysfunction diagnostics as well as its correlation with chronic nasal disease. Results: The literature review harvested 201 articles, and only 51 of them were included in the full text review. A consensus statement was identified on eustachian tube dysfunction, function and diagnostics. It appears that there is significant variability in the diagnostic tools used to identify eustachian tube dysfunction. The main diagnostic approaches used are tympanometry, tubomanometry and sonotubometry, combined with the Patient-Reported Outcome Measure ETDQ-7 questionnaire to support the diagnosis of the condition. Nasal pathology is mostly absent from the retrieved studies, while ear pathology is more commonly mentioned in the current literature. Conclusions: There is no gold standard diagnostic tool to determine the presence of eustachian tube dysfunction. Further discussion, large multicentre studies and focused research are required to achieve a consensus on a diagnostic approach. The authors suggest a diagnostic pathway that combines subjective and objective diagnostic tools to determine the presence of eustachian tube dysfunction. This pathway is simple and can be used in district ENT departments, highlighting the nasal pathology relevance to ETD.
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Affiliation(s)
- Sofia Anastasiadou
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - Polyzois Bountzis
- Department of Mathematics and Physics, Universita della Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | | | - Petros Karkos
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - Jannis Constantinidis
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - Stefanos Triaridis
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - George Psillas
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
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Herrera M, Miranda E, Villarreal I, Crespo T, Plaza G. Assessing the usefulness of tubomanometry as a diagnostic tool in Eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08724-8. [PMID: 38809266 DOI: 10.1007/s00405-024-08724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE This study aims to evaluate the validity and reliability of tubomanometry (TMM) in diagnosing obstructive Eustachian tube dysfunction (OETD) before balloon Eustachian tuboplasty (BET). METHODS A prospective cohort study was conducted, involving 25 patients with sinonasal pathology, 75 patients with middle ear disease, and 25 healthy subjects, totaling 250 ears. All participants underwent comprehensive physical examinations, including TMM, nasal videoendoscopy, otoendoscopy, Valsalva maneuver (VM), tympanometry, and audiometry. Additionally, various scales such as ETDQ-7 and ETS-7 were employed. Tympanometry served as the gold standard for assessing OETD, and comparisons were made among the measures across the three groups. RESULTS Among the 125 participants, 44.8% (n = 56) were female, and 55.2% (n = 69) were male, with ages ranging from 19 to 93 years (M = 48.5; SD = 15.6). In our study, VM demonstrated high sensitivity (86.3%) when tympanometry was considered the gold standard. Conversely, TMM, ETDQ-7, and ETS-7 exhibited high specificity, with ETDQ-7 showing the highest specificity (87.4%). Regarding TMM, all R values in patients within the middle ear disease group were pathological (R > 1). CONCLUSION TMM has exhibited notable specificity as a diagnostic tool compared to tympanogram and VM. Nonetheless, the combination of TMM and ETDQ-7 has enabled us to conduct a diagnostic assessment with high sensitivity and specificity for chronic OETD diagnosis.
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Affiliation(s)
- Mayte Herrera
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Estefanía Miranda
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Ithzel Villarreal
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Teresa Crespo
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain.
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario La Zarzuela, Madrid, Spain.
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Aldè M, Cantarella G. Commentary on "Assessment of the Eustachian tube: a review". Eur Arch Otorhinolaryngol 2024; 281:527-528. [PMID: 37715809 DOI: 10.1007/s00405-023-08241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Mirko Aldè
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
| | - Giovanna Cantarella
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lin JT, Hsu HJ, Ho CY, Tsai SW, Li YL, Wu JL. Balloon Dilation Eustachian Tuboplasty for Dilatory Dysfunction With and Without Effusion: A Comprehensive Outcome Analysis. Otolaryngol Head Neck Surg 2023; 169:1179-1186. [PMID: 37264984 DOI: 10.1002/ohn.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study aimed (1) to demonstrate the efficacy of balloon dilation Eustachian tuboplasty (BDET) for dilatory Eustachian tube dysfunction (ETD) and (2) to determine whether adjunctive ventilation tube insertion (VTI) is superior to myringotomy in relieving symptoms for patients with ETD and concurrent middle ear effusion (MEE) treated with BDET. STUDY DESIGN A retrospective cohort study. SETTING Tertiary care academic center. METHODS Patients with dilatory ETD undergoing BDET with a ≥6-month follow-up period were enrolled and evaluated mainly using Eustachian tube function (ETF) tests and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). Participants with concurrent MEE were further classified into 2 subgroups, BDET with VTI and BDET with myringotomy. An intergroup comparison and comprehensive outcome evaluation were performed. RESULTS In total, 35 patients with 50 symptomatic ears were enrolled. According to ETF test results, the normalized ETF rate was 94% on the last visit. The mean ETDQ-7 scores decreased significantly from 3.7 ± 1.4 to 2.0 ± 0.9 after interventions, with the most improvement in symptoms occurring for "ear fullness" and "muffled hearing." For the final visit, strong correlations among ETF tests, tympanometry, and Valsalva results were noted. The aforementioned assessment results did not significantly differ between (1) the patients with MEE and patients without MEE and (2) "BDET with VTI" subgroup and "BDET with myringotomy" subgroup. CONCLUSION BDET was effective for dilatory ETD, even in cases with concurrent MEE. For patients with ETD and MEE, further research is required to evaluate the benefits of adjunctive myringotomy with or without VTI.
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Affiliation(s)
- Jung-Ting Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Otolaryngology, Kuo General Hospital, Tainan City, Taiwan
| | - Chen-Yu Ho
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Otolaryngology, Kuo General Hospital, Tainan City, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yi-Lu Li
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Characteristics of tympanogram in symptomatic Eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2023; 280:581-587. [PMID: 35796829 DOI: 10.1007/s00405-022-07503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/09/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To identify the characteristics of tympanogram in symptomatic Eustachian tube dysfunction (SETD) patients. METHODS One hundred and twenty-four unilateral SETD patients presenting with type A tympanograms who underwent balloon dilation of the Eustachian tube (BDET) were recruited and assigned into effective BDET group and ineffective BDET group based on treatment effect. The unaffected ear in the same patient served as normal control. Fifty-one patients with sudden sensorineural hearing loss (SSHL) and 46 patients with Meniere's disease (MD) were selected for cases of non-ETD ear fullness. Demographics, 7-item Eustachian Tube Dysfunction Questionnaire score (ETDQ-7), and tympanograms were recorded and analyzed preoperatively and postoperatively. RESULTS Of the 124 SETD patients included in the study 94 (75.8%) showed good response to BDET based on decreased ETDQ-7 scores. There were no significantly differences in the values of tympanometric peak pressure (TPP) between diseased ears and healthy ears in SETD patients, as well as in SSHL and MD patients. Instead, TPP shifts (the difference between two values of TPP obtained under a Valsalva and Toynbee maneuver) were remarkably reduced in affected ears compared with those in unaffected ears in effective BDET group at baseline. Moreover, TPP shifts in these SETD ears significantly raised and reached the levels in healthy ears postoperatively. CONCLUSIONS This study demonstrated TPP shifts are decreased in a subset of SETD patients presenting with type A tympanograms and these patients are more likely to show good response to BDET.
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Impact of body mass index in patulous Eustachian tube: Does rapid weight loss influence symptom improvement? Am J Otolaryngol 2022; 43:103581. [DOI: 10.1016/j.amjoto.2022.103581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
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Altalhi WA, Alsulaimani AI, Alhossaini ZA, Alharthi RM, Almalki ZA, Altalhi WA, Alswat SH, Alnefaie GO. Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Taif, Saudi Arabia. Cureus 2022; 14:e27482. [PMID: 36060369 PMCID: PMC9423007 DOI: 10.7759/cureus.27482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background The eustachian tube is a tubular structure connecting the middle ear cavity with the nasopharynx, providing ventilation and pressure equalization in the middle ear, mucociliary clearance, and preventing the reflux of sound and fluid from the nasopharynx. Therefore, any kind of deficiency in this tube will lead to eustachian tube dysfunction (ETD). Aim This study aims to evaluate the prevalence and associated factors of ETD in the Taif public. Materials and methods A descriptive cross-sectional survey was conducted among the public in Taif, Saudi Arabia and it was done during the period between September 7 and September 28, 2021. A predesigned online questionnaire in the Arabic language was used to collect the data. The questionnaire contained three main parts. The first one included demographic questions, the second risk factors, and the third manifestations of ETD. The questionnaire was initiated after a literature review of similar articles and after experts' consultation for validity and reliability. Results A total of 693 participants completed the study questionnaire. The exact 546 (78.8%) participants were females and 671 (96.8%) were Saudi. The exact 122 (61%) participants among those who had ETD or hearing loss reported improvement in their symptoms after moving to another city below sea level. The exact 146 (21.1%) participants had ETD while 547 (78.9%) had reported normal function. ETD was detected among 69.2% of those who were previously diagnosed with ETD versus 20.1% of others (P=0.001). Participants with a family history of hearing loss showed a nearly doubled risk for having ETD (OR=1.98; 95% CI: 1.33-2.94) and smokers had nearly the same doubled likelihood(OR=1.83; 95% CI: 1.01-3.48). Conclusion In conclusion, our study revealed a slightly high prevalence of ETD and hearing loss among the public in Taif, Saudi Arabia, and the factors associated with ETD.
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A Novel Eustachian Tube Test: Preliminary Research of Sonotubometry With Nasopharynx Under Pressure. Otol Neurotol 2022; 43:580-586. [PMID: 35239623 DOI: 10.1097/mao.0000000000003511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to develop a novel Eustachian tube (ET) test consisting of sonotubometry with nasopharynx under pressure to measure opening of the ET. We assessed the advantages of this novel approach compared with those of sonotubometry only or tubomanometry only and explored the possibility of quantifying ET patency. STUDY DESIGN This was a prospective clinical study at a tertiary referral center. METHODS Sonotubometry, tubomanometry, and sonotubometry with nasopharynx under pressure were performed on a total of 106 ears. The ET-opening detection rates of the different test methods were compared with McNemar's test or Fisher's exact test. The correlation between the ET-opening latency index (R value) and nasopharyngeal pressure, as well as the correlation between the sound pressure of the external ear canal and the nasopharyngeal pressure, was assessed via Spearman's correlation coefficients. RESULTS ET openings were detected most frequently during sonotubometry with nasopharynx under pressure, with opening rates of 93.40, 98.10, and 98.10% at 30, 40, and 50 mbar, respectively, which were significantly higher than those of sonotubometry (80.20%) and tubomanometry (74.50, 86.80, and 90.60% at 30, 40, and 50 mbar, respectively). Both R values and sound pressures were significantly different at pressures of 30, 40, and 50 mbar; the R value decreased with the increase of nasopharyngeal pressure (r = -0.298, p = 0.000), while the sound pressure increased with nasopharyngeal pressure (r = 0.251, p = 0.000). CONCLUSIONS Sonotubometry with nasopharynx under pressure represents a novel hybrid ET test that our findings suggest is superior to sonotubometry only and tubomanometry only in detecting ET openings in healthy ears. Sound pressure resulting from sonotubometry with nasopharynx under pressure may be useful for quantifying the degree of openness of the ET. However, further validation in both healthy subjects and patients with ET dysfunction is required before this novel ET test may be recommended for clinical use.
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Alkholaiwi F, Alnatheer AM, Theyab RS, Alyousef M, Aldrees T, Dahmash AB, Alghonaim Y. Cross-Cultural Adaptation, Validation, and Arabic Translation of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Int Arch Otorhinolaryngol 2022; 26:e636-e642. [DOI: 10.1055/s-0041-1740161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/20/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) scale is used to assess the effectiveness of the treatment and to determine the severity of the eustachian tube dysfunction (ETD). There is currently no validated Arabic version of the ETDQ-7.
Objectives The aim of the present study is to test the validity and the reliability of a translated Arabic version of the ETDQ-7.
Methods A multicenter prospective validation study was conducted in Riyadh, Saudi Arabia. The ETDQ-7 was adapted and translated into Arabic using a standard validation methodology. Fifty-one patients diagnosed with Eustachian tube dysfunction and 45 healthy individuals were enrolled in the study. The known-groups method was used in the validity analysis. The test-retest method, item-total score correlation, and internal consistency analysis were used for the reliability analyses.
Result The overall internal consistency of the Arabic ETDQ items was measured using Cronbach α (Cronbach α = 0.803). The average and total ETDQ scores were significantly higher in the ETD group (17.6) than in the control group (9.87) (p < 0.001). The results indicate a good to excellent correlation (> 0.7). The area under the curve for the total ETDQ score was 88.6% (95% confidence interval [CI]: 80.3–96.8%)
Conclusion The Arabic version of the ETDQ-7 scale is a valid instrument for evaluating ETD. It can also be used as an important tool for diagnosis, patient follow-up, and treatment management.
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Affiliation(s)
- Feras Alkholaiwi
- Department of Otorhinolaryngology – Head and Neck Surgery, College of Medicine, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah M. Alnatheer
- College of Medicine, Imam Mohammed ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Rami Saud Theyab
- Department of Audiology, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Meshal Alyousef
- College of Medicine, Imam Mohammed ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Turki Aldrees
- Department of Otorhinolaryngology – Head and Neck Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Yazeed Alghonaim
- Division of Otorhinolaryngology – Head and Neck Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Choi KY, Jang S, Seo G, Park SK. Effect of Endoscopic Sinus Surgery on Eustachian Tube Function in Adult Sinusitis Patients: A Prospective Case-Control Study. J Clin Med 2021; 10:jcm10204689. [PMID: 34682811 PMCID: PMC8537722 DOI: 10.3390/jcm10204689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
The eustachian tube (E-tube) function is known to be related with sinusitis; however, the effect of endoscopic sinus surgery (ESS) on E-tube function is not clearly documented. This study aimed to prospectively evaluate the function of the E-tube by using both subjective and objective tests in adult chronic sinusitis patients undergoing ESS, and to compare with those of the patients without sinusitis. Thirty adult patients who underwent ESS for treatment of chronic sinusitis and another thirty patients without sinusitis who underwent other nasal surgeries (septoplasty, rhinoplasty, or closed reduction) were evaluated and compared for E-tube function before and after three months of their surgeries. The E-tube function tests included the seven-item eustachian tube dysfunction questionnaire (ETDQ-7), Valsalva test, and inflation-deflation test that were compared preoperatively and postoperatively in both groups. Compared with the group without sinusitis, the ESS group showed significant improvement of E-tube function after surgery in the ETDQ-7 (p = 0.002), right Valsalva test (p = 0.015), right deflation test (p = 0.005), and left deflation test (p = 0.006). A binary logistic regression analysis revealed that ESS significantly improved E-tube function in the right Valsalva test in a univariate (p = 0.021) and multivariate analysis (p = 0.008), and E-tube function in the left deflation test in a univariate (p = 0.021) and multivariate analysis (p = 0.039). These findings indicate that E-tube function is significantly improved after ESS in adult sinusitis patients, and that the presence of sinusitis and implementation of ESS should be considered (if sinusitis is present) in managing patients with ear diseases that are affected by E-tube function.
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Widodo DW, Hisyam A, Alviandi W, Mansyur M. Comparison of Eustachian tube ventilation function between cleft palate and normal patients using sonotubometry. JPRAS Open 2021; 29:32-40. [PMID: 34036142 PMCID: PMC8138675 DOI: 10.1016/j.jpra.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/01/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To compare Eustachian tube ventilation function between cleft palate subjects and normal subjects using sonotubometry. Method A comparative cross-sectional study was conducted at the Department Otolaryngology-Head and Neck Surgery of Ciptomangunkusumo National Hospital, Universitas Indonesia, Jakarta, from June 2013 to January 2014.There were 31 subjects with cleft palate and 62 healthy subjects aged ≤18 years, and both groups were matched according to age. Each subject underwent ear, nose, and throat examination with Veau classification and sonotubometry, a new assembly test in Indonesia. The results of the sonotubogram (the number of Eustachian tube openings, amplitude enhancement in dB, and the duration of Eustachian tube opening in ms) were then analyzed with SPSS using chi-square and Mann–Whitney tests. Results Subjects with cleft palate had lower Eustachian tube function than healthy subjects using three sonotubometry parameters (p < 0.001). The proportion of Eustachian tube dysfunction based on the Veau classification was significant (p < 0.001). In multivariate analysis, several determinant factors of Eustachian tube dysfunction were found, such as adenoid hypertrophy (risk factor6.46), the number of Eustachian tube openings (risk factor 36.21), and higher Veau classification (risk factor 10.41). Conclusion Sonotubometry could be used to assess parameters of Eustachian tube function. Subjects with cleft palate have a higher risk of having Eustachian tube dysfunction, as do subjects with adenoid hypertrophy.
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Affiliation(s)
- Dini Widiarni Widodo
- Department of Otolaryngology, Cipto Mangunkusumo Hospital - Universitas Indonesia, P.Diponegoro Street no. 71, Senen, Central Jakarta, 10430, Indonesia
| | - Adila Hisyam
- Department of Otolaryngology, Cipto Mangunkusumo Hospital - Universitas Indonesia, P.Diponegoro Street no. 71, Senen, Central Jakarta, 10430, Indonesia
| | - Widayat Alviandi
- Department of Otolaryngology, Cipto Mangunkusumo Hospital - Universitas Indonesia, P.Diponegoro Street no. 71, Senen, Central Jakarta, 10430, Indonesia
| | - Muchtaruddin Mansyur
- Department of Public Health and Community, Cipto Mangunkusumo Hospital - Universitas Indonesia, P.Diponegoro Street no. 71, Senen, Central Jakarta, 10430, Indonesia
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Eustachian Tube Function Assessment after Radiofrequency Turbinate Reduction in Atopic and Non-Atopic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030881. [PMID: 33498556 PMCID: PMC7908237 DOI: 10.3390/ijerph18030881] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
(1) Background: Inferior turbinates’ hypertrophy is often associated with Eustachian tube dysfunction (ETD); radiofrequency turbinate reduction (RTR) may provide a long-term improvement of nasal obstruction and ETD-related symptoms. (2) Aim: The study aimed to compare ETD in atopic and non-atopic patients before and after RTR and to investigate the correlation between tympanometry and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). (3) Methods: Ninety-seven patients, ranging from 33 to 68 years old, were screened by skin tests and divided into atopic (G1) and non-atopic (G2). Eustachian tube function (ETF) was evaluated through tympanometry, William’s test and ETDQ-7. (4) Results: A moderate to severe subjective ETDQ-7 was found in the 35.42% of G1 and in the 22.45% of G2 patients before RTR. William’s test resulted normal in 141 ears (72.68%), partially impaired in 15 (7.73%), and grossly impaired in 38 (19.59%) before surgery. A grossly ETD was evidenced in the 19.59% of cases before surgery and decreased to 6.18% after surgery with a significant difference among atopic patients (p < 0.001). (5) Conclusion: RTR may be considered a treatment option in patients suffering from ETD and inferior turbinates’ hypertrophy; RTR reduced the percentage of grossly impaired ET function (p < 0.001). ETDQ-7 and William’s test may represent valuable tools to assess ET function before and after surgery.
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Alshehri KA, Saggaf OM, Alshamrani HM, Alnefaie AM, Alghamdi KB. Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Jeddah, Saudi Arabia: Cross-Sectional Survey-Based Study. Interact J Med Res 2020; 9:e14640. [PMID: 33211016 PMCID: PMC7714651 DOI: 10.2196/14640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 02/29/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Obstruction of the Eustachian tube is a common condition that is unpleasant and might lead to various middle ear disorders. Objective This study aimed to estimate the prevalence of Eustachian tube dysfunction (ETD) among the public in Jeddah, Saudi Arabia. Methods This cross-sectional survey-based study was conducted in Jeddah during August 2018 by distributing an electronic survey form to participants from different districts of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study. Results A total of 2372 participants (female, 1535/2372, 64.71%; male, 837/2372, 35.28%; mean age 31.31 years, SD 11.85 years) agreed to contribute to our study. Upon analysis of their answers to the questionnaire, the overall prevalence of ETD in our sample was found to be 42.49% (1008/2372). The prevalence was higher among participants who reported a previous diagnosis of ETD and hearing loss (1897/2372, 80.00% and 1902/2372, 80.21%, respectively). Additionally, participants with a family history of hearing loss had a significantly higher prevalence (1136/2372, 47.92%) of ETD than those with no family history of hearing loss. Our analysis also showed that females were at a greater risk of developing ETD than males (P=.01). Conclusions As per our prevalence data, ETD is a common disease in Jeddah, pointing to the need for more attention, awareness, and research.
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Affiliation(s)
- Khalid A Alshehri
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar M Saggaf
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hussein M Alshamrani
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Khalid B Alghamdi
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Lee S, Oh SJ, Choi SW, Hwangbo L, Lee HM, Lee IW, Kong SK. The usefulness of Valsalva computed tomography as an assessment tool for the Eustachian tube. Am J Otolaryngol 2020; 41:102499. [PMID: 32354482 DOI: 10.1016/j.amjoto.2020.102499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the usefulness of 'computed tomography (CT) with Valsalva maneuver (VM)' (Valsalva CT) for localizing lesions of the eustachian tube (ET) and identifying characteristics of ET dysfunction (ETD). MATERIALS AND METHODS In this case-control study, 12, 17, and 25 patients with obstructive ETD (OETD), patulous eustachian tube (PET), and conductive hearing loss (control), respectively, underwent Valsalva CT in the supine position. The visualized length to total length ratio of the cartilaginous ET (VTRET) with and without VM were compared in the three groups. In the OETD group, obstructed areas of the ET were identified on multiplanar reconstructed images. RESULTS VTRET without VM in the PET group was significantly higher than that in the control and OETD groups (p-values, 0.003 and 0.007, respectively). However, there was no significant difference between the control and OETD groups (p = 0.053). VTRET with VM in the PET group was significantly higher than that in the other two groups (p < 0.001), whereas that in the control group was significantly higher than that in the OETD group (p < 0.001). In the OETD group, the obstructed area was clearly identified, and there were one, one, six, and eight patients in the isthmus; bony portion and isthmus; bony portion, isthmus, and cartilaginous portion; and isthmus and cartilaginous portion subgroups, respectively. CONCLUSION Valsalva CT is particularly valuable as a visualization assessment tool for identifying obstructed areas in the OETD. It may help future research of disease-specific mechanical characteristics of the ET on controlling pressure variables.
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Affiliation(s)
- Seokhwan Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Lee Hwangbo
- Department of Radiology and Biomedical Research Institute, Busan, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun-Min Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Yangsan Pusan National University Hospital, Yangsan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Yangsan Pusan National University Hospital, Yangsan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
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Plaza G, Navarro JJ, Alfaro J, Sandoval M, Marco J. Consensus on Treatment of Obstructive Eustachian Tube Dysfunction With Balloon Eustachian Tuboplasty. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.otoeng.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Alper CM, Teixeira MS, Rath TJ, Hall-Burton D, Swarts JD. Change in Eustachian Tube Function With Balloon Dilation in Adults With Ventilation Tubes. Otol Neurotol 2020; 41:482-488. [PMID: 32176133 PMCID: PMC8126344 DOI: 10.1097/mao.0000000000002559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assess the changes in Eustachian tube (ET) function (ETF) with balloon dilation of Eustachian tube (BDET). STUDY DESIGN Prospective cohort for repeated testing measures. SETTING Clinical research center. PATIENTS Eleven adults with at least one patent ventilation tube (VT) inserted for chronic ET dysfunction (ETD) and history of otitis media with effusion. INTERVENTIONS Subjects with evidence of moderate to severe ETD on the side with a VT underwent unilateral BDET. MAIN OUTCOME MEASURES Changes in ETF parameters after BDET measured by Forced Response Test (FRT), Inflation Deflation Test (IDT), and Pressure Chamber test. RESULTS With the FRT at 11 ml/min, opening pressure (OP) decreased from 458 ± 160 to 308 ± 173 daPa and closing pressure (CP) from 115 ± 83 to 72 ± 81 daPa at the 3-month post-BDET visit. The IDT and Pressure Chamber test showed that the percentage of middle ear (ME) pressure gradient equilibrated with swallows improved from 28 ± 34 to 53 ± 5% for positive and from 20 ± 28 to 38 ± 43% for negative ME pressure. Images from the pre- and post-BDET functional CT scans did not show apparent changes in the anatomy. Comparisons of ETF test parameters pre- and post-BDET suggested that the ET was easier to open and stayed open longer after the procedure. However, during the limited duration of follow-up most subjects continued to have ETD, some requiring VT re-insertion after the study period. CONCLUSIONS Adults with severe ETD may benefit from BDET, however ETD may not be completely resolved and patients may continue to need VTs.
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Affiliation(s)
- Cuneyt M. Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine (UPSOM)
- Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh (CHP)
- Clinical and Translational Research, UPSOM
| | - Miriam S. Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine (UPSOM)
| | | | | | - J. Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine (UPSOM)
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18
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Alper CM, Teixeira MS, Swarts JD. Eustachian Tube Function in Adults with Ventilation Tubes Inserted for Otitis Media with Effusion. J Int Adv Otol 2019; 14:255-262. [PMID: 30256199 DOI: 10.5152/iao.2018.4521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the eustachian tube (ET) function (ETF) in adults with ventilation tube (VT) inserted for the treatment of chronic otitis media with effusion (COME). MATERIALS AND METHODS A total of 17 subjects with at least one VT were enrolled. A detailed history was obtained, and risk factors were assessed with questionnaires. Examination including nasopharyngeal video endoscopy and ETF tests, the forced response test (FRT), inflation-deflation test (IDT), and nasal/nasopharyngeal maneuvers (such as sniffing and Valsalva, Toynbee, and the diver's maneuvers) were performed. RESULTS Averages for FRT were 580±333 daPa, 382±251 daPa, and 138±192 daPa for opening pressure, steady-state pressure, and closing pressure, respectively. Most subjects demonstrated minimal or weak active function during the FRT and IDT. While nasopharyngeal maneuvers changed the nasal/nasopharyngeal pressures, they did not significantly change the middle-ear pressures. These results indicated that most subjects had severe obstructive ET dysfunction (ETD) with an ET lumen that required high pressure differences to open and poor active muscular function inadequate for luminal dilation. These results imply that while any treatment to widen the ET, such as balloon dilation of the ET, is not expected to change the voluntary active muscular function, it may reduce the tissue pressures and resistance, thus facilitating luminal opening both passively and actively. CONCLUSION Most patients with VT inserted for the treatment of COME appear to have an abnormal ETF with difficulty in passively opening the ET and weak active muscular function. Management of such patients addressing only passive properties may not be sufficient for the resolution of ETD.
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Affiliation(s)
- Cüneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA; Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Smith ME, Bance ML, Tysome JR. Advances in Eustachian tube function testing. World J Otorhinolaryngol Head Neck Surg 2019; 5:131-136. [PMID: 31750424 PMCID: PMC6849358 DOI: 10.1016/j.wjorl.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022] Open
Abstract
Obstructive and patulous Eustachian tube dysfunction provide a significant diagnostic and management challenge. The development of new treatments such as balloon Eustachian tuboplasty has generated renewed interest in measuring Eustachian tube function, as a method of selecting appropriate patients for intervention, and measuring their treatment outcomes. This review summarises recent findings relating to Eustachian tube function assessment. Increasingly it is recognised that patient reported outcome measures based on symptoms are highly non-specific and non-diagnostic, and clinical assessment alone may not permit the selection of individuals with abnormal Eustachian tube opening. Tests of Eustachian tube opening therefore may represent a practical and objective addition to patient assessment in clinic, allowing the identification of individuals with abnormal (patulous or obstructive) Eustachian tube function. A diagnostic pathway is described on this basis. More work is required to validate the described Eustachian tube function tests, and there remain individuals, such as those with dysfunction limited to pressure challenges, in whom function tests have yet to fully characterise the disorder.
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Affiliation(s)
- Matthew E Smith
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
| | - Manohar L Bance
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
| | - James R Tysome
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
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20
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Patel A, Smith ME, Norman G, Llewellyn A, Tysome JR. Balloon dilatation of the Eustachian tube for obstructive Eustachian tube dysfunction in adults. Hippokratia 2019. [DOI: 10.1002/14651858.cd013429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anant Patel
- Norfolk & Norwich University Hospital; Department of ENT Surgery; Conley Lane Norwich UK NR4 7UY
| | - Matthew E Smith
- Cambridge University Hospitals NHS Foundation Trust; Department of ENT Surgery; Hills Road Cambridge Cambridgeshire UK CB2 0QQ
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Alexis Llewellyn
- University of York; Centre for Reviews and Dissemination; York UK YO10 5DD
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation Trust; Hills Road Cambridge UK
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21
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Herrera M, Eisenberg G, Plaza G. Clinical Assessment of Eustachian Tube Dysfunction Through the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and Tubomanometry. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Newman AC, Omrani K, Higgins TS, Ting JY, Walgama ES, Wu AW. The prevalence of eustachian tube dysfunction symptoms in temporomandibular joint disorder patients. Laryngoscope 2019; 130:E233-E236. [PMID: 31265138 DOI: 10.1002/lary.28162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS Ear fullness and pressure is a common complaint seen in otolaryngology clinics and frequently is attributed to eustachian tube dysfunction (ETD). In addition to traditional tympanometry and physical examination, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) has recently been used to aid in the diagnosis of ETD and to assess its severity. Temporomandibular joint disorder (TMJD) is a common condition that causes similar symptoms to ETD and has been recognized as a potential confounding condition in patients presenting with ETD symptoms. We sought to determine the cross-sectional prevalence of ETD symptoms in patients with TMJD using the ETDQ-7. STUDY DESIGN Prospective cross-sectional analysis. METHODS An analysis was performed of ETDQ-7 scores in patients diagnosed with TMJD. RESULTS A total of 21 patients with confirmed TMJD completed the ETDQ-7 at routine consult or follow-up for their TMJD. The mean ± standard deviation ETDQ-7 score for the cohort was 24.5 ± 12.5. Two-thirds of patients had an ETDQ-7 score of >14.5, which has been used in the literature to denote clinically significant ETD. No single question was scored significantly higher than the others. CONCLUSIONS Symptoms of ETD are highly prevalent among patients with TMJD determined by patient-reported outcome measures. It is not clear if these symptoms reflect true derangement of eustachian tube function in these patients or whether there is only clinical similarity between ETD and TMJD. However, future research efforts may resolve this dilemma. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E233-E236, 2020.
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Affiliation(s)
- Alan C Newman
- Cedars-Sinai Program for Headache, Orofacial Pain, and Sleep Apnea, Cedars-Sinai Pain Center, Los Angeles, California
| | - Katayoun Omrani
- Cedars-Sinai Program for Headache, Orofacial Pain, and Sleep Apnea, Cedars-Sinai Pain Center, Los Angeles, California
| | - Thomas S Higgins
- Rhinology, Sinus and Skull Base, University of Louisville, Louisville, Kentucky.,Kentuckiana Ear, Nose, and Throat, University of Louisville, Louisville, Kentucky.,and Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Evan S Walgama
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Arthur W Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
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Plaza G, Navarro JJ, Alfaro J, Sandoval M, Marco J. Consensus on treatment of obstructive Eustachian tube dysfunction with balloon Eustachian tuboplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:181-189. [PMID: 31133274 DOI: 10.1016/j.otorri.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/28/2018] [Accepted: 01/28/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a great variability in diagnosis of obstructive Eustachian tube dysfunction and its treatment by balloon Eustachian tuboplasty (BET). The aim of this paper was to present a consensus on indications, contraindications, methodology, complications and results after BET. MATERIAL AND METHODS We obtained a consensus on BET, after a systematic review of the literature on BET from 1966 to November 2018, using MESH terms «Eustachian tube and (dilation or dysfunction)», including a total of 1.943 papers in Spanish, English, German and French. We selected 139 papers with a relevant abstract, including two international consensuses, seven systematic revisions, and two randomised control trials on BET. RESULTS The indications for BET are barotrauma, serous otitis media, adhesive otitis, atelectatic middle ear and failure after tympanoplasty, once obstructive Eustachian tube dysfunction is confirmed. BET is more effective in barotrauma and serous otitis media. There are high- evidence reports on BET showing good results that persist long-term, as compared to conservative medical treatment. CONCLUSIONS BET is a surgical, minimally invasive treatment that has shown its effectiveness and safety in obstructive Eustachian tube dysfunction in adults and children. It is most effective in barotrauma and serous otitis media.
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Affiliation(s)
- Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - Juan José Navarro
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España
| | - Jorge Alfaro
- Servicio de Otorrinolaringología. Hospital Quirón Salud, Zaragoza, España
| | - Marta Sandoval
- Servicio de Otorrinolaringología, Hospital Sant Joan Despi-Moisés Broggi, Barcelona, España
| | - Jaime Marco
- Servicio de Otorrinolaringología, Hospital Clínico de Valencia, Universidad de Valencia, Valencia, España
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Pöyhönen L, Kivekäs I, Silvola J, Poe D, Rautiainen M. Mucociliary function of the eustachian tube in the eustachian tube dysfunction. Acta Otolaryngol 2019; 139:238-242. [PMID: 30870045 DOI: 10.1080/00016489.2018.1562218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Most of the tests to evaluate the eustachian tube (ET) function are focused on the ventilation function of the ET. AIM Here we evaluate mucociliary function of the ET in patients with ET dysfunction. MATERIALS AND METHODS Ten patients with ET dysfunction were enrolled into the study. Six patients had chronic tympanic membrane retraction and four patients had chronic middle ear effusion (MEE). All patients had intact tympanic membranes. Tympanometry and clinical examinations were done to all patients. Mucociliary function was evaluated with technetium labeled albumin and blue dye. Tympanometry and clinical examinations were done to six patients with chronic tympanic membrane retraction and four patients with chronic middle ear effusion (MEE). Mucociliary function of the ET was evaluated with technetium labeled albumin and blue dye placed into middle ear through an intact tympanic membrane and followed from nasopharynx ET orifice (blue dye) and with gamma camera (technetium). RESULTS Blue dye was observed in tubal orifice in six (6 of 10) patients during 30 min observation. Five of those patients (5 of 6) had tympanic membrane retraction and one patient (1 of 6) had MEE. Tracer activity decreased from middle ear in six (6 of 10) patients. Four of those patients had tympanic membrane retraction and two had MEE. CONCLUSION Mucociliary function of the ET seems to be better in patients with tympanic membrane retraction than patients with middle ear effusion. SIGNIFICANCE Mucociliary function of the ET is an important function for middle ear aeration, blue dye test is easily available to be used also in clinical practice.
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Affiliation(s)
- Leena Pöyhönen
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
| | - Juha Silvola
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
- Department of Otorhinolaryngology, Akershus Universitetssykehus HF, Lorenskog, Norway
| | - Dennis Poe
- Department of Otolaryngology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Markus Rautiainen
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
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Alper CM, Teixeira MS, Richert BC, Douglas Swarts J. Presentation and eustachian tube function test results in children evaluated at a specialty clinic. Laryngoscope 2018; 129:1218-1228. [PMID: 30474114 DOI: 10.1002/lary.27545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET-specific or sinus balloons around the world and off-label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children. STUDY DESIGN Retrospective cross-sectional study. METHODS This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable. RESULTS Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%). CONCLUSIONS ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1218-1228, 2019.
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Affiliation(s)
- Cuneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Beverly C Richert
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway. PLoS One 2018; 13:e0206946. [PMID: 30408100 PMCID: PMC6224095 DOI: 10.1371/journal.pone.0206946] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background and aims Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD. Methods Index tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results. Results The expert panel diagnosis and PROMs results correlated with each other, but not with ET function measured by tests of ET opening. All index tests were found to be feasible in clinic, and acceptable to patients. PROMs had very poor specificity, and no diagnostic value. Combining the results of tests of ET function appeared beneficial. The latent class model suggested tympanometry, sonotubometry and tubomanometry have the best diagnostic performance for obstructive ETD, and these are included in a proposed diagnostic pathway. Conclusions ETD should be diagnosed on the basis of clinical assessment and tests of ET opening, as PROMs have no diagnostic value. Currently diagnostic uncertainty exists for some patients who appear to have intermittent ETD clinically, but have negative index test results.
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Herrera M, Eisenberg G, Plaza G. Clinical assessment of Eustachian tube dysfunction through the Eustachian tube dysfunction questionnaire (ETDQ-7) and tubomanometry. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:265-271. [PMID: 30086886 DOI: 10.1016/j.otorri.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/20/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Evaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM). MATERIALS AND METHODS Spanish validation of the ETDQ-7. PATIENTS Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. OUTCOME MEASURES The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction. RESULTS The Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction. CONCLUSIONS The Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients' lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction.
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Affiliation(s)
- Mayte Herrera
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - Gustavo Eisenberg
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
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Analyzing eustachian tube function in patients with symptoms of chronical Eustachian tube dysfunction by pressure chamber measurements. Eur Arch Otorhinolaryngol 2018; 275:1087-1094. [DOI: 10.1007/s00405-018-4938-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/14/2018] [Indexed: 11/25/2022]
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Balloon dilatation of the Eustachian tube in adult patients with chronic dilatory tube dysfunction: a retrospective cohort study. Eur Arch Otorhinolaryngol 2017; 275:395-400. [DOI: 10.1007/s00405-017-4857-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/22/2017] [Indexed: 11/26/2022]
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Teixeira MS, Swarts JD, Alper CM. Accuracy of the ETDQ-7 for Identifying Persons with Eustachian Tube Dysfunction. Otolaryngol Head Neck Surg 2017; 158:83-89. [PMID: 28949806 DOI: 10.1177/0194599817731729] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare the accuracy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) in identifying people with eustachian tube (ET) dysfunction based on symptoms and an objective ET function test. Study Design Cross-sectional study. ObjSettingective Tertiary referral center. Subjects and Methods Fifty-five subjects with and without symptoms suggestive of ET dysfunction completed the ETDQ-7 and had their ET function evaluated by the percentage of middle ear pressure equilibrated after 5 swallows (PEq5) either during a pressure chamber test (intact tympanic membranes) or by the inflation-deflation test (nonintact tympanic membranes). ETDQ-7 score ≥14.5 and PEq5 <60% were used to define ET dysfunction, and sensitivity, specificity, and receiver operating characteristic curves were used to assess the level of association between ETDQ-7 scores and PEq5. Results Twenty-five asymptomatic subjects (group 1 = 15 females, 15 white; mean ± SD age, 32 ± 12.8 years) and 30 subjects with ET dysfunction symptoms (group 2 = 17 females, 25 white; age, 27 ± 16.3 years) were included in the analysis. ETDQ-7 sensitivity and specificity regarding correct group assignment were 70% and 100%, respectively, and with respect to predicting PEq5<60%, 54% and 78%. An area under the curve (AUC) of 0.68 (95% CI, 0.53-0.83) at the participant level and 0.64 (95% CI, 0.50-0.77) at the ear level indicated a moderate level of association that was lower, though not statistically significant, for nonintact tympanic membranes (AUC = 0.63 at the participant level and AUC = 0.49 at the ear level). Conclusion The ETDQ-7 score had a higher correlation with the ET dysfunction symptoms than with an objective measure of ET function.
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Affiliation(s)
- Miriam S Teixeira
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J Douglas Swarts
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cuneyt M Alper
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,2 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Doyle WJ. A formal description of middle ear pressure-regulation. Hear Res 2017; 354:73-85. [PMID: 28917121 DOI: 10.1016/j.heares.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Middle ear (ME) pressure-regulation (MEPR) is a homeostatic mechanism that maintains the ME-environment pressure-gradient (MEEPG) within a range optimized for "normal" hearing. OBJECTIVE Describe MEPR using equations applicable to passive, inter-compartmental gas-exchange and determine if the predictions of that description include the increasing ME pressure observed under certain conditions and interpreted by some as evidencing gas-production by the ME mucosa. METHODS MEPR was modeled as the combined effect of passive gas-exchanges between the ME and: perilymph via the round window membrane, the ambient environment via the tympanic membrane, and the local blood via the ME mucosa and of gas flow between the ME and nasopharynx during Eustachian tube openings. The first 3 of these exchanges are described at the species level using the Fick's diffusion equation and the last as a bulk gas transfer governed by Poiseuille's equation. The model structure is a time-iteration of the equation: PMEg(t=(i+1)Δt) = ∑s(PMEs(t=iΔt)+(1/(βMEsVME)∑P(ҚPs(PCs(t=(iΔt)-PMEs(t=(iΔt))). There, PMEg(t=iΔt) and PMEs(t=iΔt) are the ME total and species-pressures at the indexed times, PCs(t=iΔt) is the species-pressure for each exchange-compartment, βMEsVME is the product of the ME species-capacitance and volume, ҚPs is the pathway species-conductance, and ∑S and ∑P are operators for summing the expression over all species or exchange pathways. RESULTS When calibrated to known values, the model predicts the empirically measured ME species-pressures and the observed time-trajectories for total ME pressure and the MEEPG under a wide variety of physiologic, pathologic and non-physiologic conditions. CONCLUSIONS Passive inter-compartmental gas exchange is sole and sufficient to describe MEPR.
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Affiliation(s)
- William J Doyle
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
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Assessment of laryngopharyngeal reflux and the shape of the Eustachian tube should be considered in chronic rhinosinusitis with nasal polyps and chronic otitis media. Eur Arch Otorhinolaryngol 2017; 274:4265-4266. [DOI: 10.1007/s00405-017-4684-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022]
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Alper CM, Luntz M, Takahashi H, Ghadiali SN, Swarts JD, Teixeira MS, Csákányi Z, Yehudai N, Kania R, Poe DS. Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis). Otolaryngol Head Neck Surg 2017; 156:S22-S40. [PMID: 28372527 DOI: 10.1177/0194599816647959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
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Affiliation(s)
- Cuneyt M Alper
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,3 Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michal Luntz
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Haruo Takahashi
- 5 Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Samir N Ghadiali
- 6 Department of Biomedical Engineering, Ohio University, Columbus, Ohio, USA.,7 Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio University, Columbus, Ohio, USA
| | - J Douglas Swarts
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Miriam S Teixeira
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zsuzsanna Csákányi
- 8 Department of Pediatric Otorhinolaryngology, Heim Pal Children's Hospital, Budapest, Hungary
| | - Noam Yehudai
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Romain Kania
- 9 Department of Otorhinolaryngology-Head and Neck Surgery, Lariboisière Hospital, Diderot University, University Paris Sorbonne, Paris, France
| | - Dennis S Poe
- 10 Department of Otology and Laryngology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,11 Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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Han WG, Yoo J, Rah YC, Chang J, Im GJ, Song JJ, Chae SW, Jung HH, Choi J. Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media. Clin Exp Otorhinolaryngol 2017; 10:315-320. [PMID: 28602066 PMCID: PMC5678035 DOI: 10.21053/ceo.2016.01683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube. METHODS We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function. RESULTS We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012). CONCLUSION DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests.
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Affiliation(s)
- Won Gue Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jun Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jiwon Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Gi Jung Im
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hak Hyun Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
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Areias B, Parente MPL, Santos C, Gentil F, Natal Jorge RM. The human otitis media with effusion: a numerical-based study. Comput Methods Biomech Biomed Engin 2017; 20:958-966. [PMID: 28460599 DOI: 10.1080/10255842.2017.1316382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Otitis media is a group of inflammatory diseases of the middle ear. Acute otitis media and otitis media with effusion (OME) are its two main types of manifestation. Otitis media is common in children and can result in structural alterations in the middle ear which will lead to hearing losses. This work studies the effects of an OME on the sound transmission from the external auditory meatus to the inner ear. The finite element method was applied on the present biomechanical study. The numerical model used in this work was built based on the geometrical information obtained from The visible ear project. The present work explains the mechanisms by which the presence of fluid in the middle ear affects hearing by calculating the magnitude, phase and reduction of the normalized umbo velocity and also the magnitude and phase of the normalized stapes velocity. A sound pressure level of 90 dB SPL was applied at the tympanic membrane. The harmonic analysis was performed with the auditory frequency varying from 100 Hz to 10 kHz. A decrease in the response of the normalized umbo and stapes velocity as the tympanic cavity was filled with fluid was obtained. The decrease was more accentuated at the umbo.
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Affiliation(s)
- B Areias
- a INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal
| | - M P L Parente
- a INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal .,b FEUP, Faculty of Engineering , University of Porto , Porto , Portugal
| | - C Santos
- b FEUP, Faculty of Engineering , University of Porto , Porto , Portugal
| | - F Gentil
- c ESS, Escola Superior de Saúde, P. Porto , Porto , Portugal .,d Clínica ORL - Dr. Eurico de Almeida , Porto , Portugal
| | - R M Natal Jorge
- a INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal .,b FEUP, Faculty of Engineering , University of Porto , Porto , Portugal
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Smith ME, Zou CC, Baker C, Blythe AJC, Hutchinson PJA, Tysome JR. The repeatability of tests of eustachian tube function in healthy ears. Laryngoscope 2017; 127:2619-2626. [DOI: 10.1002/lary.26534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/15/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Matthew E. Smith
- Department of ENT Surgery; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Charlie C. Zou
- University of Cambridge Clinical School; Cambridge United Kingdom
| | - Charlotte Baker
- University of Cambridge Clinical School; Cambridge United Kingdom
| | | | - Peter J. A. Hutchinson
- Department of Neurosurgery; Cambridge University Hospitals NHS Foundation Trust; Cambridge United Kingdom
| | - James R. Tysome
- Department of ENT Surgery; Addenbrooke's Hospital; Cambridge United Kingdom
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The Association of Valsalva Status With Smoking and Its Impact on Ossiculoplasty Outcomes and Complications. Otol Neurotol 2016; 37:914-8. [DOI: 10.1097/mao.0000000000001098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schilder AGM, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, Norman G, Pennings RJ, Poe D, Silvola JT, Sudhoff H, Lund VJ. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol 2016; 40:407-11. [PMID: 26347263 PMCID: PMC4600223 DOI: 10.1111/coa.12475] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- A G M Schilder
- evidENT, Ear Institute, University College London, London, UK.,Royal National Throat Nose and Ear Hospital, University College London Hospitals, London, UK
| | - M F Bhutta
- evidENT, Ear Institute, University College London, London, UK.,Royal National Throat Nose and Ear Hospital, University College London Hospitals, London, UK
| | - C C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - C Holy
- Acclarent Inc, Menlo Park, CA, USA
| | - L H Levine
- Acclarent Inc, Menlo Park, CA, USA.,Cleveland Clinic, Cleveland, OH, USA
| | - K J Kvaerner
- Department of Research and Education, Oslo University Hospital, Ullevål, Norway.,BI Norwegian Business School, Oslo, Norway
| | - G Norman
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - R J Pennings
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - D Poe
- Department of Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - J T Silvola
- Department of Otorhinolaryngology, Oslo University Hospital, Oslo, Norway
| | - H Sudhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - V J Lund
- evidENT, Ear Institute, University College London, London, UK.,Royal National Throat Nose and Ear Hospital, University College London Hospitals, London, UK
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Mandel EM, Casselbrant ML, Richert BC, Teixeira MS, Swarts JD, Doyle WJ. Eustachian Tube Function in 6-Year-Old Children with and without a History of Middle Ear Disease. Otolaryngol Head Neck Surg 2015; 154:502-7. [PMID: 26626132 DOI: 10.1177/0194599815620149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test the hypothesis that eustachian tube opening efficiency, measured as the fractional gradient equilibrated (FGE), is lower in 6-year-old children with no middle ear disease but a well-documented history of recurrent acute otitis media, as compared with children with a negative disease history (control). STUDY DESIGN Cross-sectional study. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS Bilateral eustachian tube function was evaluated in 44 healthy 6-year-old children (19 boys, 29 white). None had middle ear disease at the time of testing, but 23 had a history of recurrent acute otitis media. Twenty-one had no significant past otitis media. Eustachian tube function was measured with a pressure chamber protocol that established negative middle ear gauge pressures (referenced to the chamber pressure) and recorded that pressure before and after a swallow. FGE was calculated as the change in middle ear gauge pressure with swallowing divided by the preswallow pressure. Between-group comparisons of the preswallow pressures and FGEs were made with a 2-tailed Student's t test. RESULTS FGE was independent of the preswallow middle ear gauge pressure. For the 39 and 44 evaluable ears in the control and recurrent acute otitis media groups, the mean preswallow pressures were -194 daPa (95% confidence interval [95% CI] = -211 to -177) versus -203 (95% CI = -216 to -190; P > .40), and FGEs were 0.32 (95% CI = 0.21-0.43) vs 0.16 (95% CI = 0.08-0.24; P = .016), respectively. CONCLUSION In children with past recurrent acute otitis media, residual eustachian tube opening inefficiency is maintained after they have "outgrown" their middle ear disease.
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Affiliation(s)
- Ellen M Mandel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Margaretha L Casselbrant
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Beverly C Richert
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William J Doyle
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Bakhshaee M, Ardakani HP, Ghazizadeh AH, Movahed R, Jarahi L, Rajati M. Middle ear function in sinonasal polyposis. Eur Arch Otorhinolaryngol 2015; 273:2911-6. [DOI: 10.1007/s00405-015-3812-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/20/2015] [Indexed: 11/30/2022]
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Smith M, Tysome J. Tests of Eustachian tube function: a review. Clin Otolaryngol 2015; 40:300-11. [DOI: 10.1111/coa.12428] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M.E. Smith
- Department of Otorhinolaryngology; Cambridge University Hospitals; Cambridge UK
| | - J.R. Tysome
- Department of Otorhinolaryngology; Cambridge University Hospitals; Cambridge UK
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Abstract
Objective A systematic review and meta-analysis of the evidence on balloon Eustachian tuboplasty (BET) as a treatment modality for Eustachian tube dysfunction (ETD). We followed the PRISMA guideline and registered with PROSPERO No. CRD42014009461. Data Sources We searched 12 databases including PubMed and Embase from January 1, 2010, to April 7, 2014, for studies of BET. Endpoints: change in symptoms, middle ear pathology, eardrum status, Eustachian tube function tests, hearing, adverse events, complications, and health-related quality of life. Review Methods Study quality was assessed using the modified Delphi technique quality appraisal tool for case series studies. Risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Results Nine case series studies with 443 patients (642 tubes) were included. Population size n = 4 (7 tubes) to n = 210 (320 tubes). All studies were of poor quality and featured a high risk of bias. We found reduction of patient symptoms in ETD questionnaire ( P < .001), postoperative normalization of the tympanic membrane, conversion of type B or type C into type A tympanograms, reduced mucosal inflammation, increased number of positive Valsalva test and Swallowing tests, improvement in Eustachian tube score, reduction in Sino-Nasal Outcome Test (SNOT)-22 score ( P = .001), and increased quality of life ( P = .001). No serious adverse events were found. Conclusion The evidence of BET is poor and biased. No firm conclusions can be made to identify patients who will benefit from the procedure or to accurately predict surgical results. Randomized controlled trials or case-control trials are needed.
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Affiliation(s)
- Thomas Skov Randrup
- Department of ENT, Head and Neck Surgery, Aarhus University Hospital, Århus C, Denmark
| | - Therese Ovesen
- Department of ENT, Head and Neck Surgery, Aarhus University Hospital, Århus C, Denmark
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Casselbrant ML, Mandel EM, Seroky JT, Swarts JD, Doyle WJ. The forced-response test does not discriminate ears with different otitis media expressions. Laryngoscope 2014; 124:2619-23. [PMID: 24550093 DOI: 10.1002/lary.24647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/22/2014] [Accepted: 02/12/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Test the hypothesis that the eustachian tube (ET) function measured using standard manometric test methods is different between groups of ears with tympanostomy tubes inserted for recurrent acute otitis media (RAOM) and for chronic otitis media with effusion (COME). STUDY DESIGN A cross-sectional study of ET function in populations of young children with different otitis media expressions. METHODS The results for forced-response testing of ET function were compared using a general linear model between 37 ears of 26 children and 34 ears of 26 children, aged 3 and 4 years, with ventilation tubes inserted for COME and RAOM, respectively. RESULTS There were no significant between-group differences in either the active measure of ET opening function, dilatory efficiency, or in the passive measures reflecting the magnitude of the forces that tend to hold the ET lumen closed, the opening and closing pressures, and passive trans-ET conductance. CONCLUSIONS The results do not support the hypothesis that ET closing forces are less in ears with RAOM when compared to ears with COME, and from the results of earlier studies, ears without disease. Both groups were characterized by a low ET opening efficiency (referenced to ears of adults with no disease history). Because both disease expressions present the same pattern of ET dysfunction, other factors are required to explain why a subset of ears with that type of dysfunction develop RAOM, as opposed to the default expression of COME. LEVEL OF EVIDENCE 2b
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Affiliation(s)
- Margaretha L Casselbrant
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Swarts JD, Casselbrant ML, Teixeira MS, Mandel EM, Richert BC, Banks JM, El-Wagaa J, Doyle WJ. Eustachian tube function in young children without a history of otitis media evaluated using a pressure chamber protocol. Acta Otolaryngol 2014; 134:579-87. [PMID: 24828350 DOI: 10.3109/00016489.2014.882017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Protocol limitations were identified and accounted for in the analysis. Percent gradient equilibrated (PGE) was affected by driving gradient direction in a similar manner to other efficiency measures. A finer resolution of possible age-related changes in eustachian tube opening efficiency is expected with the application of more sophisticated statistical models to the complete dataset at study end. OBJECTIVE To report the results of an interim analysis for an ongoing study designed to characterize the age-related changes in eustachian tube opening efficiency measured using a pressure chamber protocol in children without a history of middle ear disease. METHODS To date, 41 children aged 3 years without a history of otitis media have been enrolled in a longitudinal study of the age-related changes in eustachian tube function and evaluated at yearly intervals between 3 and 7 years of age. Eustachian tube opening efficiency, the percent of the applied pressure gradient equilibrated by swallowing, was measured by repeat tympanometry during a pressure chamber protocol. Data (120 tests) were analyzed using an ANOVA with variance partitioned by age (3 through 6 years), gradient direction (positive/negative), and ear (left/right). RESULTS PGE was higher for left ears and positive driving gradients, but was not different among age groups.
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Affiliation(s)
- John Douglas Swarts
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
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46
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Teixeira MS, Banks J, Swarts JD, Alper CM, Doyle WJ. Eustachian tube opening measured by sonotubometry is poorer in adults with a history of past middle ear disease. Int J Pediatr Otorhinolaryngol 2014; 78:593-8. [PMID: 24491807 PMCID: PMC4017584 DOI: 10.1016/j.ijporl.2014.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/30/2013] [Accepted: 01/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Test the hypothesis that active Eustachian tube opening efficiency as measured by sonotubometry is higher in adults with no extant middle-ear disease and no history of previous otitis media (Group-1) when compared to adults with no middle-ear disease but a positive history for otitis media (Group-2). METHODS Eustachian tube function for 1 ear of 33 otherwise healthy adult subjects, 16 assigned to Group-1 and 17 to Group-2, was tested by sonotubometry using a standard protocol. For each test, the sound envelopes for 3 swallows were abstracted independently by 2 observers from the data stream and 7 descriptive parameters related to sound envelope "shape" were calculated. Inter-relatedness among the values for the parameters was explored using correlation analysis. The contributions of swallow, observer and group to the variance in each parameter were evaluated for significance using a General Linear Model. RESULTS The shape parameters reflecting envelope height, area and rise and fall rates were highly inter-correlated, but those reflecting envelope widths were not. There was no effect of "swallow" on any of the parameters; but there was a significant "observer" effect on all measures of envelope width, greater for observer-2, and a significant "group" effect for 5 of the 7 shape parameters, all greater in Group-1. CONCLUSIONS Quantifiable measures of the sound signal "shape" recorded by sonotubometry during swallowing were significantly different between the 2 groups of subjects. This is interpretable as evidencing a more efficient Eustachian tube opening-function in adults with healthy middle ears who do not have a previous history of otitis media when compared to similar adults with a history of prior otitis media. Inefficient Eustachian tube function as children may not be completely resolved by adulthood increasing adult otitis media risk when Eustachian tube function is down-graded by extant upper respiratory diseases that provoke nasopharyngeal inflammation.
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Affiliation(s)
- Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Juliane Banks
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cuneyt M Alper
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William J Doyle
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
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