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Kim JY, Kim D, Moon IS, Han JH, Bae SH. Interpretation of the nine-step test for Eustachian tube function should consider mastoid cavity volume. Clin Otolaryngol 2024; 49:588-594. [PMID: 38714328 DOI: 10.1111/coa.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/22/2023] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION The modified nine-step test is a classical method for evaluating Eustachian tube function. However, clinical interpretation of the increased maximal difference in middle ear pressure (mdMEP) in the modified nine-step test is unknown. We hypothesised that the different reservoir effects of the mastoid cavity can bias the results of the modified nine-step test. METHODS A total of 108 consecutive participants (216 ears) were retrospectively screened. Of these, 55 participants (82 ears) who met the inclusion/exclusion criteria were enrolled. The volumetric results of the mastoid cavity, parameters of the modified nine-step test (mdMEP, middle ear pressure, tympanic membrane compliance), and demographic data were analysed. RESULTS A significant negative correlation was found between mdMEP and mastoid cavity volume (R = .467, p < .001). Ears with mdMEP >70 daPa showed poor pneumatization in the mastoid cavity, with volumes less than 3000 mm3 (10th percentile of all ears analysed). Ears with mastoid cavity volumes lower than the 25th percentile showed a significantly higher mdMEP (p < .001). Patients with mastoid cavity volumes higher than the 75th percentile were significantly younger (p < .001). Multivariate regression analysis for mdMEP showed a good fit (R = .854) using factors including middle ear pressure, admittance and, most importantly, the reciprocal of mastoid volume (Beta = 0.752, p < .001). CONCLUSIONS The mdMEP, the main parameter of the modified nine-step test, was negatively correlated with the mastoid cavity volume. Therefore, the results of the modified nine-step test should be interpreted with consideration of mastoid cavity volume.
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Affiliation(s)
- Jun Yup Kim
- Department of Physical Medicine and Rehabilitation, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Dachan Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyuk Han
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
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Li D, Wei R, Ding Y, Hu R, Chen S, Liu C, Xin Y, Zhang Q, Liu Y. Endoscopic cartilage underlay myringoplasty with or without balloon Eustachian tuboplasty for chronic perforation with Eustachian tube dysfunction. Am J Otolaryngol 2024; 45:104475. [PMID: 39121639 DOI: 10.1016/j.amjoto.2024.104475] [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: 02/29/2024] [Revised: 07/21/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE The objective of this study was to compare the outcomes of endoscopic cartilage underlay myringoplasty(CNM) with or without balloon Eustachian tuboplasty (BET) for the treatment of chronic perforation with Eustachian tube dysfunction (ETD). MATERIALS AND METHODS A total of 50 ears diagnosed with chronic perforation and ETD were randomly divided into receiving alone CNM and CNM + BET. During the 12 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results and graft success rate of the patients were recorded and analyzed. RESULTS The improvement in the ETDQ-7 score was 6.23 ± 2.51 in the CNM + BET group, which was significantly higher than that in the CNM group (4.22 ± 3.85, P < 0.01) at postoperative 3 months, however, no significant between-group difference was found at post-12 months.The graft success rate was 88.0 % in the CNM group and 92.0 % in the CNM + BET group at postoperative 3 months (P > 0.05). Also, no significant difference was found among two groups (84.0 % vs 88.0 %, P > 0.05).The ABG improvement was 13.16 ± 3.19 dB in the CNM + BET group and 9.74 ± 2.56 dB in the CNM group, with a statistically significant between-group difference (P < 0.01)at postoperative 3 months. However, no significant between-group difference was found at postoperative 12 months. During followup process, neither complications nor patulous symptoms were noted. No patients developted atelectasis or otitis media with effusion. However, myringitis was seen in 8 % patients in the CNM group and 12 % patients in the CNM + BET group. CONCLUSIONS Although BET combined with endoscopic cartilage myringoplasty had better short-term improvement of hearing and ETDQ-7 scores compared with endoscopic cartilage myringoplasty for the treatment of chronic large perforation with ETD, the long-term outcomes was not satisfactory. Also, BET did not improve the 3-and 12 months graft success rate.
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Affiliation(s)
- Dong Li
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Ruili Wei
- Hebei North University, Zhangjiakou City 075000, Hebei Province, China
| | - Yongqing Ding
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Ruili Hu
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Shenghua Chen
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Chuan Liu
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Yunchao Xin
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Qingjun Zhang
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Yachao Liu
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China.
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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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Deuss E, Löding K, Breitrück N, Lang S, Klußmann JP, Jansen S, Meyer MF. Concordance Analysis of the Pressure Chamber and Tubomanometer According to Estève for the Determination of Eustachian Tube Opening Pressure. Otol Neurotol 2024; 45:e411-e419. [PMID: 38509803 DOI: 10.1097/mao.0000000000004171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
INTRODUCTION For the diagnosis of Eustachian tube dysfunction (ETD), clinical procedures such as tympanometry, micro-otoscopy, and maneuvers according to Toynbee and Valsalva only allow an indirect assessment for the moment. With a prevalence of up to 5%, the selection of patients with ETD and its subtypes is clinically relevant. Dynamic methods of Eustachian tube function assessment include a hypo/hyperbaric pressure chamber and Estève's tubomanometer (TMM). One method of assessing ETD is the evaluation of Eustachian tube opening pressure (ETOP). MATERIAL AND METHODS We performed a concordance analysis between pressure chamber and TMM to determine ETOP. For this purpose, we analyzed the measurements of both methods from 28 healthy subjects using Bland-Altman plots, regression according to Passing-Bablok and Lin's concordance correlations coefficient. The maximum tolerated clinical deviation of measured values was set at 10%. RESULTS A maximum of 53 measurements of ETOP between pressure chamber and TMM were compared. Mean ETOP for TMM was 28.7 hPa, passive opening was 32 hPa, Toynbee maneuver was 28.4 hPa, and Valsalva maneuver was 54.6 hPa. Concordance analysis revealed following results: passive opening versus TMM: Bland-Altman mean difference 3.3 hPa, limits of agreement ±31.8 hPa; Passing-Bablok regression y = 0.67 x + 9.36; Lin's rccc = 0.18. Toynbee versus TMM: Bland-Altman mean difference 0.7 hPa, limits of agreement ±35.8 hPa; Passing-Bablok regression y = 0.47x + 14.03; Lin's rccc = 0.14. Valsalva versus TMM: Bland-Altman mean difference 24.2 hPa, limits of agreement ±117.5 hPa; Passing-Bablok regression y = 0.17x + 25.12; Lin's rccc = 0.18. CONCLUSION Estève's tubomanometer and pressure chamber measurements of ETOP are not concordant. The two methods cannot be interchanged without reservation.
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Affiliation(s)
- Eric Deuss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Katharina Löding
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Nils Breitrück
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University Hospital of Cologne, 50937 Cologne, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University Hospital of Cologne, 50937 Cologne, Germany
| | - Stefanie Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University Hospital of Cologne, 50937 Cologne, Germany
| | - Moritz Friedo Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, 45147 Essen, Germany
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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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Laakso JT, Oehlandt H, Kivekäs I, Harju T, Jero J, Sinkkonen ST. Balloon Eustachian Tuboplasty-A Feasible Double-Blinded Sham Surgery Randomized Clinical Trial Protocol to Study Efficacy. Laryngoscope 2024; 134:1874-1881. [PMID: 37776248 DOI: 10.1002/lary.31092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Balloon Eustachian tuboplasty (BET) is used to treat obstructive Eustachian tube dysfunction (OETD) and recurrent otitis media with effusion (OME). However, there are no indisputable evidence of its efficacy. Here, we present a multicenter, double-blinded, randomized, placebo-controlled trial (MDRCT) design to evaluate the efficacy of BET, and the results of a pilot trial with 3- and 12-months' follow-up. MATERIAL AND METHODS This was a prospective MDRCT. For a pilot study, OETD (n = 10) and OME (n = 5) patients were recruited and followed. Detailed inclusion and exclusion criteria were used. Participants were randomized at beginning of the operation to active or sham surgery. All procedures were performed under local anesthesia. Controls were performed in double-blinded manner (both patient and physician), at 3 and 12 months after the procedure. RESULTS Altogether, 20 ears were treated and followed for 12 months, including 14 active BETs and 6 sham surgeries. Both the active and sham surgery were performed under local anesthesia without problems or deviations from the protocol. There were no differences in the preoperative symptoms (ETDQ-7) or objective measures (tympanometry, Valsalva and Toynbee maneuvers, tubomanometry, Eustachian tube score) between active and sham surgery arms. During follow-up, we noticed largely similar reduction in subjective symptoms and improvement in Eustachian tube score both in active and sham surgery arms. CONCLUSIONS The pilot study demonstrates that our MDRCT protocol is feasible, and that blinded RCTs are dearly needed to objectively measure the efficacy of BET. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1874-1881, 2024.
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Affiliation(s)
- Juha T Laakso
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heidi Oehlandt
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Teemu Harju
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Fieux M, Tournegros R, Biot T, Tringali S. Eustachian tube balloon dilation. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:103-106. [PMID: 37620173 DOI: 10.1016/j.anorl.2023.08.003] [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] [Indexed: 08/26/2023]
Abstract
Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Université Paris-Est-Creteil, Inserm, IMRB, 94010 Créteil, France; CNRS EMR 7000, 94010 Créteil, France.
| | - R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France
| | - T Biot
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Institut de biologie et chimie des protéines, laboratoire de biologie tissulaire et d'ingénierie thérapeutique, UMR 5305, CNRS/université Claude-Bernard Lyon 1, 7, passage du Vercors, 69367, cedex 07 Lyon, France
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Azevedo C, Moreira F, Lima AF, Mar FM, Vilarinho S, Dias L. Prospective Evaluation of the Efficacy of Isolated Balloon Eustachian Tuboplasty: Short- and Medium-term Follow-up Results Based on Tubomanometry, ETDQ-7, Tympanometry, and Valsalva Maneuver. Int Arch Otorhinolaryngol 2024; 28:e76-e82. [PMID: 38322434 PMCID: PMC10843926 DOI: 10.1055/s-0043-1767804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/03/2022] [Indexed: 02/08/2024] Open
Abstract
Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective To evaluate the efficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performed a prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction ( p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement ( p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short- and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.
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Affiliation(s)
- Cátia Azevedo
- Otorhinolaryngology Service, Hospital de Braga, Braga, Portugal
| | - Filipa Moreira
- Otorhinolaryngology Service, Hospital de Braga, Braga, Portugal
| | | | | | | | - Luís Dias
- Otorhinolaryngology Service, Hospital de Braga, Braga, Portugal
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9
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Liu S, Ni X, Zhang J. Assessment of the Eustachian tube: a review. Eur Arch Otorhinolaryngol 2023; 280:3915-3920. [PMID: 37246976 DOI: 10.1007/s00405-023-08026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Dysfunction of the Eustachian tube (ET) can lead to negative pressure within the middle ear, which, in turn, causes various pathological changes. Multiple testing methods for ET function have been devised, each with its own advantages and disadvantages. Knowing the characteristics of each ET function test and the unique characteristics of ET dysfunction (ETD) in children are prerequisites for choosing the optimal assessment method. For a comprehensive diagnosis, assessment should also include the localisation of any sites of obstruction. This review aims to summarise the methods of evaluating ET function and locating sites of ET lesions. METHODS Articles evaluating ET function, localising lesions in the ET, and ETD in children were collected from the PubMed database. We selected only relevant English publications. RESULTS ETD in children has different characteristics to those in adults. The appropriate tests for assessing ET function depend on the specific conditions of the individual patient. Valsalva computed tomography can provide information on the soft and bony anatomy of the ET to facilitate identification of lesion sites. CONCLUSION An accurate diagnosis should be based on a combined analysis of objective and subjective results, with interpretation made in conjunction with clinical history and physical examination. A comprehensive assessment should include lesion localisation. When assessing ETD in children, it is important to take into account the characteristics of this population.
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Affiliation(s)
- Shanshan Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing, China.
| | - Jie Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing, China.
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Cetin-Ferra S, Teixeira MS, Swarts JD, Rath TJ, Alper CM. CT Imaging of Eustachian Tube Balloon Dilation: Method Development on Cadaver Heads. Bioengineering (Basel) 2023; 10:bioengineering10050592. [PMID: 37237662 DOI: 10.3390/bioengineering10050592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Objective: To develop a methodology for the measurement of balloon dilation (BD) effects on Eustachian Tube (ET) structure using Computerized Tomography (CT) images. Methods: The BD of the ET was performed on three cadaver heads (five ears) through the nasopharyngeal orifice. The axial CT images of the temporal bones were obtained before dilation, while an inflated balloon was in the lumen of ET, and after balloon removal in each ear. Utilizing Dicom images captured by the ImageJ software 3D volume viewer function, the anatomical landmark coordinates of the ET were matched with their pre- and post-dilation counterparts, and the longitudinal axis of the ET was captured with serial images. The histograms of the regions of interest (ROI) and three different lumen width and length measurements were obtained from captured images. The densities of air, tissue, and bone were determined with histograms as a baseline to determine the BD rate as a function of increased air in the lumen. Results: The small ROI box included the area of prominently dilated ET lumen after BD and best represented the visually obvious changes in the lumen, compared to the ROIs that extended the wider areas (longest and longer). Air density was the outcome measure for comparison with each corresponding baseline value. The average increase in air density in the small ROI was 64%, while the longest and long ROI boxes showed 44 and 56% increases, respectively. Conclusion: This study describes a method to image the ET and quantify the outcomes of BD of the ET using anatomical landmarks.
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Affiliation(s)
- Selma Cetin-Ferra
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
| | - Miriam S Teixeira
- Graduate Medical Education Research Division, Arnot Ogden Medical Center, Elmira, NY 14905, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine Pittsburgh, PA 15213, USA
| | - Tanya J Rath
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine, Phoenix, AZ 85054, USA
| | - Cuneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine Pittsburgh, PA 15213, USA
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 1 Children's Place, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Ros L, Gargula S, Montava M, Michel J, Radulesco T, Lavieille JP. Place of Tubomanometry in Patulous Eustachian Tube Diagnosis. Otolaryngol Head Neck Surg 2023; 168:707-713. [PMID: 35727632 DOI: 10.1177/01945998221108118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of our study was to describe the diagnostic performances of tubomanometry (TMM) and to determine tubomanometric parameter thresholds for the diagnosis of patulous eustachian tube (PET). STUDY DESIGN We performed a retrospective, monocentric study, including patients treated for PET vs control group. SETTING This study was performed at the Otolaryngology Department of a tertiary-care hospital in the south of France. METHODS We collected epidemiologic and clinical data, as well as adjusted opening latency index ("R"-index), rhinopharyngeal pressure threshold of tubal opening (Po), and velar contraction index (IVC) on TMM. Receiver operating characteristic (ROC) curves were used for determination of R index and Po thresholds. RESULTS Twenty-one patients (26 patulous ears) and 14 controls (24 normal ears) were included. The R index values and Po values were significantly lower in the PET group vs controls (0.46 vs 0.80, respectively; P < .05 for R index and 13.89 vs 26.42 mbar, respectively; P < .05 for Po). No significant difference was reported between the 2 groups on IVC measurement (P = .784). After ROC curve analysis, R index was the most discriminating factor to classify PET patients with 89% specificity and 76% sensitivity with a threshold ≤0.6. Po value ≤10 mbar could support this diagnosis with more than 83% specificity. CONCLUSION TMM is a reliable noninvasive method for positive diagnosis of PET. TMM could provide an accurate positive PET diagnosis and an objective evaluation for PET management.
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Affiliation(s)
- Laetitia Ros
- Otorhinolaryngology, Assistance publique des Hôpitaux de Marseille (APHM), Conception University Hospital, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Stéphane Gargula
- Otorhinolaryngology, Assistance publique des Hôpitaux de Marseille (APHM), Conception University Hospital, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Marion Montava
- Otorhinolaryngology, Assistance publique des Hôpitaux de Marseille (APHM), Conception University Hospital, Marseille, Provence-Alpes-Côte d'Azur, France
- Aix-Marseille University, Marseille, France
| | - Justin Michel
- Otorhinolaryngology, Assistance publique des Hôpitaux de Marseille (APHM), Conception University Hospital, Marseille, Provence-Alpes-Côte d'Azur, France
- Aix-Marseille University, Marseille, France
| | - Thomas Radulesco
- Otorhinolaryngology, Assistance publique des Hôpitaux de Marseille (APHM), Conception University Hospital, Marseille, Provence-Alpes-Côte d'Azur, France
- Aix-Marseille University, Marseille, France
| | - Jean-Pierre Lavieille
- Otorhinolaryngology, Assistance publique des Hôpitaux de Marseille (APHM), Conception University Hospital, Marseille, Provence-Alpes-Côte d'Azur, France
- Aix-Marseille University, Marseille, France
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Bilgili AM, Durmaz HÖ, Dilber M. Eustachian Tube Dysfunction in Children with Adenoid Hypertrophy: The Effect of Intranasal Azelastine-Fluticasone Spray Treatment on Middle Ear Ventilation and Adenoid Tissue. EAR, NOSE & THROAT JOURNAL 2023; 102:198-203. [PMID: 36416201 DOI: 10.1177/01455613221140281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Eustachian tube dysfunction (ETD) is frequent in children with adenoid hypertrophy (AH). Although the most common treatment of AH is surgical removal of adenoid tissue, numerous studies have reported the efficacy of intranasal steroids. The effects of the intranasal steroid and azelastine combination on AH and ETD have not been reported before. In this study, we tried to determine the effects of 3-month intranasal Azelastine-Fluticasone dipropionate combination (Aze-Flu) treatment in children with ETD and AH. MATERIALS AND METHODS 100 children who had open mouth sleep, snoring, and sleep apnea and were diagnosed with AH and ETD participated in this study. The mean age was 7.73 ± 2.37 (4-14 years). The rates of adenoid tissue hypertrophy and choanal occlusion were evaluated using a rigid pediatric nasal endoscope and reassessed after 3 months of Aze-Flu nasal spray treatment. The function of the Eustachian tube (ET) was evaluated before and after medical treatment using the Eustachian tube score, the Eustachian dysfunction test-7 (ETS-7) and tubomanometry (TMM). RESULTS The results were evaluated in 100 patients with AH and ETD. The adenoid tissue to choana rate was 82% before treatment and decreased to 37% after treatment. The ETS-7 test score was 6.36 before treatment and increased to 9.72 at the end of 3 months. Both the regression of the adenoid tissue and the improvement in the Eustachian function scores were statistically significant (p < 0.05). CONCLUSIONS AH significantly increases the frequency of ETD. In this study, it was observed that Aze-Flu treatment was significantly effective in both regression of the adenoid tissue and Eustachian tube dysfunction. We believe that it can be applied as an initial therapy in children with AH and associated ETD.
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Affiliation(s)
- Ahmet Mert Bilgili
- School of Health Sciences, 64188Cyprus International University, Lefkoşe, Cyprus
| | - Hacı Ömer Durmaz
- Department of Odiology, 420479Biruni University, İstanbul, Turkey
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Kaderbay A, Karkas A, Schmitt D, Mura T, Lavieille JP, Venail F. Balloon dilation for persistent unilateral chronic obstructive Eustachian tube dysfunction is effective: a prospective multicentre study. Eur Arch Otorhinolaryngol 2023; 280:1101-1109. [PMID: 35932313 DOI: 10.1007/s00405-022-07578-2] [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: 02/17/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Balloon dilatation of the Eustachian tube (BDET) is an option for treating chronic obstructive Eustachian tube dysfunction (COETD). In this prospective multicentric study, the main objective was to evaluate the results of BDET in unilateral COETD refractory to medical treatment. METHODS Adults with unilateral COETD whose Eustachian Tube Score (ETS) was less than 5 despite medical pressure therapy were included. The primary endpoint was the change in ETS measured at 2, 6, and 12 months after BDET. Secondary objectives were the evolution of clinical symptoms assessed by the Eustachian Tube Questionnaire (ETDQ-7), audiometry, tympanometry, and otoscopy changes after BDET. RESULTS Twenty-eight patients were included between May 2014 and December 2017 and were treated with BDET without adverse effects in three different referral centers. Population's median age was 52 (Q25; Q75: 24, 82) years. The median follow-up time was 381 (Q25; Q75: 364; 418) days. The median ETS was 2 (Q25; Q75: 1; 4) before BDET. There was a significant improvement in ETS at 2 and 6 months and 1 year after BDET (score at 1 year: 6 (Q25; Q75: 2; 8) (p < 0.0001)). There was a significant, sustained improvement in the ETDQ-7 with a score of 4.21 (Q25; Q75-3.50; 4.79) before BDET and 3.43 (Q25; Q75-2.43; 4.14) (p = 0.0012) at 1 year. There was a suggestive improvement in tympanometry results at 1 year (p = 0.025). CONCLUSION BDET provides an improvement in symptoms and objective measures assessed at 1 year in patients with COETD who have failed medical treatment. TRIAL REGISTRATION NCT02123277 (April 25, 2014).
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Affiliation(s)
- Akil Kaderbay
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - Alexandre Karkas
- Oto-Rhino-Laryngology, Head and Neck Surgery Department, Saint-Etienne University, Hôpital Nord, Saint Etienne, France
| | - David Schmitt
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Thibault Mura
- Medical Information Department, Montpellier University, CHU La Colombière, Montpellier, France
| | - Jean Pierre Lavieille
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Frédéric Venail
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.,Neurosciences Institute of Montpellier, INSERM U1298 and Montpellier University, Montpellier, France
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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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Maddineni S, Ahmad I. Updates in Eustachian Tube Dysfunction. Otolaryngol Clin North Am 2022; 55:1151-1164. [DOI: 10.1016/j.otc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Raymond MJ, Shih MC, Elvis PR, Nguyen SA, Brennan E, Meyer TA, Lambert PR. A Systematic Review of Eustachian Tube Procedures for Baro-challenge Eustachian Tube Dysfunction. Laryngoscope 2022; 132:2473-2483. [PMID: 35442523 DOI: 10.1002/lary.30132] [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: 01/08/2022] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the effectiveness of Eustachian tube procedures for the treatment of baro-challenge Eustachian tube dysfunction. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases, including PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and CINAHL (EBSCO), were searched for articles examining the effectiveness of Eustachian tube procedures for baro-challenge Eustachian tube dysfunction. Outcome measures included symptom resolution, ability to return to work, equalization problems (EP) scores, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and pressure chamber testing parameters. Pooled meta-analysis was performed for dichotomous measures and ETDQ-7 scores. RESULTS Eleven articles with 81 patients were included. Seventy-two patients from 10 articles underwent balloon Eustachian tube dilation; nine patients in 1 study underwent laser Eustachian tuboplasty (LET). All 81 patients were preoperatively symptomatic with barometric pressure change, and 26/30 (86.7%) were unable to work due to symptoms. On meta-analysis, after balloon dilation Eustachian tuboplasty (BDET), 82.5% (n = 30 [95% confidence interval: 42%-100%]) had improvement in ability to valsalva, 79.1% (n = 16 [57.9%-94.1%]) in ability to return to work, and 84.3% (n = 69 [69.8%-94.7%]) in any symptom. Of 25 patients with individual ETDQ-7 scores, 79.1% [51.4, 96.9] had improvements after BDET. For four case series with 36 patients, ETDQ-7 scores decreased by 1.2 [0.7, 1.7] (p < 0.00001). Of 20 patients with preoperative ETDQ-7 scores >2.0, there was a mean decrease of 2.1 [1.3, 2.8] (p < 0.00001). CONCLUSION From the available evidence, Eustachian tube procedures appear to be effective at improving symptoms of baro-challenge Eustachian tube dysfunction. However, higher quality evidence is needed to support making definite recommendations for the use of balloon Eustachian tube dilation or LET for these patients. Laryngoscope, 132:2473-2483, 2022.
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Affiliation(s)
- Mallory J Raymond
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Michael C Shih
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phillip Ryan Elvis
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina Libraries, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Paul R Lambert
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Zhen Z, Zhao T, Wang Q, Zhang J, Zhong Z. Laryngopharyngeal reflux as a potential cause of Eustachian tube dysfunction in patients with otitis media with effusion. Front Neurol 2022; 13:1024743. [PMID: 36408490 PMCID: PMC9671220 DOI: 10.3389/fneur.2022.1024743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To explore the association between laryngopharyngeal reflux disease (LPRD)-related symptoms and the Eustachian tube (ET) function in adult patients with otitis media with effusion (OME). MATERIALS AND METHODS A total of 105 adult patients with OME were retrospectively studied. All these patients had undergone tubomanometry (TMM) test for the affected ears before treatments. The LPRD-related symptoms were all assessed by the Reflux Symptom Index (RSI) scale. RESULTS Among the 105 included patients, the numbers of subjects with only one and both two ears affected were 65 (57.1%) and 40 (42.9%), respectively. Therefore, a total of 145 affected ears were studied. For these affected ears, a linear regression analysis that included sex, age, BMI, smoking history, drinking history, RSI value, and the condition of the contralateral ear suggested that only RSI value was significantly associated with TMM value (P < 0.001), with the correlation coefficient of -0.112. Among the 9 symptoms in RSI scale, affected ears with the following symptoms (vs. affected ears without) showed significantly lower TMM values: excess throat mucus or postnasal drip, difficulty swallowing food, liquids, or pills, and sensations of something stuck in your throat or a lump in your throat (all P < 0.05). CONCLUSION LPRD may disrupt ET function in adult OME patients. A higher RSI score is independently predictive for a bad ET patency in such patients and is indicative for an additional anti-reflux therapy.
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Affiliation(s)
- Zhen Zhen
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Tingting Zhao
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Quangui Wang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Zhen Zhong
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
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高 华, 陈 文, 卢 晓, 童 军. [Balloon dilation with stent implantation for the treatment of Eustachian tube obstruction]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:715-718. [PMID: 36036075 PMCID: PMC10127627 DOI: 10.13201/j.issn.2096-7993.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/15/2021] [Indexed: 06/15/2023]
Abstract
When the Eustachian tube is dysfunctional, the external air cannot enter the middle ear, resulting in a negative pressure state in the middle ear, which can cause a series of pathological changes in the middle ear. In this paper, 13 patients with recurrence of otitis media after balloon dilatation of the Eustachian tube were treated with stenting in the Eustachian tube for Eustachian tube dysfunction with satisfactory results, and this method can provide a reference for the clinical treatment of Eustachian tube dysfunction.
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Affiliation(s)
- 华公 高
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
| | - 文文 陈
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
| | - 晓清 卢
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
| | - 军 童
- 同济大学附属上海市第四人民医院耳鼻咽喉科(上海,200434)Department of Otolaryngology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China
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杨 亚, 王 士, 韩 曙, 龚 树, 刘 娇, 卢 洁, 张 爽, 王 伟. [Correlation between acoustic immittance and ETS in eustachian tube function test]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:587-591. [PMID: 35959575 PMCID: PMC10128209 DOI: 10.13201/j.issn.2096-7993.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Objective:To investigate the correlation between acoustic immittance and eustachian tube score(ETS) in eustachian tube function test. Methods:124 ears eustachian tube function with tympanic tension perforation of 107 patients with chronic suppurative otitis media were measured by acoustic immittance positive pressure balance method and ETS. According to the positive pressure balance test results of acoustic immittance, the ear eustachian tube open pressure between 100 and 200 daPa is assigned 2, the ear with open pressure between 200 and 300 daPa is assigned 3, the ear with open pressure betwween 300 and 400 daPa is assigned 4, the ear open pressure is greater than 400 daPa but eustachian tube open after swallowing is assigned 5, and the ear which eustachian tube open pressure is greater than 400 daPa and cannot open after swallowing is assigned 6. Then compare the results. Results:In the acoustic immittance test, there was no ears whose eustachian tube opening pressure less than 100 daPa, 10 ears(8.1%) open pressure between 100 and 200 daPa, 16 ears(12.9%) open pressure between 200 and 300 daPa, 46 ears(37.1%) open pressure between 300 and 400 daPa, 19 ears(15.3%) whose eustachian tube don't open pressure at 400 daPa but open after swallowing, and the cumulative percentage of the above was 73.4%. There were 33 ears(26.6%) whose eustachian tubes not opening after receiving maximum pressure(400 daPa) and repeated swallowing. The score of acoustic immittance eustachian tube function test was significantly correlated with the scores of ETS, eustachian tube manometry(TMM) and subjective part of ETS(P<0.05). The result of acoustic immittance was moderately negatively correlated with ETS(r=-0.439) and TMM(r=-0.425), and weakly negatively correlated with subjective part of ETS(r=-0.249). The scores of 2-5 points (the affected ears with open eustachian tube in all acoustic impedance test methods) were defined as the normal group, and the scores of 6 point were defined as the abnormal group. The results of acoustic immittance between the normal group and the abnormal group showed that there were significant differences with the subjective scores of ETS, TMM and ETS. The consistency compared the results of acoustic immittance eustachian tube test with the results of ETS was poor(kappa value was negative), and the difference was statistically significant. Conclusion:The open pressure of acoustic immittance positive pressure balance method is a good predictor of the subjective scores of ETS, TMM and ETS. The smaller the open pressure is, the better the subjective scores of ETS, TMM and ETS may be. This two methods results are inconsistent and cannot be replaced. More consideration should be given to the middle ear. The open pressure, equilibrium pressure and the difference between them need to be paid attention to at the same time.
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Affiliation(s)
- 亚利 杨
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - 士杰 王
- 中国航天科工集团七三一医院耳鼻咽喉科Department of Otolaryngology, No. 731 Hospital of China Aerospace Science and Industry Corp, Beijing
| | - 曙光 韩
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - 树生 龚
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
- 首都医科大学耳聋疾病临床诊疗与研究中心Clinical Center for Hearing Loss, Capital Medical University
| | - 娇 刘
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - 洁琼 卢
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - 爽 张
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - 伟 王
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
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Weiss NM, Bennöhr F, Lenz JH, Mlynski R, Rettschlag S. [Eustachian tube dysfunction after cleft palate surgery : Use of the latest diagnostics]. HNO 2022; 70:557-563. [PMID: 35318498 PMCID: PMC9242949 DOI: 10.1007/s00106-022-01147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In patients with cleft palate, a high incidence of chronic obstructive Eustachian tube dysfunction (ETD) is assumed after surgery. Consequently, an increased rate of retracted eardrum or cholesteatoma is expected. Even though no common standard for investigating ETD is available, the development of objective tests has increased during the past 10 years. This study aimed to investigate the incidence of persisting chronic obstructive ETD in adult patients with cleft palate surgically treated in early childhood by using a combination of diagnostic tools. METHODS Adult participants with cleft palate repair in early childhood were invited for a follow-up examination and compared to a control group. Examination included tympanometry, tubomanometry, the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and the Eustachian Tube Score 7 (ETS-7). RESULTS A total of 16 adult patients were re-examined after cleft palate surgery and compared to a control group of 40 healthy individuals. Significant differences were found in the median ETS‑7 (p < 0.0001) score but not in the median ETDQ‑7 (p = 0.09) score. Only 2 of the 32 investigated ears (6%) had pathologic scores in ETS‑7 and ETDQ‑7 (p = 0.09), whereas 5 (31%) cleft palate patients showed symptoms of chronic obstructive ETD according to ETS‑7. No patient had examination findings indicating a requirement for further treatment. CONCLUSION By combining diagnostic tools for ETD, a lower rate of persisting obstructive ETD in adults after cleft palate surgery was found than previously reported. Successful surgical treatment of cleft palate seems to lead to physiological Eustachian tube function in long-term follow up.
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Affiliation(s)
- Nora M Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137-139, 18057, Rostock, Deutschland.
| | - Franziska Bennöhr
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137-139, 18057, Rostock, Deutschland
| | - Jan-Hendrik Lenz
- Klinik und Poliklinik für Mund‑, Kiefer- und Plastische Gesichtschirurgie, Klinik und Polikliniken für Zahn‑, Mund- und Kieferheilkunde, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Robert Mlynski
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137-139, 18057, Rostock, Deutschland
| | - Stefanie Rettschlag
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137-139, 18057, Rostock, Deutschland
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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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Moon S, Lee Y, Jung J, Moon IS, Bae SH. Association Between Eustachian Tube Dysfunction Questionnaire-7 Scores and Eustachian Tube Function Test Results in Symptomatic Patients With a Normal Drum. J Audiol Otol 2022; 26:142-146. [PMID: 35538865 PMCID: PMC9271737 DOI: 10.7874/jao.2021.00654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives We investigated the clinical validity of and correlation between the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores and the eustachian tube function test (ETFT) results in patients with a normal drum. Subjects and Methods The study included 49 patients (93 ears) with unilateral or bilateral ear fullness over >3 months. All patients were administered the ETDQ-7 survey and underwent the ETFT on the same day. The receiver operating characteristic (ROC) curve and the association between the results were statistically analyzed. Results ETDQ-7 scores were not significantly correlated with the ETFT results or with middle ear pressure. ETDQ-7 scores in patients with eustachian tube dysfunction (ETD) were significantly higher than those in patients with normal ETFT results (p=0.039) when ETD was defined as a pressure change <10 daPa on the ETFT. The area under the ROC curve was 0.631, with a sensitivity of 37.0% and specificity of 89.4%. Conclusions The ETDQ-7 has limited clinical significance in patients with ETD but a normal drum. Therefore, concomitant objective tests should be performed to diagnose patients with ETD.
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Affiliation(s)
- Seojin Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yujin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Tubomanometry correlations with patient characteristics and other diagnostic tests of Eustachian tube dysfunction: a cohort study of 432 ears. Eur Arch Otorhinolaryngol 2022; 279:5153-5160. [PMID: 35381864 PMCID: PMC9519667 DOI: 10.1007/s00405-022-07358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
Objectives Currently, there is no consensus regarding the best protocol for diagnosing Eustachian tube dysfunction (ETD). We aimed to evaluate how patient characteristics affect tubomanometry (TMM) results. If an association between patient characteristics and TMM results exists, this should be considered in TMM interpretation. We also wanted to study if TMM correlates with other diagnostic tools of ETD. Methods A retrospective chart review was conducted on all patients with TMM results available from November 2011 to October 2020 at a tertiary referral center, including 432 ears from 219 patients. An association between diagnostic tests and patient characteristics was assessed using regression models. Spearman’s rank correlation was used to analyze correlations between diagnostic tests. Results None of the studied patient characteristics (age, gender, body mass index, smoking, sinonasal disease) was associated with TMM results except for pollen allergy (OR 1.74, 95% CI 1.15–2.63, P = 0.009). TMM results correlated with Valsalva maneuver performance (P < 0.001, ρ = 0.31) and otomicroscopic signs of inadequate middle ear ventilation (P < 0.001, ρ = 0.28). The Eustachian tube dysfunction questionnaire-7 (ETDQ-7) score did not correlate with any diagnostic method. Conclusions TMM results are unaffected by patient characteristics other than pollen allergy. Thus, TMM may be used in ETD diagnostics in a wide variety of patients with straightforward interpretation. TMM correlates with other diagnostic tests studied but not with ETDQ-7. ETDQ-7 does not seem to correlate with other diagnostic tests and appears nonspecific in ETD diagnostics.
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Bae SH, Moon S, Jeong M, Moon IS. Revisiting the Diagnostic Performance of the Modified Nine-Step Test for Obstructive and Patulous Eustachian Tube Dysfunction. Diagnostics (Basel) 2022; 12:diagnostics12030732. [PMID: 35328285 PMCID: PMC8947718 DOI: 10.3390/diagnostics12030732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
The nine-step test is a classical method for evaluating Eustachian tube function. It directly assesses the patient’s capacity to equilibrate middle ear pressure by swallowing. However, there are insufficient studies to appraise its diagnostic performance. The purpose of this study is to evaluate the sensitivity, specificity, and cut-off value of the nine-step test in patients with obstructive Eustachian tube dysfunction (oETD) and patulous Eustachian tube (PET). Enrolled subjects were divided into three groups. Control (50 ears of healthy volunteers), oETD (19 ears with oETD), and PET (29 ears with PET). Receiver operating characteristics curve analysis was conducted to evaluate the diagnostic performance of maximal peak pressure difference (ETTmd) in the nine-step test. Both the oETD group and the PET group showed decreased ETTmd. The nine-step test showed moderate accuracy when used to diagnose oETD (area under the curve = 0.875) and PET (area under the curve = 0.769). The highest diagnostic performance was observed when the cut-off value was 13 daPa for both the oETD group (sensitivity = 73.7%, specificity = 90.0%) and the PET group (sensitivity = 58.6%, specificity = 90.0%). The nine-step test has moderate diagnostic performance for oETD and PET.
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Yan S, Feng Y, Yao L. Analysis of effects of laryngopharyngeal reflux disease and proton pump inhibitor treatment on Eustachian tube function in patients with obstructive sleep apnea hypopnea. EAR, NOSE & THROAT JOURNAL 2022; 101:248-254. [PMID: 35187968 DOI: 10.1177/01455613221076786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aims to explore the effects of laryngopharyngeal reflux disease (LPRD) and proton pump inhibitor (PPI) treatment on Eustachian tube function in patients with obstructive sleep apnea (OSA). METHODS The Eustachian tube score-7 (ETS-7) was observed before and after PPI treatment in the control group, OSA only group, and OSA + LPRD group. RESULTS Age, sex, smoking history, and drinking history showed no differences among 3 groups (P > .05). The body mass index (BMI) in the control group was lower than that in other groups (P < .017). Before PPI treatment, the abnormality rate of ETS-7 in the OSA + LPRD group statistically differed from that in the control group and the OSA only group (P < .017). After PPI treatment, the abnormality rate of ETS-7 in the OSA + LPRD group exhibited no significant differences compared with that in the control group and the OSA only group (P > .017), and it declined remarkably compared with that before PPI treatment (75% vs 35%, χ2 = 13.334, P = .001). Moreover, the multivariate analysis revealed that only LPRD had an independent correlation with the abnormality of ETS-7 (OR = 1.245, 95% CI: 1.759-6.861, P = .000). CONCLUSION In view of its high incidence in OSA patients, LPRD may be a considerable factor for the high incidence of abnormality rate of ETS-7 in OSA patients, and PPI therapy is of significant value in improving Eustachian tube function in OSA patients with LPRD.
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Affiliation(s)
- Suying Yan
- Department of Otolaryngology-Head and Neck Surgery, Bejing Anzhen Hospital, Captal Medical University, Beijing, China
| | - Yanjun Feng
- Department of Otolaryngology-Head and Neck Surgery, Bejing Anzhen Hospital, Captal Medical University, Beijing, China
| | - Linyin Yao
- Department of Otolaryngology-Head and Neck Surgery, Bejing Anzhen Hospital, Captal Medical University, Beijing, China
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王 梦, 景 红, 郭 红, 李 雪, 孙 建. [Evaluation of Eustachian tube function in children with adenoid hypertrophy by nasopharyngeal digital photography and ETDQ-7 scores]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:24-26. [PMID: 34979614 PMCID: PMC10128219 DOI: 10.13201/j.issn.2096-7993.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Indexed: 06/14/2023]
Abstract
Objective:To evaluate the Eustachian tube function of children with simple adenoid hypertrophy and adenoid hypertrophy with secretory otitis media(OME) by using the A/N value of lateral radiograph of nasopharyngeal X-ray and EDQ-7 scale scores. Methods:Sixty cases of children with adenoid hypertrophy admitted from February 2019 to August 2021 were all underwent nasopharyngeal X-ray lateral radiographs to determine the adenoid/nasopharyngeal cavity ratio(A/N ratio) and then determine the size of adenoids. The Eustachian tube function ETDQ-7 survey was used to evaluate the patient's self-evaluation of the severity of the disease and ear symptoms, and the degree of influence were scored. Subsequently, the correlation between adenoid hypertrophy with OME and ETDQ-7 scores was statistically analyzed by using the Spearman rank correlation statistical method. Results:In adenoid hypertrophy with OME group, the ETDQ-7 scores of A/N≤0.60, A/N 0.61-0.70 and A/N≥0.71 were 4.15±1.75, 14.55±6.67 and 23.95±6.63, respectively. The higher the grade of adenoid hypertrophy, the higher the ETDQ-7 scores. In adenoid hypertrophy with OME group, the degree of adenoid hypertrophy was positively correlated with the ETDQ-7 scores(P<0.05). Conclusion:Adenoid hypertrophy is also one of the potential factors causing OME in children.
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Affiliation(s)
- 梦航 王
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
| | - 红 景
- 北京大学国际医院儿科Department of Pediatrics, Peking University International Hospital
| | - 红光 郭
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
| | - 雪盛 李
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
| | - 建军 孙
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
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Lu H, Su J, Chi W, Zou T, Yu M, Wang K. Clinical value of the Eustachian Tube Function Scoring System T-ETDQ: a prospective diagnostic study. Eur Arch Otorhinolaryngol 2021; 279:2223-2230. [PMID: 34590179 DOI: 10.1007/s00405-021-07108-6] [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: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Tubomanometry (TMM) and the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was integrated to establish the Tubomanometry Eustachian Tube Dysfunction Questionnaire (T-ETDQ), and its reliability, potential clinical application, and diagnostic value for Eustachian tube function were investigated. METHODS This prospective diagnostic study included patients visiting the ENT Department of our Hospital, between April and June 2021. Patients were grouped into Eustachian tube dysfunction (ETD) and control groups according to tympanometry diagnosis results. The diagnostic value of the T-ETDQ was evaluated using receiver-operating characteristic (ROC) curve analysis. RESULTS There were 48 patients with Obstructive ETD and 24 patients without. The area under the ROC curve (AUC) of T-ETDQ was 0.898 (95% confidence interval [CI] 0.826-0.969), and the highest sensitivity and specificity were 76.7% and 86.7% respectively when the positive cutoff value was 4.72. The AUC of Eustachian tube score (ETS) was 0.731 (95% CI 0.625-0.837) and the highest sensitivity and specificity were 48.3% and 90.0% respectively when the positive cut-off value was 4.5. The ETS and T-ETDQ had kappa values of 0.311 and 0.585, respectively (P < 0.001 for both), showing both methods were comparable to tympanometry; however, T-ETDQ had more consistent results than ETS. CONCLUSION T-ETDQ can effectively quantify and evaluate ETD severity in adults, has a higher diagnostic value than ETS, making it a suitable diagnostic tool.
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Affiliation(s)
- Hongyi Lu
- Zhejiang Chinese Medical University, Hangzhou, China.,Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jun Su
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Wanlei Chi
- Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Ting Zou
- Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Mingqiang Yu
- Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Kang Wang
- Department of Otolaryngology, Zhejiang Hospital, Hangzhou, China.
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Diagnostic value of computed tomography in Eustachian tube dysfunction. Auris Nasus Larynx 2021; 49:352-359. [PMID: 34593272 DOI: 10.1016/j.anl.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Investigate radiological findings on temporal bone computed tomography, which are associated with obstructive Eustachian tube dysfunction and determine its diagnostic validity. METHODS The present study was conducted as a prospective, cross-sectional case series study in a tertiary referral center. Forty patients with clinically diagnosed unilateral Eustachian tube dysfunction and older than 16 years old underwent pre interventional radiological assessment by temporal bone computed tomography while performing a Valsalva-maneuvre to enhance visualization of Eustachian tube lumen. The Eustachian tubes were assessed for intersite morphological differences, presence of mucus in the lumen or middle ear cleft and secretion retention or mucosal swelling in the adjacent sinuses. Image analyses and radiological statements about the side of pathology were delivered blinded to the clinical diagnoses. RESULTS The radiologic detection of mucus/mucosal edema in Eustachian tube or adjacent middle ear cleft structures was associated with the pathological side (t (1, N = 40) = 3.60, p = 0.001 < 0.05). On the contrary, there is no association between radiological findings of sinonasal disease and side of Eustachian tube dysfunction (x2 (1, N = 40) = .00, p = 1.00 > 0.05). The diagnostic value of radiologic assessment in Eustachian tube dysfunction has a sensitivity and specificity of 52,5 and 97,5% respectively. CONCLUSION The sensitivity of radiologic assessment is rather low, and hence it is inappropriate as a screening tool for Eustachian tube dysfunction in routine clinical practice. In the case of present CT-scans of the temporal bone, the focus should be laid on the detection of mucus in the Eustachian tube or adjacent structures, as a predictor of disease.
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Abstract
OBJECTIVES Tubomanometry (TMM) is an objective method for investigating Eustachian tube (ET) function, but difficulties in technique and interpretation may reduce its usability. The objective of our study was to investigate common difficulties with TMM in different ET dysfunction (ETD) patient groups and at different pressures (30, 40, and 50 mbars) when first introducing TMM to otologic practice. Furthermore, we wanted to investigate whether it would be possible to perform TMM at only one pressure and obtain a representative result. METHODS A retrospective chart review of a 2-year cohort of 114 patients with a history of ETD treated at a tertiary referral center. Primary outcome was the success rate of TMM, secondary the reasons for unsuccessful measurements. Tertiary outcome was the correlation of TMM results at adjacent pressures. RESULTS TMM success rate was 91%, varying 81 to 94% in different ETD patient groups and 87 to 94% at different pressures. Unsuccessful measurements resulted from air-leaks from the external ear canal, abnormal ear canal pressure curves (R < 0) and at 50 mbar, difficulties in reaching sufficient nasopharyngeal pressure. TMM results were similar in 88% of cases at 30 and 40 mbars and in 86% of cases at 40 and 50 mbars. CONCLUSIONS TMM success rate seems sufficiently high for clinical diagnostics, and most difficulties may be overcome with proper interpretation during the TMM measurement session, and thus repeating the measurements when necessary. Considering the diagnostic information that would be lost if using only a single, predefined pressure, we suggest using all three pressures.
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OuYang Z, Lou Z, Lou Z, Jin K, Sun J, Chen Z. The effect of concurrent nasal surgery on the eustachian tube function and myringoplasty outcomes. Am J Otolaryngol 2021; 42:102926. [PMID: 33482565 DOI: 10.1016/j.amjoto.2021.102926] [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: 01/04/2021] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the Effect of concurrent nasal surgery on the eustachian tube function (ETF) and myringoplasty outcomes for the chronic perforations with coexistent nasal pathology. MATERIALS AND METHODS We retrospectively reviewed the records of 93 patients with perforations who underwent same-day myringoplasty and nasal-septal surgery. Group A exhibited septal deviations (n = 34) and Group B inflammatory sinus disease (n = 59). Groups were compared with respect to pre- and postoperative air-bone gaps (ABGs), graft success rates and ETF (Eustachian tube score [ETS] and seven-item Eustachian Tube Dysfunction Questionnaire [ETDQ-7]) at 6 and 24 months. RESULTS Graft success rates were 100.0% in Group A and 98.3% in Group B at 6 months postoperatively (P = 0.445). Graft success rates were 85.3% in Group A and 96.6% in Group B at 24 months postoperatively (P = 0.046), the re-perforation rate was significantly higher in Group A than in Group B (P = 0.015). Although the preoperative ETS was similar between two groups, the postoperative ETS in the Group B was significantly higher compared with Group A regardless of at postoperative 6th and 24th months. In addition, difference was significant for the patients with positive Valsalva maneuver among two groups at postoperative 24th months. Also, the improvement in the ETDQ-7 score in the B group was significantly higher than that in the A group at postoperative 6th and 24th months. CONCLUSIONS Concurrent nasal surgery and myringoplasty is feasible. In addition, ESS improves ETF and thus long-term outcomes of myringoplasty for the chronic perforations with inflammatory sinus disease.
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Angeletti D, Pace A, Iannella G, Rossetti V, Colizza A, Visconti IC, Gulotta G, Messineo D, de Vincentiis M, Greco A, D’Ambrosio F, Magliulo G. Chronic obstructive Eustachian tube dysfunction: CT assessment with Valsalva maneuver and ETS-7 score. PLoS One 2021; 16:e0247708. [PMID: 33651800 PMCID: PMC7924743 DOI: 10.1371/journal.pone.0247708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/11/2021] [Indexed: 12/25/2022] Open
Abstract
Chronic obstructive Eustachian tube dysfunction (ETD) is a common disorder of the middle ear. In recent years, two main diagnostic tools have become available: Eustachian tube score (ETS-7) and computed tomography (CT) combined with Valsalva maneuver. The aim of this study is to evaluate the outcomes of ETS-7 and CT in a group of patients affected by middle ear atelectasis with a strong suspicion of ETD. Three males and nine females, affected by middle ear atelectasis with retraction of the TM were enrolled. Each patient underwent to Eustachian tube dysfunction evaluation adopting the ETS-7 score and a temporal bone CT with Valsalva maneuver. The ears analyzed at steady state were divided into 2 groups: ETS<7 group and ETS≥ 7 group. The same division was applied for the ears analyzed after the Valsalva maneuver: ETS<7 group and ETS≥ 7 group. ETs were categorized as "well defined" (WD) and "not defined" (ND). The results of the analysis of the ETS-7 score in all 24 ears showed that 42% presented ETS ≥7, while 58% had ETS <7, indicating a diagnosis of ETD. In the ETS<7 group after Valsalva, ET was visualized in 33% of patients. In the ETS≥7 group it was WD in 29% after the Valsalva manoeuver. In both groups the comparison between the visualization of the ET before and after the Valsalva manoeuver did not present a statistical difference. No correlation emerged between ET evaluation with CT scan during Valsalva maneuver and ETS-7 score. It confirms that there is not a gold standard for the study of ET dysfunction.
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Affiliation(s)
- Diletta Angeletti
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | - Annalisa Pace
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | | | - Valeria Rossetti
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | - Andrea Colizza
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | | | - Giampiero Gulotta
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | - Daniela Messineo
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Greco
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Magliulo
- Department of “Organi di Senso”, Sapienza University of Rome, Rome, Italy
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[Evaluation of standardized questionnaires for diagnosis and differentiation of obstructive and patulous Eustachian tube dysfunction]. HNO 2021; 69:198-205. [PMID: 32885310 PMCID: PMC8241754 DOI: 10.1007/s00106-020-00931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hintergrund Eine klaffende Tube kann insbesondere durch Autophonie, Druckgefühl und gestörten Höreindruck zu einer Einschränkung der Lebensqualität führen. Bei fehlenden spezifischen Symptomen kann die Diagnose der klaffenden Tube schwierig sein. Insbesondere die Abgrenzung zur chronisch obstruktiven Tubenfunktionsstörung stellt eine Herausforderung dar. Da derzeit kaum standardisierte Diagnostik- und Therapieoptionen zur Verfügung stehen, ist eine strukturierte Untersuchung zur sicheren Diagnostik und wissenschaftlichen Aufarbeitung dieser Erkrankung erforderlich. Für die Diagnostik der chronisch obstruktiven Tubenfunktionsstörung wurde 2012 bereits der „Eustachian Tube Dysfunction Questionnaire“ (ETDQ-7-Fragebogen) nach McCoul entwickelt. Für die klaffende Tube existiert seit 2017 der PHI-10-Fragebogen („patulous Eustachian tube handicap inventory“) nach Kobayashi. Material und Methoden Der PHI-10-Fragebogen wurde ins Deutsche übersetzt und an 41 Gesunden, 13 Patienten mit Tinnitus auris, 11 Patienten mit klaffender Tube und 18 Patienten mit chronisch obstruktiver Tubenventilationsstörung getestet. Zusätzlich erfolgte im Vergleich die Auswertung des ETDQ‑7 nach McCoul. Ergebnisse Es erfolgt die Präsentation der deutschen Übersetzung des PHI-10 und der Ergebnisse von PHI-10 und ETDQ‑7 in allen Patientengruppen. Der ETDQ‑7 hat das Risiko falsch-positiver Ergebnisse bei Patienten mit klaffender Tube und der PHI-10 bei Patienten mit obstruktiver Tubenfunktionsstörung. Beide untersuchten Fragebögen sind falsch-positiv bei Tinnituspatienten. Schlussfolgerung Der PHI-10 (deutsch) und ETDQ‑7 (deutsch) sind eine nützliche Unterstützung der Anamnese bezüglich Tubenfunktionsstörungen. Sie unterscheiden jedoch nur unzureichend zwischen klaffenden und obstruktiven Tubenfunktionsstörungen und eignen sich nicht für Patienten mit Tinnitus. Die Stärke der Fragebögen ist in der Verlaufskontrolle und dem Monitoring von Therapieergebnissen zu sehen.
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Kourtidis S, Bier G, Preyer S, Hempel JM. Morphologic measurements of 3D Eustachian tube model and their diagnostic value regarding Eustachian tube dysfunction - A cross-sectional observational study. Eur J Radiol 2021; 136:109563. [PMID: 33517248 DOI: 10.1016/j.ejrad.2021.109563] [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: 05/13/2020] [Revised: 10/15/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the diagnostic value of three-dimensional morphologic measurements of the Eustachian tube on computed tomography in Eustachian tube dysfunction. METHOD This prospective cross-sectional observational study includes forty patients with unilateral Eustachian tube dysfunction. The clinical diagnosis is verified using the Eustachian tube score - 7 and the Eustachian tube dysfunction questionnaire - 7. Computed tomography scans of the temporal bone are acquired while performing a Valsalva manoeuvre to improve the visualization of the air-filled Eustachian tube lumen. The Eustachian tubes are delineated on curved planar reconstructions, and three-dimensional models are constructed. Seven morphological parameters are measured for each Eustachian tube: the cross-sectional size of the tympanic and pharyngeal orifice; the visualization length; the inclination angles, and the curvature angles. Morphological measurements and Eustachian tube scores are correlated. RESULTS The mean value of the visualization length of the complete Eustachian tube and in its bony segment is significantly higher in healthy sides than in pathological sides (p = 0.034 and p = 0.029, respectively). There is a significant correlation between the Eustachian tube score - 7 and the cross-sectional size of the tympanic orifice (rP = 0.361; p = 0.022). The Eustachian tube score - 7 correlates significantly with the visualization length of complete Eustachian tube (rP = 0.436; p = 0.005) and its bony segment (rS = 0.598; p < 0.0001), respectively. CONCLUSIONS The cross-sectional size of the tympanic orifice may be a specific imaging feature indicating the obstructive Eustachian tube. However, 3D morphologic measurements of the Eustachian tube are insufficient to yield useful data about its function.
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Affiliation(s)
- Savvas Kourtidis
- Department of Otolaryngology Head and Neck Surgery, ViDia Christian Hospital, Karlsruhe, Germany
| | - Georg Bier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Germany; Clinic of Neuroradiology, Alexianer Clemenshospital Münster, Germany
| | - Serena Preyer
- Department of Otolaryngology Head and Neck Surgery, ViDia Christian Hospital, Karlsruhe, Germany
| | - Johann-Martin Hempel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Germany.
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Manno A, Iannella G, Savastano V, Vittori T, Bertin S, Pasquariello B, Pace A, Rossetti V, Magliulo G. Eustachian Tube Dysfunction in Children With Adenoid Hypertrophy: The Role of Adenoidectomy for Improving Ear Ventilation. EAR, NOSE & THROAT JOURNAL 2021:145561321989455. [PMID: 33470833 DOI: 10.1177/0145561321989455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To our knowledge, few papers have addressed preoperative evaluation of the impact of adenoid hypertrophy (AH) on the pathogenesis of eustachian tube dysfunction (ETD) in children with otitis media with effusion (OME). AIM The aim of this study was 2-fold: first, to evaluate ETD using tubomanometry and Eustachian Tube Score 7 (ETS-7), in a group of children having AH; second, to assess the clinical impact of adenoidectomy on the ETD of these patients. METHODS Fifty patients, aged 4 to 15 years, underwent adenoidectomy based on various parameters: size of the adenoids causing canal obstruction (grades 1-4), the presence of OME, and recurrent episodes of rhinosinusitis. The function of the eustachian tube was evaluated using ETS-7 before and after surgical treatment. The patients were followed up for 6 months. RESULTS Forty children presented ETD. Of these, 36 had a grade 4 AH. The preoperative mean value for ETS-7 was 6.62. The mean postoperative ETS-7 score showed a value of 9.60 with a statistical difference compared to the preoperative value (P = .0015). CONCLUSIONS Adenoid hypertrophy has a high impact on the frequency of ETD. In the patients observed in the present study, the ETS-7 score appeared to be a valid tool for assessing ETD both preoperatively and postoperatively. Adenoidectomy seemed to be effective in improving ETD as well as middle ear ventilation.
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Affiliation(s)
- Alessandra Manno
- Department of Organi di Senso, 9311University "Sapienza", Rome, Italy
| | | | - Vincenzo Savastano
- Head and Neck Department, Unit of Pediatric Otolaryngology, 9311University "Sapienza", Rome, Italy
| | - Tommaso Vittori
- Head and Neck Department, Unit of Pediatric Otolaryngology, 9311University "Sapienza", Rome, Italy
| | - Serena Bertin
- Head and Neck Department, Unit of Pediatric Otolaryngology, 9311University "Sapienza", Rome, Italy
| | | | - Annalisa Pace
- Department of Organi di Senso, 9311University "Sapienza", Rome, Italy
| | - Valeria Rossetti
- Department of Organi di Senso, 9311University "Sapienza", Rome, Italy
| | - Giuseppe Magliulo
- Department of Organi di Senso, 9311University "Sapienza", Rome, Italy
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Sun H, Cao C, Qiu X, Hu J, Zhang J. Efficacy of balloon dilatation of the eustachian tube in patients with refractory otitis media with effusion after radiotherapy for nasopharyngeal carcinoma. Am J Otolaryngol 2020; 41:102724. [PMID: 32950831 DOI: 10.1016/j.amjoto.2020.102724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the efficacy of balloon dilatation of the eustachian tube (BDET) in patients with refractory otitis media with effusion (OME) after radiotherapy for nasopharyngeal carcinoma. MATERIALS AND METHODS A total of 58 patients (74 ears) who had received BDET for treatment of refractory OME after radiotherapy for nasopharyngeal carcinoma were enrolled. The efficacy was evaluated by seven-item eustachian tube scores (ETS-7), tympanogram type and air-bone gap, and the total effective rate was also calculated. All patients were followed up for 2 years. RESULTS ETS-7 scores at every postoperative visit were significantly higher than preoperative scores (all P < 0.05). ETS-7 score 6 months after surgery was the highest, which declined sharply from the 6th to the 24th month after surgery. Air-bone gap from the 1st to the 18th month after surgery was significantly smaller than preoperative one (all P < 0.05). Air-bone gap 6 months after surgery was the smallest, followed by that 12 months after surgery. The improvement in tympanogram type 6 months after surgery was the highest. The improvement of tympanogram type declined sharply from 12 to 24 months after surgery. According to evaluation of efficacy, only one patient completely recovered, and five patients partially recovered during the 2-year follow-up. CONCLUSION BDET can only significantly improve efficacy of refractory OME after radiotherapy for nasopharyngeal carcinoma for a certain period of time during the 2-year follow-up.
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Zhong Z, Zhang J, Ren L, Liu Y, Zhen Z, Xiao S. Predictors of Conservative Treatment Outcomes for Adult Otitis Media with Effusion. J Int Adv Otol 2020; 16:248-252. [PMID: 32784164 DOI: 10.5152/iao.2020.8091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Conservative treatments are usually the preferred choices for newly diagnosed adult otitis media with effusion (OME). This study was performed to explore the efficacy of conservative treatments, including medication and eustachian tube auto-inflation (ETA), for treating OME in adults and to analyze its predictors. MATERIALS AND METHODS A total of 107 adult patients with OME were included. All patients completed two weeks of conservative treatments including medication alone or the combination of medication and ETA. RESULTS The numbers of patients with only one and both ears affected were 79 and 28, respectively, and therefore, 135 affected ears were included. After treatment, 75 affected ears were classified as responders (55.6%), while 60 ears were classified as nonresponders (44.4%). Four predictive factors, including age, air-bone gap (ABG), tubomanometry value (TMM), and the treatment plan (all p<0.05) were found in treatment outcomes. Patients with age ≤50 years (vs. age>50 years), ABG <17 dB (vs. ABG≥17dB), TMM values of 2-6 (vs. TMM values of 0-1), and patients who received combined treatments, including medication and ETA (vs. patients who received medication only), were more likely to be responders (all p<0.05). CONCLUSION For OME in adult patients, younger age, smaller ABG, higher TMM value, and combined treatment including medication and ETA are good predictors for treatment success.
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Affiliation(s)
- Zhen Zhong
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Junbo Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Lei Ren
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Yuhe Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Zhen Zhen
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Shuifang Xiao
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
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Li R, Wu N, Zhang J, Hou Z, Yang S. Analysis on the correlation between Eustachian tube function and outcomes of type I tympanoplasty for chronic suppurative otitis media. Acta Otolaryngol 2020; 140:664-667. [PMID: 32400245 DOI: 10.1080/00016489.2020.1754462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial.Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM).Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed.Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air-bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group (p < .05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group.Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.
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Affiliation(s)
- Ruixiang Li
- Medical School of Chinese PLA, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- The Outpatient Clinic, Communication University of China, Beijing, China
| | - Nan Wu
- Medical School of Chinese PLA, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Jiabing Zhang
- Department of Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Zhaohui Hou
- Medical School of Chinese PLA, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Shiming Yang
- Medical School of Chinese PLA, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
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Biadsee A, Fanadka F, Dagan O, Firas K, Nageris B. Ostmann's Fat Pad-Does it Really Matter? Ann Otol Rhinol Laryngol 2020; 130:173-176. [PMID: 32700549 DOI: 10.1177/0003489420943219] [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: 11/15/2022]
Abstract
OBJECTIVE To compare the size of Ostmann's fat pad (OFP) between healthy ears and ears with chronic otitis media with cholestatoma (COMwC) using magnetic resonance imaging (MRI). METHODS Twenty-six patients with unilateral COMwC underwent mastoidectomy. Pre-operative MRI records were reviewed retrospectively. The healthy ears served as the control group. OFP is represented by the maximum diameter of the high intensity area medial to the tensor veli palatini muscle (TVP); M1. A reference diameter was defined from the medial border of OFP reaching the medial border of the medial pterygoid muscle; M2. Values of M1, M2 and the ratio of M1:M2 was compared between the healthy and pathological ear in each patient. RESULTS All 26 patients (16 females,10 males) had unilateral cholestatoma. Mean age was 37.6 years (range 19-83). In the healthy (H) ears group, mean M1H was 2.04 ± 0.53 mm, mean M2H was 9.57 ± 2.57 mm.In the pathological (P) ears group; mean M1P was 2.03 ± 0.55 mm, mean M2P was 9.86 ± 2.37 mm. A comparison of M1 and M2 values between the healthy and pathological ear groups was not statistically significant (P = .853 and P = .509, respectively).Mean M1H:M2H ratio in the healthy ears group was 0.22 ± 0.05, mean M1P:M2P ratio in the pathological ear group was 0.21 ± 0.06. A comparison between these ratios found no significant statistical correlation (P = .607). CONCLUSION The size of Ostmann's fat pad does not affect the development of chronic otitis media with cholestatoma in adults.
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Affiliation(s)
- Ameen Biadsee
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Feda Fanadka
- Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Or Dagan
- Hillel Yaffe Medical Center, Hadera, Israel
| | - Kassem Firas
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Benny Nageris
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Balloon Eustachian Tuboplasty (BET) in Children: A Retrospective Multicenter Analysis. Otol Neurotol 2020; 41:e921-e933. [PMID: 32658110 DOI: 10.1097/mao.0000000000002789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Generation of pilot data for planning of prospective BET-studies for treatment of dilatory Eustachian tube (ET) dysfunction in children. STUDY DESIGN Retrospective multicenter analysis. SETTING Nine ENT departments at tertiary care teaching hospitals. PATIENTS 4-12-year-old children with chronic otitis media with effusion (COME) for more than 3 months or more than 3 episodes of acute otitis media during the last year, having failed standard surgical therapy at least once. INTERVENTION BET with or without paracentesis, ventilation tube insertion, or tympanoplasty. MAIN OUTCOME MEASURES Tympanic membrane appearance, tympanometry, and hearing threshold. RESULTS Two hundred ninety-nine ETs of 167 children were treated. Mean age was 9.1 years (95% confidence interval [95% CI]: 8.7-9.4 yr). In 249 ears (83.3%), COME and/or retraction of the tympanic membrane were the indication for BET. Median hearing threshold was 20 dB HL (95% CI: 0-46 dB). One hundred fifty-five ears (51.8%, 95% CI: 46.1-57.4%) showed a tympanogram type B. Treatment consisted of BET without other interventions ("BET-only") in 70 children, 128 ears. Median length of follow-up for 158 (94.6%) children was 2.6 months (95% CI: 0.3-16.1 mo). After treatment, the tympanic membrane appeared normal in 196 ears (65.6%, 95% CI: 60.0-70.8%, p < 0.001). Median hearing threshold improved to 10 dB HL (95% CI: 0-45 dB, p < 0.001). Tympanograms shifted toward type A and C (type A: 39.1%, 95% CI: 33.7-44.7, p < 0.001). These improvements were also observed in subgroup analyses of "BET-only" treatment and the indication of "COME" respectively. CONCLUSION BET is improving a variety of dilatory ET dysfunction-related ear diseases in children. This study provides detailed data for design and planning of prospective studies on BET in children.
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Yan S, Wei Y, Zhan X, Yao L, Li X, Fang F, Xu J. Gastroesophageal Reflux Disease: A Cause for Eustachian Tube Dysfunction in Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2020; 100:937S-942S. [PMID: 32495651 DOI: 10.1177/0145561320931219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To explore the effect of gastroesophageal reflux disease (GERD) on Eustachian tube function in patients with obstructive sleep apnea (OSA). METHODS This was a cross-sectional study. The patients were divided into 4 groups according to OSA and GERD: OSA+GERD group; OSA-only group; GERD-only group; and normal control group. RESULTS There were no differences among the 4 groups regarding age, sex, smoking history, and alcohol history (all P > .05). The patients in the OSA and OSA+GERD groups had a significantly larger body mass index than those in the control and GERD-only groups (all P < .05). The proportions of patients with abnormal ETS-7 and ETD-Q results were higher in the GERD and OSA+GERD groups compared to the control group (P < .008). There were no significant differences in ETS-7 and ETD-Q between the control and the OSA-only groups (P > .008). The multivariable analysis showed that only GERD was independently associated with abnormal ETS-7 results (odds ratio = 3.090, 95% CI: 1.332-7.169, P = .009). CONCLUSION Given the high concomitance rate in patients with OSA, GERD might be an important association factor of Eustachian tube dysfunction in patients with OSA.
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Affiliation(s)
- Suying Yan
- Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongxiang Wei
- Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaojun Zhan
- Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Linyin Yao
- Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiping Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fang Fang
- Anzhen Hospital Sleep Center, Beijing, People's Republic of China
| | - Jie Xu
- Anzhen Hospital Sleep Center, Beijing, People's Republic of China
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Froehlich MH, Le PT, Nguyen SA, McRackan TR, Rizk HG, Meyer TA. Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes. Otolaryngol Head Neck Surg 2020; 163:870-882. [PMID: 32482125 DOI: 10.1177/0194599820924322] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction. DATA SOURCES PubMed, Scopus, and Google Scholar. REVIEW METHODS A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver. RESULTS The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, -3.02 to -1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms (P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline (P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term (P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks (P < .001) and 55.4% in the long term (P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline (P < .001). CONCLUSION Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phong T Le
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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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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Subjective and Objective Effectiveness of Eustachian Tube Balloon Dilatation for Patients With Eustachian Tube Dysfunction-Evaluation in a Pressure Chamber. Otol Neurotol 2020; 41:795-801. [PMID: 32282784 DOI: 10.1097/mao.0000000000002648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Eustachian tube plays a crucial role in pressure equalization between the middle ear and ambient pressure for fast and large pressure differences. In patients with chronic Eustachian tube dysfunction, Eustachian tube balloon dilatation is increasingly used as surgical therapy. Subjectively, many patients report an improvement of the symptoms postoperatively. Hence, there is a need to objectively measure this effect. METHODS The objectivity of Eustachian tube balloon dilatation was evaluated using a precise method of measuring Eustachian tube function. In a hypo/hyperbaric pressure chamber, 23 ears in 13 patients were exposed to a standardized profile of compression and decompression before Eustachian tube balloon dilatation and 4 weeks afterwards. Standardized parameters of Eustachian tube function were determined and statistically compared before and 4 weeks after intervention. In addition, an Eustachian Tube Dysfunction Questionnaire-7 (ETDQ7) questionnaire was completed beforehand and 4 weeks postoperatively to determine subjective surgical success. RESULTS The results from the ETDQ7 questionnaire showed a significant improvement in symptoms after Eustachian tube balloon dilatation (p = 0.0002). Objective measurements results showed a significant reduction of the Eustachian tube opening pressure during pressure decrease 4 weeks after intervention (p = 0.0012). CONCLUSION Eustachian tube balloon dilatation significantly reduced Eustachian tube opening pressure, in addition to subjective improvement of symptoms determined by ETDQ7.
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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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Ruan K, Li J, Tan S, Liu L, Tang A. Comparison of sonotubometry, impedance, tubo-tympano-aerography, and tubomanometry to test eustachian tube function. Am J Otolaryngol 2020; 41:102384. [PMID: 31883755 DOI: 10.1016/j.amjoto.2019.102384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE There is currently no gold standard for the diagnosis of eustachian tube (ET) dysfunction. To provide an objective basis for the clinical diagnosis of ET dysfunction, we explored the characteristics of sonotubometry, impedance, tubo-tympano-aerography (TTAG), and tubomanometry (TMM) in volunteers with healthy ETs. MATERIALS AND METHODS Sonotubometry, impedance, TTAG, and TMM tests were performed in 110 healthy ears of 55 volunteers, and the characteristics of each ET test were compared and discussed. RESULTS The ET opening rate was compared between sonotubometry with dry swallowing, impedance with the Valsalva maneuver, TTAG with the Valsalva maneuver, and TMM with a nasopharyngeal pressure of 50 mbar in 100 (90.9%), 102 (92.7%), 99 (90.0%), and 104 (94.5%) ears, respectively; there was no significant difference among the four methods (P = 0.575). In sonotubometry, both dry swallowing and the Valsalva maneuver were superior to wet swallowing in terms of detecting ET opening (P = 0.000). In TMM, both the opening rate and the external auditory canal pressure were positively correlated with the nasopharyngeal pressure. Specifically, the opening rate and external auditory canal pressure increased with an increase in the nasopharyngeal pressure (r = 0.271, P = 0.000; r = 0.315, P = 0.000, respectively). CONCLUSIONS Sonotubometry, impedance, TTAG, and TMM have their own advantages and disadvantages. In clinical practice, the appropriate ET function test should be chosen on the basis of the patient's specific condition.
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Affiliation(s)
- Kaian Ruan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangXi, China; Department of Otolaryngology Head and Neck Surgery, Yulin City The First People's Hospital, Yulin, GuangXi, China
| | - Jingyu Li
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangXi, China
| | - Songhua Tan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangXi, China
| | - Lei Liu
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangXi, China
| | - Anzhou Tang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangXi, China.
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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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Luukkainen V, Kivekäs I, Silvola J, Jero J, Sinkkonen ST. Balloon Eustachian Tuboplasty: Systematic Review of Long-term Outcomes and Proposed Indications. J Int Adv Otol 2019; 14:112-126. [PMID: 29764785 DOI: 10.5152/iao.2018.4769] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the long-term outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up ≥12 months). Five additional articles (follow-up, 6-11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET.
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Affiliation(s)
- Veera Luukkainen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Juha Silvola
- Department of Otorhinolaryngology, Akershus University Hospital and Campus AHUS/University of Oslo, Akershus and Oslo, Norway
| | - Jussi Jero
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Outcome Measures for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review. Otol Neurotol 2019; 39:138-149. [PMID: 29315176 DOI: 10.1097/mao.0000000000001666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Baro-challenge-induced Eustachian tube dysfunction (baro-induced ETD) is characterized by failure of the Eustachian tube (ET) to open adequately to permit middle-ear pressure regulation during ambient pressure changes. There are no well-characterized tests for identifying the condition, which makes both patient diagnosis and research into treatment efficacy challenging. This systematic review evaluates ET function tests as potential outcome measures for baro-induced ETD. DATA SOURCES MEDLINE and CENTRAL were searched (database inception to March 2017) and reference lists reviewed for all relevant English Language articles. STUDY SELECTION Tests in included studies were required to measure ET function in patients reporting baro-induced ear symptoms or barotrauma. DATA EXTRACTION Data were extracted in a standardized manner, and studies assessed according to Standards for Reporting of Diagnostic Accuracy Studies (STARD) criteria. The primary outcome of interest was the accuracy of ET function tests. DATA SYNTHESIS Heterogeneity of subject demographics, ET function test methodology, and reference standards only permitted narrative systematic review. CONCLUSION Sixteen studies involving seven different types of ET function tests were identified. The nine-step test was the most commonly used outcome measure, with overall test sensitivity and specificity ranges of 37 to 100% and 57 to 100%, respectively. Tympanometry test sensitivity was consistently poor (0-50%) while specificity was higher (52-97%). Published accuracy data for other ET function tests and test combinations were limited. Currently, no single test can be recommended for use in clinical practice. A combination of the nine-step test with other objective tests or patient-reported measures appears most promising as a core set of outcome measures for baro-induced ETD.
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Di Rienzo Businco L, Di Mario A, Tombolini M, Mattei A, Lauriello M. Eustachian tuboplasty and shrinkage of ostial mucosa with new devices : Including a proposal of a classification system. HNO 2019; 65:840-847. [PMID: 28361174 DOI: 10.1007/s00106-017-0346-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A new combined approach to Eustachian tube dysfunction (ETD) employing new minimally invasive devices is described. STUDY DESIGN An anatomoclinical classification of ETD was conceived to allow correct categorization of patients and enable comparative studies to be performed. Herein, the authors report on their experience with a consecutive series of obstructive ETD patients treated by balloon dilation of the Eustachian tube using AERA (Acclarent, Menlo Park, CA, USA), combined with a quantic molecular resonance (QMR)-mediated rhinopharyngeal tubal ostial mucosa shrinkage technique with a dedicated "Mitto" hand piece (Telea, Sandrigo-Vicenza, Italy). METHODS A prospective study was conducted in 102 patients with ETD. Medical history, complete clinical ENT evaluation and oto-functional examinations were performed in all patients. In all cases, balloon dilatation of the Eustachian tube was performed via the transnasal approach under video-endoscopic control. This was followed by decongestion of the torus tubarius and the inferior turbinate by QMR, with immediate shrinkage of the mucosa of the turbinate and a reduction of the prolapse of the mucosal plica on the tubal ostium. RESULTS Comparison of pre- and postoperative oto-functional examinations revealed a significant improvement. The postoperative hearing symptoms were reduced in a statistically significant manner on the visual analog scale (VAS). It was possible to perform the postoperative "swallowing-opening-Toynbee-Valsalva" (SOTV) test in a significant percentage of cases compared to the preoperative test. CONCLUSION The combined surgical procedure of balloon tubodilation with simultaneous QMR-mediated shrinkage of the tubal ostial mucosa and reduction of the posterior portion of the inferior turbinate was found to be an effective, safe, and complete treatment for tubal dysfunction in the majority of patients.
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Affiliation(s)
- L Di Rienzo Businco
- Otorhinolaryngology Unit, S. Spirito Hospital, Lungotevere in Saxia, 1, 00193, Rome, Italy.
| | - A Di Mario
- Otorhinolaryngology Unit, S. Volto Clinic, Rome, Italy
| | - M Tombolini
- Otorhinolaryngology Unit, S. Volto Clinic, Rome, Italy
| | - A Mattei
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Lauriello
- Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
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