Funktionsuntersuchungen der Tuba Eustachii

Eustachian Tube Balloon Dilation in Children: Short- and Long-Term Outcome

OBJECTIVE

Eustachian Tube Balloon Dilation (ETBD) represents an innovative therapeutic approach for chronic Eustachian tube dysfunction (CETD), a common disease in children. Some evidence of a benefit of ETBD in the adults exist in contrast to sparse reports in children. The objective was to analyze short- and long-term outcome of ETBD in children with CETD.

METHODS

A retrospective chart-review was performed in a cohort of 19 children (mean age 13 years, 7-17) who underwent ETBD. The following parameters were analyzed: tubomanometry (R-value), tympanogram, hearing (CPT-AMA, Air-bone gap [ABG]), Eustachian Tube Score (ETS and ETS-7), and Eustachian Tube Disease questionnaire (ETDQ).

RESULTS

Twenty-four ears were dilated (in 5 patients subsequently after successful first intervention) and grouped as A (17) without and B (7) with additional T-tube insertion. Most children suffered from either chronic otitis media with effusion or chronic perforation (12, 63%), the remainder comprising recurrent otitis media, adhesive otitis media and CETD with barotrauma. Mean duration of symptoms were 7/8.2 years and mean follow-up 13.7/11.1 months. Eighty percent of patients reported a subjective benefit. Accordingly, the R-value, ETS, and ETS-7 were significantly (P < .05) improved. Tympanometry, CPT-AMA and ABG showed a positive trend, but the result was not significant. Tympanic retraction remained largely the same; a spontaneous closure of a chronic tympanic perforation was seen in 1 of 3 cases.

CONCLUSIONS

The high subjective benefit and some significant objective improvement warrants further analysis of ETBD as part of the therapeutic management in pediatric CETD.

Prevalence of Eustachian Tube Dysfunction and Its Associated Factors Among the General Public in Al-Madinah, Saudi Arabia

Objectives To determine the association between patient demographics including gender, age, family history of hearing loss, and eustachian tube dysfunction (ETD) in the Al-Madinah region. Methods This is a cross-sectional observational study that was conducted using an online survey in the Al-Madinah region of Saudi Arabia from March 2022 to August 2022. Data were collected using a self-administered questionnaire (ETDQ-7) that was designed based on previous studies and frameworks. It consists of seven items, each with a score ranging from 1 to 7, for a total score of between 7 and 49 points. A total score of 14.5 or above, or a mean domain score of 2.5 or above, is considered abnormal, with higher scores indicating greater severity of symptoms. The analysis was carried out using SPSS v23. Results About 380 participants were included in the current study. The mean age of the participants was 29.2 ± 8.7 years old. About 13 (3.4%) of the participants had a history of ETD. The prevalence of ETD among the study population was 41.3%. Gender was significantly associated with the prevalence of ETD (p-value=0.004), with females tending to have the condition more frequently than males. Moreover, the history of ETD was also significant (p=0.001) Conclusion A higher prevalence of ETD was found in the current study when compared to international studies, gender and history of ETD were found to be linked with increased prevalence of EDT.

Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Taif, Saudi Arabia

Background

The eustachian tube is a tubular structure connecting the middle ear cavity with the nasopharynx, providing ventilation and pressure equalization in the middle ear, mucociliary clearance, and preventing the reflux of sound and fluid from the nasopharynx. Therefore, any kind of deficiency in this tube will lead to eustachian tube dysfunction (ETD).

Aim

This study aims to evaluate the prevalence and associated factors of ETD in the Taif public.

Materials and methods

A descriptive cross-sectional survey was conducted among the public in Taif, Saudi Arabia and it was done during the period between September 7 and September 28, 2021. A predesigned online questionnaire in the Arabic language was used to collect the data. The questionnaire contained three main parts. The first one included demographic questions, the second risk factors, and the third manifestations of ETD. The questionnaire was initiated after a literature review of similar articles and after experts' consultation for validity and reliability.

Results

A total of 693 participants completed the study questionnaire. The exact 546 (78.8%) participants were females and 671 (96.8%) were Saudi. The exact 122 (61%) participants among those who had ETD or hearing loss reported improvement in their symptoms after moving to another city below sea level. The exact 146 (21.1%) participants had ETD while 547 (78.9%) had reported normal function. ETD was detected among 69.2% of those who were previously diagnosed with ETD versus 20.1% of others (P=0.001). Participants with a family history of hearing loss showed a nearly doubled risk for having ETD (OR=1.98; 95% CI: 1.33-2.94) and smokers had nearly the same doubled likelihood(OR=1.83; 95% CI: 1.01-3.48).

Conclusion

In conclusion, our study revealed a slightly high prevalence of ETD and hearing loss among the public in Taif, Saudi Arabia, and the factors associated with ETD.

Association Between Eustachian Tube Dysfunction Questionnaire-7 Scores and Eustachian Tube Function Test Results in Symptomatic Patients With a Normal Drum

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.

A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty

To assess the safety and efficacy of navigation-guided balloon Eustachian tuboplasty (BET) compared to medical management (MM) alone in patients with chronic Eustachian tube dilatory dysfunction (ETD). This is a prospective, multicenter, 1:1 parallel-group, randomized controlled trial (RCT). It aims to assess the efficacy of navigation-guided BET compared to MM alone in patients with chronic ETD. The primary outcome measure was an improvement in the Eustachian tube dysfunction questionnaire (ETDQ)-7 score at the 6-week follow-up compared with baseline. Secondary outcome measures included changes in the signs and symptoms during the follow-up, changes in the score for each subcategory of ETDQ-7, type of tympanometry, pure tone audiometry, and the availability of a positive modified Valsalva maneuver. Navigation-guided BET was safely performed in all patients. A total of 38 ears of 31 patients (19 ears of 16 patients in the BET group and 19 ears of 15 patients in the control group) completed the planned treatment and 6 weeks of follow-up. More patients in the BET group (1.99 ± 0.85) had less symptomatic dysfunction than in the control group (3.40 ± 1.29) at 6 weeks post-procedure (P = 0.001). More patients experienced tympanogram improvement in the BET group at 6 weeks compared to the control group (36.5% vs. 15.8%) with a positive modified Valsalva maneuver (36.6% vs. 15.8%, P = 0.014). Additionally, air–bone gap change was significantly decreased in the BET group compared to the control group at the 6-week follow-up visit (P = 0.037). This prospective, multicenter, RCT study suggests that navigation-guided BET is a safe and superior treatment option compared to MM alone in patients with chronic ETD.

Evaluation of eustachian tube function using a portable device

The present paper investigates a portable eustachian-tube-function testing device by sonotubometry based on pure-tone sound transmission via the eustachian tube (ET). The measured results obtained by the proposed method were validated through comparison with the existing testing technique based on broadband sound inspection. The measurement results for the ET opening time (T_open) and the sound pressure difference in the ear canal between open and closed ETs (ΔL) obtained using pure-tone sounds with tonal frequency components of 7.0 and 9.5 kHz generally agreed with the results obtained by the existing technique with broadband testing sound.

Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Jeddah, Saudi Arabia: Cross-Sectional Survey-Based Study

Background

Obstruction of the Eustachian tube is a common condition that is unpleasant and might lead to various middle ear disorders.

Objective

This study aimed to estimate the prevalence of Eustachian tube dysfunction (ETD) among the public in Jeddah, Saudi Arabia.

Methods

This cross-sectional survey-based study was conducted in Jeddah during August 2018 by distributing an electronic survey form to participants from different districts of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study.

Results

A total of 2372 participants (female, 1535/2372, 64.71%; male, 837/2372, 35.28%; mean age 31.31 years, SD 11.85 years) agreed to contribute to our study. Upon analysis of their answers to the questionnaire, the overall prevalence of ETD in our sample was found to be 42.49% (1008/2372). The prevalence was higher among participants who reported a previous diagnosis of ETD and hearing loss (1897/2372, 80.00% and 1902/2372, 80.21%, respectively). Additionally, participants with a family history of hearing loss had a significantly higher prevalence (1136/2372, 47.92%) of ETD than those with no family history of hearing loss. Our analysis also showed that females were at a greater risk of developing ETD than males (P=.01).

Conclusions

As per our prevalence data, ETD is a common disease in Jeddah, pointing to the need for more attention, awareness, and research.

Endoscopy Guided Eustachian Tube Balloon Dilation: Our Experiences

Introduction:

Eustachian tube (ET) dysfunction is a common clinical entity but its treatment is still challenging to Otorhinolaryngologists. This study is done to know the effectiveness of transnasal endoscopic balloon dilatation of eustachian tube for treatment of chronic eustachian tube dysfunction.

Materials and Methods:

It is a retrospective observational study conducted between May 2018 to June 2019 at IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India. Twenty one patients were identified with diagnosis of ET dysfunction and assigned to this study. The transnasal endoscopic procedure was done to dilate the cartilaginous part of the eustachian tube with a balloon catheter. Preoperative computed tomography was done in all cases. All patients were post-operatively assessed in 1^st, 2^nd and 8^th weeks after the procedure.

Result:

Balloon dilatation of the eustachian tube was easily performed in all cases of this study. No abnormality including carotid canal was seen before this procedure. All except 2 cases revealed significant improvement in the ET functions. There was no damage to any vital structures like internal carotid artery in this study.

Conclusion:

The majority of the patients participated in this study showed positive outcome after balloon dilation of eustachian tube. It is a feasible and safe procedure for dilating the eustachian tube. This treatment is a very promising and requires more research on this aspect.

Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review

Objectives

Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments. This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.

Data sources

A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language. References of included studies were checked.

Methods

A systematic review was undertaken. Outcomes assessed were: primary outcomes-subjective improvement in symptoms (ETDQ-7), audiometric improvement of hearing, improvement of negative middle ear pressure noticed in tympanometry, objective improvement of tympanic membrane retraction. Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e. Valsalva manoeuvre, improved quality of life, passive tubal opening, tubomanometry, swallowing test, reduction in mucosal inflammation of Eustachian tube orifice in the nose, complications from the procedure, the need for further procedures. Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.

Results

Three studies were included. All included studies were small-scale case series (13–38 participants). Studies were conducted outside the UK. Subjective and objective improvement of Eustachian tube function was reported in all studies. But all included studies were at high risk of bias and subject to multiple limitations. No major complications were reported in either study.

Conclusions

Based on current evidence, it is not possible to recommend the clinical use of either of these two interventions i.e. Laser or Microdebrider Eustachian tuboplasty. Lack of controlled studies was identified as a gap in the evidence. Future research should be directed toward designing randomised controlled trials. These trials should use strict standard methodology and reporting criteria. Future trials should make use of consensus statement document about Eustachian tube dysfunction definition, diagnostic methods, and outcome assessment criteria to design clinical trials.

Navigation-Assisted Balloon Eustachian Tuboplasty for Eustachian Tube Dilatory Dysfunction

Objectives.

Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD.

Methods.

Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients’ symptoms preoperatively and at the postoperative follow-up.

Results.

Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient’s final visit at 6 months post-procedure.

Conclusion.

Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.

[Auditory tube dysfunction in children (literature review, part 1)]

We present the review of the literature on the anatomical and physiological features of the structure of the auditory tube in children, epidemiology, etiology, and the pathogenesis of the formation of auditory tube dysfunction is presented. The first part of the article presents in more detail the structural and functional differences in the Eustachian tube in children, the classification and mechanism of the occurrence of the auditory tube dysfunction in pediatric practice.

[Seasonal differences of tympanogram and middle ear findings in children. German version]

BACKGROUND

It is a known fact that bacterial or viral acute otitis media occurs more frequently in the winter months. Only a few older studies on seasonal differences in middle ear findings are available. These studies are based solely on tympanography, without correlation to intraoperative middle ear findings. This study addresses the question of whether seasonal differences can be found in the preoperative tympanogram and in the corresponding intraoperative findings in children with chronic middle ear problems.

PATIENTS AND METHODS

This retrospective study included patients who had undergone myringotomy with or without tympanostomy tube insertion at the Charité-Universitätsmedizin Berlin between January and December 2011. Corresponding to the catarrhal phases, winter months were defined as those from November to April; summer months from May to October. The preoperative tympanogram and the documented intraoperative middle ear finding were statistically analyzed for seasonal differences.

RESULTS

A total of 654 ears from 206 male and 127 female patients with mean age 3.7 ± 2.5 years were analyzed. In the majority of cases, a type B tympanogram was found (n = 376; 57.5%), whereas the middle ear was filled with air in 19.1% of cases. No significant seasonal differences were found for either the intraoperative middle ear findings or the preoperative tympanograms (p > 0.05).

CONCLUSION

For children with a typical history of chronic otitis media without effusion and chronic tube ventilation dysfunction, myringotomy with or without tympanostomy tube insertion is indicated independently of the season. The results indicate that a wait-and-see approach with hope of improvement during the summer months is not rational.

Analysis of chemosensory function in patients with chronic Eustachian tube dysfunction prior to and after balloon dilatation

OBJECTIVE

Eustachian tube dysfunction (ETD) affects approximately 1% of adults in the general population. Non treated Eustachian tube dysfunction can result in chronic middle ear diseases, which have been shown to significantly affect taste sensitivity. A promising treatment is balloon dilatation of the Eustachian tube. The primary aim of the present study was to investigate whether individuals with ETD had impairment in chemosensory functions, and the changes of the chemosensory function after balloon dilatation of the Eustachian tube.

METHODS

26 patients (17 female, 9 male) (=56 ears) suffering from ETD with a mean age of 39±15years were included in the present study. 20 patients (76%) returned to be evaluated at the follow up (=40 ears) 51±22days after balloon dilatation. For pre- and post operation, gustatory function was measured with a lateralized gustatory test with the taste strips and olfactory function was tested by means of the Sniffin' Sticks test battery (threshold, discrimination and identification (ID)).

RESULTS

Patients' baseline taste function (summed taste score 9.8±3.5 (mean±SD)) was significantly impaired compared to normative data (summed taste score 12.4±2.3; p=0.002). After balloon dilatation of the Eustachian tube, the taste function remained stable (summed taste score 9.4±4.3; p=0.814). Olfactory function (odor ID, summed score (TDI)) improved postoperatively (TDI 32.4±3.6) compared to pre-operative scores (TDI 33.6±4.0; p=0.012), but not to a clinically relevant extent.

CONCLUSION

This study suggests, that patients suffering from ETD exhibit reduced taste scores. Balloon dilatation of the Eustachian tube does not seem to influence gustatory function, but olfactory function showed improvement.

[Diagnosis and treatment of Eustachian tube dysfunction]

The Eustachian tube protects against secretion, germs and sound pressure from the nasopharynx, it acts as a drain, and serves pressure equalization in both directions so that the ear drum and sound-conducting apparatus can vibrate optimally. The incidence of Eustachian tube dysfunction in adults is about 1%, in children almost 40%. Symptoms are often unspecific. For diagnosis, the Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum. Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children. Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter. The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated.

Treatment of pharyngotympanic tube dysfunction

Eustachian tube dysfuntion intends to describe a variety of signs, symptoms, and physical findings that result from the impairment of ET function. A large variety of methods have been employed to assess ET function in the literature. Due to the lack of high level evidence, it is difficult to draw conclusions on the effectiveness of medical and surgical treatments. There are various medical and surgical interventions available for chronic obstructive ET dysfunction including balloon Eustachian tuboplasty (BET) and laser or microdebrider tuboplasty. Consensus on diagnostic criteria for ETD is required to define inclusion criteria of future trials. There is however emerging work with reassuring, but preliminary, results that suggest evidence for safety in the surgical management of ETD. Like many newly introduced techniques the current data remains limited to non-controlled case-series, with heterogeneous data collection methods and lacking substantial long-term outcomes. Nevertheless, short-term data provide favorable results. Current treatment options comprising BET and patulous ET surgery may be offered as a treatment possibility to selected patients.

[Balloon dilatation of the Eustachian tube during middle ear surgery : Study planning and first experiences during recruitment]

BACKGROUND

Eustachian tube dysfunction is considered a major contributor to chronic middle ear disease. In clinical case series, the results of balloon dilation (balloon Eustachian tuboplasty, BET) as a treatment for Eustachian tube dysfunction have been reported.

OBJECTIVE

This study aims to analyze whether patients undergoing planned surgery for chronic middle ear disease would benefit from additional BET.

METHODS

In a randomized controlled, patient and observer (not surgeon)-blind clinical study, 100 adult patients with planned surgery for chronic middle ear disease will be investigated. Patients will be randomized into two groups, one of which (50%) will receive additional BET of the affected side during the planned surgery. Eustachian tube function will be evaluated using the Valsalva maneuver and tubomanometry according to Estève, as well as on the basis of patient reports. Various scores will be used as outcome measures, including ETS-5 (Eustachian Tube Score 5), the extended version ETS-7, and the ETDQ-7 (Seven-Item Eustachian Tube Dysfunction Questionnaire). Follow-up is at 3, 6, and 12 months.

RESULTS

From June to December 2015, 162 patients underwent microscopic ear surgery. Inclusion criteria were not fulfilled by 90 patients. Of the remaining 72 patients with chronic middle ear disease, 12 patients (17%) have been randomized so far, 28 (39%) did not exhibit Eustachian tube dysfunction, and 32 (44%) patients could not be included for other reasons.

CONCLUSION

The rate of recruitment was lower than expected. Depending on the case number calculations for the patient groups identified in the study for whom BET might be particularly beneficial, multicenter studies in specific disease groups may follow.

Seasonal differences of tympanogram and middle ear findings in children

BACKGROUND

It is a known fact that bacterial or viral acute otitis media occurs more frequently in the winter months. Only a few older studies on seasonal differences in middle ear findings are available. These studies are based solely on tympanography, without correlation to intraoperative middle ear findings. This study addresses the question of whether seasonal differences can be found in the preoperative tympanogram and in the corresponding intraoperative findings in children with chronic middle ear problems.

PATIENTS AND METHODS

This retrospective study included patients who had undergone myringotomy with or without tympanostomy tube insertion at the Charité-Universitätsmedizin Berlin between January and December 2011. Corresponding to the catarrhal phases, winter months were defined as those from November to April; summer months from May to October. The preoperative tympanogram and the documented intraoperative middle ear finding were statistically analyzed for seasonal differences.

RESULTS

A total of 654 ears from 206 male and 127 female patients with mean age 3.7 ± 2.5 years were analyzed. In the majority of cases, a type B tympanogram was found (n = 376; 57.5%), whereas the middle ear was filled with air in 19.1% of cases. No significant seasonal differences were found for either the intraoperative middle ear findings or the preoperative tympanograms (p > 0.05).

CONCLUSION

For children with a typical history of chronic otitis media without effusion and chronic tube ventilation dysfunction, myringotomy with or without tympanostomy tube insertion is indicated independently of the season. The results indicate that a wait-and-see approach with hope of improvement during the summer months is not rational.

[The pressure-equalizing function of the Eustachian tube : Evaluation in a hypo-/hyperbaric pressure chamber]

BACKGROUND

The Eustachian tube connects the tympanic cavity (cavum tympani) and the nasopharynx, and enables pressure equalization between the middle ear and ambient pressure. Functional pressure compensation is very important for flying and diving in particular, due to non-physiologically large pressure differences.

OBJECTIVE

Evaluation of the pressure-equalizing function of the Eustachian tube is still a clinical challenge. This review article evaluates the existing data.

METHODS

Based on a selective literature search, different methods for evaluation of tube function are presented and evaluated, with special reference to evaluation of the pressure-equalizing function in a hypo-/hyperbaric pressure chamber.

RESULTS

The pressure chamber enables the dynamics of active and passive pressure compensation to be provoked and also permits accurate measurement of pressures in the millibar range.

CONCLUSION

A pressure chamber seems to be suitable to evaluate Eustachian tube function and therapeutic approaches to tube dysfunction. Further studies are needed to assess the value of the pressure chamber in combination with other functional tests.

Eustachian Tube Opening Measurement by Sonotubometry Using Perfect Sequences for Healthy Adults

Objectives

The aim of this study was to establish the rate variation of sonotubometric measurements using a specific broadband class of signals, the so-called perfect sequences (PSEQ) among healthy adults and to identify an optimal and technically simple test to provoke Eustachian tube (ET) openings.

Methods

Sonotubometry was performed on 105 healthy adult subjects. Three different consecutive maneuvers were performed for ET opening: dry swallowing, water swallowing (a small [2 mL] and a large [5 mL] water bolus). Values of the amplitude and duration of each measured ET opening were calculated.

Results

A total of 6,300 measurements were performed. Sonotubometric ET openings were detected for all subjects but not for each measurement. In 6,180 of 6,300 measurements (98.1%), objective ET openings were registered. In 11 of 105 subjects (10.5%) at least one sonotubometric ET opening was not detected. The mean ET opening duration time and the mean sound amplitude similar for all performed test and were 270 (SD, ±96) msec, 13.48 (SD, ±6.57) dB.

Conclusion

Sonotubometry based on PSEQ stimuli is a reliable methodology to assess the ET opening function in healthy subjects. Mean ET opening duration time and the mean sound wave amplitude performed similarly in all analysed tests, hence it might be concluded that dry (saliva) and water swallowing are reliable sonotubometric maneuvers and may be used when examining ET opening function. The size of a sip during water swallowing does not affect the sonotubometry result. All maneuvers can be equally used as the optimal test, and water swallow is most comfortable for the subject.

Balloon dilation eustachian tuboplasty: a feasibility study

OBJECTIVE

To assess the feasibility and safety of balloon dilation Eustachian tuboplasty (BET) as an option for treatment of patients with Eustachian tube dysfunction.

PATIENTS AND INTERVENTIONS

A cadaveric study of 5 temporal human bones was performed. Each bone underwent transnasal balloon dilation Eustachian tuboplasty (BET) with computed tomography and post-dilation histology. The procedure involved the dilation of the cartilaginous and bony portion of the Eustachian tube with a balloon catheter.

RESULTS

BET is technically easy to perform. No damage to essential structures, particularly the carotid canal, was found.

CONCLUSION

This newly introduced method seems to be a feasible and safe procedure to dilate the Eustachian tube.

Sonotubometry with perfect sequences: First results in pathological ears

CONCLUSION

Sonotubometry with perfect sequences (PSEQ) was able to detect eustachian tube (ET) openings in both normal and pathological ears. Impaired ears showed ET openings in almost all cases; however, these proved to be not only less frequent, but also with lower amplitude and shorter duration.

OBJECTIVES

To investigate the function of impaired ET under physiological conditions, using a novel kind of sound stimulus for sonotubometry – the PSEQ.

METHODS

Twenty otologically healthy subjects (40 normal ears) and 32 patients with ear diseases (40 pathological ears) were examined sonotubometrically using noise signals with an ideally flat spectrum (PSEQ). Dry swallowing, water swallowing, and Toynbee maneuver were used to induce ET openings. Analysis was performed regarding the frequency of occurrence, duration, amplitude, and form of the ET openings.

RESULTS

PSEQ allowed the detection of an ET opening in all 40 normal ears (91% of the performed maneuvers) and in 87.5% of the ears with impaired ET function (but only 47% of the maneuvers). The average amplitude of the openings in healthy ears was 16.86 dB, the average duration was 363 ms. In diseased ears these values were significantly lower: 9.73 dB, p < 0.001 and 280 ms, p < 0.05.

Evaluation of Eustachian tube function with perfect sequences: technical realization and first clinical results

The aim of this study was the introduction of a specific class of signals, the so-called perfect sequences (PSEQ), in a novel approach for sonotubometry of the Eustachian tube (ET). Sonotubometry using PSEQ stimuli was performed on 20 healthy subjects in order to gauge its potential for clinical applications. In a series of 320 measurements ET opening was probed, which was induced by dry and water swallowing, Toynbee maneuver, and yawning. All sonotubograms were analyzed with respect to their shape, increase of sound intensity, and opening duration. In 298/320 measurements (>93%) the subjects reported subjective ET openings. The evaluation of the recorded sonotubograms showed good detection of ET opening for the inducing maneuvers of swallowing (dry and water swallowing) and the Toynbee maneuver, with 90, 86, and 80% valid sonotubograms, respectively. Yawning led to only 40% valid sonotubograms. In total, 237/320 (~74%) sonotubograms were classified as valid. The evaluation of the sound level increase during ET openings showed that it was significantly higher in measurements with dry and water swallowing, as well as Toynbee maneuvers (mean 17.1, 19.0 and 17.2 dB, respectively), than with yawning (mean 10.17 dB; P < 0.0001). Nasal decongestion was found to have little influence on the results (P > 0.05). Sonotubometry using PSEQ stimuli is a novel sonotubometry methodology that provides valuable information regarding the auditory tube patency. By further technical refinements of the method, a diagnostic tool with high sensitivity and specificity could be developed.

[Treatment of chronic tube dysfunction. Use of the tube conductor]

BACKGROUND

Chronic tube dysfunction plays a major part in the development of chronic otitis media. Owing to the complex structure of the Eustachian tube, the development of successful therapeutic approaches to the treatment of tube function disorders is still difficult even today. The application of a gold tube wire (tube conductor) was reported in 1991, but no studies have yet been performed on the postoperative success rates achieved with tube conductors.

MATERIAL AND METHODS

In a retrospective study, the data relating to 125 patients who were operated on from 1996 to 1999 for treatment of different forms of chronic otitis media and also underwent transtympanic tube conductor implantation to improve tube ventilation disorder were evaluated. Data on pre- and postoperative tube function were available for 96 patients after a mean follow-up period of 18 months.

RESULTS

All tube implantations were achieved without complications. Tube function normalized in 8 patients (8.3%), while the tube ventilation disorder remained unaffected in 88 patients (91.7%). A total of 23 (18.4%) tube conductors have so far been removed. The reasons for removal include persistent tube ventilation disorder, dislocation of the tube conductor in 7 patients (5.6%) and granulation around the tube wire in 7 cases (5.6%).

CONCLUSIONS

The chronic tube ventilation disorder was improved by implantation of a tube conductor in only 8.3% of the patient population investigated. We are therefore of the opinion that this is not a suitable treatment for chronic tube ventilation disorders. The development of new, effective therapeutic approaches to the treatment of chronic tube ventilation disorders remains a priority.

Evaluation of Eustachian tube function by sonotubometry: results and reliability of 8 kHz signals in normal subjects

Sonotubometry allows an assessment of the Eustachian tube (ET) function under physiological conditions. The reliability of the application of an 8 kHz pure-tone signal was investigated. In 40 normal subjects (80 ears) sonotubometric studies were performed with a custom-made device. ET opening was provoked by swallowing, yawning and Valsalva manoeuvre. An opening was detected in all patients but not in all manoeuvres. Four characteristic sonotubogram types were found. Most common was the spike-type (60%). The double-peak and the plateau-shaped curves occurred in 17% each. The finding of an descendant curve was rare (5%). Of 623 measurements, only in 55% manouvres a positive sonotubometric result was found despite the fact that the patients reported an opening in all cases. The median opening time in dry swallowing, liquid swallowing, yawning and Valsalva was found to be 486, 355, 1,263 and 1,250 ms. A median sound increase of 16.0, 13.8, 15.0 and 15.0 dB was recorded for these manoeuvres. There was a statistic significant difference (P < 0.02) between the increase in sound intensity of liquid and dry swallowing. There was also a statistic significant difference found for the duration of the forced manoeuvres Valsalva and yawning as compared to dry and liquid swallowing (P < 0.0001). The use of an 8 kHz pure-tone signal showed a limited sensitivity for the detection of ET openings. This is mainly due to noise pollution, but also because of an altered positioning and/or dislocation of the probes and compression of the nostrils. The application of an 8 kHz signal is therefore not reliable enough for the use in practice. Further technical refinements and the use of alternative signals are necessary for a broader clinical application.

Längenvariable Titanprothesen bei Typ-III-Tympanoplastik

INTRODUCTION

For type III tympanoplasty by partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), the length of the prosthesis must match the individual intraoperative anatomical and physiological characteristics.

MATERIALS AND METHODS

Databanks were used to determine the necessary sizer length of the sizer disc. The measurement template for the size of the cartilage to overlay the prosthesis headplate was derived from the headplates of the Tübinger titanium prostheses (TTP) and the Dresdener titanium prostheses. Finally all functions were integrated into a synthetic plate.

RESULTS

The result was a simple and reasonably priced disposable multifunctional instrument (Tübinger sizer disc TSD) which allowed an exact measurement for every prosthesis in TORP and PORP. For the TTP-Variac, the TSD enabled the simple intraoperative production of prostheses with the length desired by the surgeon. For PORP the TSD enabled an adaptation of the diameter of the prosthesis foot for TTP, TTP-Vario and TTP-Variac and provided a template for the size determination of the cartilage overlay of the titanium prosthesis head. The sizers and the resulting prostheses were used for initial tympanoplastic operations. Audiometric investigations carried out 6 weeks postoperatively gave results corresponding to those previously obtained in a study with TTP and TTP-Vario using the old instrumentation.

CONCLUSIONS

The new instrumentation leads to an improvement of the intraoperative practicability and a simplification. The audiological results remain the same.

Endoskopische Untersuchungen der Eustachi-Röhre

BACKGROUND AND OBJECTIVE

Endoscopy of the eustachian tube allows direct examination of endoluminal alterations in the course of the organ. The aim of this study was to describe anatomic and functional findings in healthy awake subjects.

PATIENTS/METHODS

Ten eustachian tubes in six healthy individuals with no history of tube dysfunction were examined under local anesthesia using different types of rigid and flexible endoscopes.

RESULTS

Nine of ten tubes presented with no pathologic finding. The motility of the tube cartilage could be visualized in all cases and showed a wide variety. Prior anesthesia of the mucosa with the subject in the supine position, if necessary supplemented by a tube catheter, rendered the procedure more comfortable.

CONCLUSION

The eustachian tube shows a wide spectrum of anatomic and functional varieties in normal subjects. The method allows comprehensive evaluation of anatomic and functional stenoses of the eustachian tube. The transnasal-transpharyngeal approach allows only limited evaluation of the middle ear structures.