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Fricano EE, Gremba AP, Teixeira MS, Swarts JD, Alper CM. Using Geometric Morphometric Analysis of Magnetic Resonance Imaging to Assess the Anatomy of the Eustachian Tube in Children with and without Otitis Media. Bioengineering (Basel) 2023; 10:1115. [PMID: 37892845 PMCID: PMC10604907 DOI: 10.3390/bioengineering10101115] [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: 07/26/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Otitis media (OM) is among the most common of childhood illnesses. It has long been hypothesized that children under age two are predisposed to OM due to differences in the anatomy of the Eustachian tube (ET), including the angle of the ET. OM in later childhood is less common but does occur, begging the question, are there shape differences in the ET that persist underlying later occurrences of OM? To answer this question, a novel method, which applied geometric and morphometric shape analysis to landmarks obtained from MRI data, was used. MRI scans were performed on 16 children (5 control, 3 cOME, and 8 rAOM) between 2011 and 2015. Sixteen landmarks representing the shape of the ET, cranial base, and palate were analyzed. The results of a Procrustes ANOVA indicate that the shape of the ET varies significantly (p < 0.01) between the OM and control groups. The shape differences between the OM group and the control are a medial and low attachment site of the tensor veli palatini (TVP) muscle, a posterior and high torus tubarius, and an anteriorly projected palate. These results support previous findings that a relatively horizontal ET is associated with a predisposition for OM. This study used a novel approach to examine anatomical differences in children with and without OM. First, the data set is unique in that it includes MRI scans of children with a confirmed OM diagnosis. Second, the use of MRI scans in craniofacial anatomy OM research is novel and allows for the collection of soft tissue landmarks and the visualization of soft tissue structures. Third, geometric morphometric shape analysis is a statistical method that captures shape differences, offering a more universal picture of nuanced changes within the entire set of landmarks, in contrast to more traditional linear and angular measurements used in prior OM studies examining craniofacial anatomy.
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Affiliation(s)
- Ellen E. Fricano
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Allison P. Gremba
- Doctor of Physical Therapy Program, School of Natural and Health Sciences, Seton Hill University, Greensburg, PA 15601, USA
| | - Miriam S. Teixeira
- Department of Graduate Medical Education, Arnot Ogden Medical Center, Elmira, NY 14905, USA
| | - J. Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Cuneyt M. Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
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Şahin MM, Sözmen Cılız D, Çayönü M, Kayalı Dinç S, Akbal Ş, Boynueğri S, Eryılmaz A. Magnetic Resonance Imaging of the Eustachian Tube and the Paratubal Structures in Patients with Unilateral Acquired Cholesteatoma. J Int Adv Otol 2020; 16:373-377. [PMID: 33136019 DOI: 10.5152/iao.2020.7508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to compare the Eustachian tube (ET) and the paratubal structures between the two sides in subjects with unilateral acquired cholesteatoma and a healthy contralateral ear to determine if there are anatomical differences. MATERIALS AND METHODS Of the 217 patients with cholesteatoma evaluated, 36 patients with unilateral cholesteatoma were included in the study. All of the patients had a healthy contralateral ear with no history of surgery. Nine different paratubal parameters were measured through contrast-enhanced magnetic resonance imaging (MRI). The measurements of the ear with cholesteatoma were compared with those of the healthy ear. RESULTS The bimucosal thickness of the ET lumen, the mucosal thickness of the pharyngeal orifice, the lengths and diameters of the tensor veli palatini muscle and the levator veli palatini muscle, the diameter of the pharyngeal orifice of the ET, the diameter of the lateral pharyngeal recess mucosal thickness, and the diameter between the posterior border of the inferior nasal concha and the pharyngeal orifice of the ET were measured in MRI scans. No statistically significant difference was observed between the healthy ear and the ear with cholesteatoma for any of the parameters measured (p>0.05). CONCLUSION We did not observe any anatomical differences in the measurements of the ET and the paratubal structures on MRI scans. Although ET dysfunction is considered to be the leading etiologic factor in acquired cholesteatoma, the ET and the paratubal structures may not exhibit an anatomic difference between the ear with cholesteatoma and the healthy contralateral ear.
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Affiliation(s)
- Muammer Melih Şahin
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Sözmen Cılız
- Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Melih Çayönü
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Seçil Kayalı Dinç
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Şeyda Akbal
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Süleyman Boynueğri
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Adil Eryılmaz
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Eisen EA, Wu X, Rees CA, Pastel DA, Paydarfar JA, Saunders JE. Tensor Veli Palatinopexy as a Novel Treatment for Eustachian Tube Dysfunction: A Cadaveric Feasibility Study. Otolaryngol Head Neck Surg 2020; 164:652-656. [PMID: 32894994 DOI: 10.1177/0194599820952407] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of a novel procedure whereby a suture is placed transorally in the tensor veli palatini muscle to tighten it, thereby dilating the cartilaginous portion of the eustachian tube (ET). STUDY DESIGN The study design was a prospective cadaveric experiment to examine the feasibility of a novel treatment for ET dysfunction. SETTING Academic medical center in a research-oriented operating room with intraoperative computed tomography (CT) capabilities. METHODS Seven fresh-frozen cadaver heads were obtained, each of which was thawed for 36 hours prior to use. The preprocedural volumes of the cartilaginous ET were measured by filling the ET with an iodine-containing radiocontrast agent via the nasopharynx and then obtaining CT images. Submucosal flaps in the soft palate were raised, and sutures were placed in the tensor veli palatini bilaterally to increase tension. After completion of the procedure, contrast placement and CT imaging were repeated. Three-dimensional models of the ETs were created, and the volumes were measured and compared. RESULTS Of the 14 ETs evaluated, 13 showed an increase in postprocedure volume. On average, postprocedure volumes showed a 57% increase from preprocedure volumes (mean relative change, 57.1%; P = .013). CONCLUSION Placement of a tension-holding suture in the tensor veli palatini muscle can reliably dilate the cartilaginous portion of the ET. Such a procedure may be useful in the treatment of ET dysfunction.
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Affiliation(s)
- Eric A Eisen
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Xiaotian Wu
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA
| | | | - David A Pastel
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joseph A Paydarfar
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - James E Saunders
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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George TN, Kotlarek KJ, Kuehn DP, Sutton BP, Perry JL. Differences in the Tensor Veli Palatini Between Adults With and Without Cleft Palate Using High-Resolution 3-Dimensional Magnetic Resonance Imaging. Cleft Palate Craniofac J 2018; 55:697-705. [PMID: 29360409 DOI: 10.1177/1055665617752802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the dimensions of the tensor veli palatini (TVP) muscle in adults with and without cleft palate. DESIGN Prospective study. PARTICIPANTS There were a total of 14 adult participants, 8 noncleft and 6 with cleft palate. METHODS Analysis and comparison of the TVP muscle and surrounding structures was completed using 3D MRI data and Amira 5.5 Visualization Modeling software. TVP muscle volume, hamular process distance, mucosal thickness, TVP muscle length, and TVP muscle diameter were used for comparison between participant groups based upon previous research methods. RESULTS Mann-Whitney U tests revealed a significantly smaller ( U < .001, P = .002) TVP muscle volume in the cleft palate group (median = 536.22 mm3) compared to individuals in the non-cleft palate group (median = 895.19 mm3). The TVP muscle was also significantly shorter ( U = 1.00, P = .003) in the cleft palate group (median = 18.04 mm) versus the non-cleft palate (median = 21.18 mm). No significant differences were noted for the other measured parameters. CONCLUSION Significant differences in the TVP muscle volume and length among the noncleft participants found in this study may insights into the reported increased incidence of otitis media with effusion (OME) seen in the cleft population. Results from this study contribute to our understanding of the underlying anatomic differences among individuals with cleft palate.
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Affiliation(s)
- Thomas N George
- 1 Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Katelyn J Kotlarek
- 2 Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - David P Kuehn
- 3 Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, IL, USA
| | - Bradley P Sutton
- 4 Department of Bioengineering and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, IL, USA
| | - Jamie L Perry
- 2 Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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Tensor veli palatini electromyography for monitoring Eustachian tube rehabilitation in otitis media. The Journal of Laryngology & Otology 2017; 131:411-416. [PMID: 28294083 DOI: 10.1017/s0022215117000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The pathogenesis of otitis media is related to Eustachian tube dysfunction. The tensor veli palatini muscle actively opens the Eustachian tube and promotes middle-ear ventilation. This study describes a technique for paratubal electromyography that uses a surface, non-invasive electrode able to record tensor veli palatini muscle activity during swallowing. METHODS Twenty otitis media patients and 10 healthy patients underwent tensor veli palatini electromyography. Activity of this muscle before and after Eustachian tube rehabilitation was also assessed. RESULTS In 78.5 per cent of patients, the electromyography duration phase and/or amplitude were reduced in the affected side. The muscle action potential was impaired in all patients who underwent Eustachian tube rehabilitation. CONCLUSION This study confirmed that Eustachian tube muscle dysfunction has a role in otitis media pathogenesis and showed that muscle activity increases after Eustachian tube rehabilitation therapy.
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Terzi S, Beyazal Çeliker F, Özgür A, Çeliker M, Beyazal M, Demirci M, Dursun E. The evaluation of eustachian tube paratubal structures using magnetic resonance imaging in patients with chronic suppurative otitis media. Acta Otolaryngol 2016; 136:673-6. [PMID: 27008280 DOI: 10.3109/00016489.2016.1154187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusion Eustachian tube (ET) dysfunction, which plays a role in the pathogenesis chronic suppurative otitis media (CSOM), does not seem to be due to differences in paratubal structures. Objective The aim of this study was to compare the magnetic resonance imaging (MRI) findings of the paratubal structures of the ET between normal ears and ears in patients with CSOM. Methods The MRI records of 40 patients who underwent tympanomastoidectomy for a diagnosis of CSOM were reviewed retrospectively. The healthy ears served as the control group. The length, diameter, surface area and volume of the tensor veli palatini muscle (TVPM) and levator veli palatini muscle (LVPM) were measured, in addition to the diameter of the pharyngeal orifice of the ET, volume of the Ostmann fat pad, bimucosal thickness of the lumen of the ET, and mucosal thickness. Results In the pathological ears, the mean length of the TVPM and LVPM was 22.6 mm and 19.3 mm, the mean diameter was 3.2 and 5.3 mm, and the mean volume was 1.75 and 3.2 cm(3), respectively. In addition, the mean diameter of the pharyngeal orifice of the ET was 1.9 mm. There were no significant between-group differences in the paratubal structures (p > 0.05).
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Affiliation(s)
- Suat Terzi
- a Medical Faculty, Department of Otorhinolaryngology , Recep Tayyip Erdogan University , Rize , Turkey
| | - Fatma Beyazal Çeliker
- b Medical Faculty, Department of Radiology , Recep Tayyip Erdogan University , Rize , Turkey
| | - Abdulkadir Özgür
- a Medical Faculty, Department of Otorhinolaryngology , Recep Tayyip Erdogan University , Rize , Turkey
| | - Metin Çeliker
- c Department of Otorhinolaryngology , Recep Tayyip Erdogan University Research and Training Hospital , Rize , Turkey
| | - Mehmet Beyazal
- b Medical Faculty, Department of Radiology , Recep Tayyip Erdogan University , Rize , Turkey
| | - Münir Demirci
- a Medical Faculty, Department of Otorhinolaryngology , Recep Tayyip Erdogan University , Rize , Turkey
| | - Engin Dursun
- a Medical Faculty, Department of Otorhinolaryngology , Recep Tayyip Erdogan University , Rize , Turkey
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Heidsieck DSP, Smarius BJA, Oomen KPQ, Breugem CC. The role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems. Clin Oral Investig 2016; 20:1389-401. [PMID: 27153847 PMCID: PMC4992026 DOI: 10.1007/s00784-016-1828-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 04/17/2016] [Indexed: 12/05/2022]
Abstract
Objective Otitis media with effusion is common in infants with an unrepaired cleft palate. Although its prevalence is reduced after cleft surgery, many children continue to suffer from middle ear problems during childhood. While the tensor veli palatini muscle is thought to be involved in middle ear ventilation, evidence about its exact anatomy, function, and role in cleft palate surgery is limited. This study aimed to perform a thorough review of the literature on (1) the role of the tensor veli palatini muscle in the Eustachian tube opening and middle ear ventilation, (2) anatomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair. Materials and methods A literature search on the MEDLINE database was performed using a combination of the keywords “tensor veli palatini muscle,” “Eustachian tube,” “otitis media with effusion,” and “cleft palate.” Results Several studies confirm the important role of the tensor veli palatini muscle in the Eustachian tube opening mechanism. Maintaining the integrity of the tensor veli palatini muscle during cleft palate surgery seems to improve long-term otological outcome. However, anatomical variations in cleft palate children may alter the effect of the tensor veli palatini muscle on the Eustachian tube’s dilatation mechanism. Conclusion More research is warranted to clarify the role of the tensor veli palatini muscle in cleft palate-associated Eustachian tube dysfunction and development of middle ear problems. Clinical relevance Optimized surgical management of cleft palate could potentially reduce associated middle ear problems.
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Affiliation(s)
- David S P Heidsieck
- Division of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, KE.04.140.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Bram J A Smarius
- Division of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, KE.04.140.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Karin P Q Oomen
- Division of Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Division of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, KE.04.140.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
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Imaging of the Eustachian tube and its function: a systematic review. Neuroradiology 2016; 58:543-556. [PMID: 26922743 PMCID: PMC4877436 DOI: 10.1007/s00234-016-1663-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/05/2016] [Indexed: 12/17/2022]
Abstract
Introduction The Eustachian tube is a complex and inaccessible structure, which maintains middle ear ventilation to facilitate transmission of sound from the tympanic membrane to the cochlea. A renewed interest in treatments for eustachian tube dysfunction has led to a demand for methods of imaging the Eustachian tube, and assessing tube opening non-invasively. This review aims to summarise the use of imaging in the anatomical assessment of the Eustachian tube, and to explore how radiological techniques can be used to assess tube function. Methods A systematic review of the literature was performed with narrative data analysis. Results With high-resolution images, the soft and bony anatomy of the Eustachian tube can be assessed in detail. CT and MRI are best suited to identifying features associated with obstructive or patulous Eustachian tube dysfunction, though true assessments of function have only been achieved with contrast enhanced radiographs and scintigraphy. A single modality has yet to provide a complete assessment. No test has entered routine clinical use, but further development and research is underway. Conclusion Significant information can be gained from imaging the Eustachian tube, and as faster acquisition techniques are developed, it is possible that dynamic imaging of tubal opening could play an important role in the assessment of patients with ET dysfunction.
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Smith M, Tysome J. Tests of Eustachian tube function: a review. Clin Otolaryngol 2015; 40:300-11. [DOI: 10.1111/coa.12428] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M.E. Smith
- Department of Otorhinolaryngology; Cambridge University Hospitals; Cambridge UK
| | - J.R. Tysome
- Department of Otorhinolaryngology; Cambridge University Hospitals; Cambridge UK
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Schönmeyr B, Sadhu P. A review of the tensor veli palatine function and its relevance to palatoplasty. J Plast Surg Hand Surg 2013; 48:5-9. [DOI: 10.3109/2000656x.2013.793603] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Functional evaluation of paratubal muscles using electromyography in patients with chronic unilateral tubal dysfunction. Eur Arch Otorhinolaryngol 2012; 270:1217-21. [PMID: 22760845 DOI: 10.1007/s00405-012-2091-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.
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Ralli G, Ruoppolo G, Mora R, Guastini L. Deleterious sucking habits and atypical swallowing in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2011; 75:1260-4. [PMID: 21802155 DOI: 10.1016/j.ijporl.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 07/01/2011] [Accepted: 07/02/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the possible correlation between otitis media with effusion, bad sucking habits and atypical swallowing in children affected by otitis media with effusion. METHODS 65 children, aged from 7 to 12 years, observed in the ENT Department of the "La Sapienza" University of Rome, were enrolled in the study group (group A). All children were affected by otitis media with effusion for more than 3 months. As control group, 60 healthy children, aged from 7 to 12 years were identified (group B). All the children underwent medical history, with evaluation of the sucking habits, ENT examination, tympanometry, orthodontic examination and evaluation of swallowing. In the orthodontic examination the variables analyzed were: maximum mouth opening, right and left mandibular lateral movements and mandibular protrusion. Atypical swallowing was considered to occur when lip activity produced strong tension in the perioral musculature, and/or the tip of the tongue was placed or pushed against the anterior teeth during swallowing. RESULTS In the group A, atypical swallowing was found in 33/65 subjects out of the 65 children (50.7%). In the control group (group B) 16/60 children (26.6%) showed atypical swallowing. Compared with group B, deleterious sucking habits were significantly higher (p<0.05) in the study group (28/65 vs. 12/60). In both the study and control group, deleterious sucking habits were present in almost all children with atypical swallowing (28/33 in group A and 12/16 in group B). CONCLUSIONS Our data suggest a correlation between otitis media with effusion, deleterious sucking habits and prevalence of atypical swallowing.
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Ghadiali SN, Bell ED, Swarts JD. Timing of tensor and levator veli palatini force application determines eustachian tube resistance patterns during the forced-response test. Auris Nasus Larynx 2010; 37:720-9. [PMID: 20413236 DOI: 10.1016/j.anl.2010.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 02/01/2010] [Accepted: 02/12/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The forced-response test (FRT) is used to assess eustachian tube (ET) function in patients with middle ear disease (otitis media). This test often documents a dynamic pattern of luminal dilation and constriction during swallowing which can be quantified as a function relating active tubal resistance with time. The goal of this study is to use a generalized finite element model (FEM) to test the hypothesis that the relative timing of muscle force application by the tensor veli palatini muscle (mTVP) and levator veli palatini muscle (mLVP) on the ET determines the form of active resistance functions. METHODS Seven resistance waveforms were obtained during the FRT in five adult subjects. A 2D FEM of the ET was constructed from an adult histological specimen and viscoelastic tissue mechanical properties were specified based on measurements obtained in each subject. Least-squared regression routines were used to vary the timing and magnitude of mTVP and mLVP force applications to the ET in order to match the active resistance functions recorded during the FRT. RESULTS Variation of muscle force timing and magnitude in the FEM simulations reproduced the seven active resistance waveforms with high fidelity. Early application of mTVP force in combination with mLVP force produced a waveform characterized by an initial dilation (low resistances) followed by lumen constriction (higher resistances), while delayed mTVP force application caused an initial lumen constriction followed by dilation. CONCLUSIONS These results indicate that the active resistance waveforms observed during the FRT reflect differences in the temporal pattern of mLVP and mTVP force application to the ET and emphasize that, like the mTVP, the mLVP functionally interacts with the ET. Results also indicate that in normal adults contraction of the mLVP promotes lumen constriction and that the initial lumen constriction is highly sensitive to the relative delay timing of mTVP and mLVP force application.
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Affiliation(s)
- Samir N Ghadiali
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, United States.
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