Does balloon Eustachian tuboplasty increase the success rate in repair of subtotal tympanic membrane perforations with resistant tubal dysfunction?

Clinical Analysis of Ear Congestion after Balloon Eustachian Tuboplasty (BET) with or without Tympanostomy Tube Insertion

Objective

To explore the clinical analysis of ear congestion after balloon Eustachian tuboplasty (BET) with or without tympanostomy tube insertion.

Methods

A total of 35patients (49 affected ears) with ear congestion following BET with or without tympanostomy tube insertion were recruited from the hospitalized patients from January 2015 to December 2017. The score of Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) 15, visual analogue scale (VAS), and Valsalva scores were recorded before and after operation, and the influencing factors of prognosis were analyzed. The duration of follow-up was 1-4 years.

Results

All patients showed significantly decreased average preoperative ETDQ-7 score, VAS, and Valsalva score after operation (p < 0.05). The significance of the surgery types, course of disease, severity of tympanic membrane retraction, and tympanogram tracings classification as influencing factors of prognosis did not come up to the statistical standard (p > 0.05).

Conclusion

The patients showed relatively stable postoperative conditions after 3 years, and there were variations in the range of ETDQ-7 scores at 5 years postoperatively. Patients with levels I and II tympanic membrane retraction showed more favorable surgical effects. Surgical interventions are required for patients diagnosed with obstructive Eustachian tube dysfunction (ETD) after three months of conservative treatment without satisfactory results.

Study of the Reliability of High Resolution CT Scan Evaluation of Eustachian Tube as Predictor of Predisposition for Chronic Otitis Media

Eustachian tube (ET) dysfunction is one of the predisposing factors for chronic otitis media (COM). This study looks at two parameters in High Resolution Computed Tomography of temporal bone namely tubotympanic angle (TTA) and pretympanic diameter (PTD) and its relationship with COM. The objectives of the study were to compare the tubotympanic angle and pretympanic diameter of the affected ear in patients with unilateral COM with that of healthy controls, and with contralateral non-COM ear. This was a retrospective study done at a tertiary referral hospital. Database of patients who underwent high resolution CT scan of temporal bone over a period of  three and half years, was studied. The TTA and PTD of ET were measured with the help of a senior radiologist well-versed in the imaging of temporal bone. Group A consisted of 45 patients with unilateral COM, while Group B comprised 50 patients without COM. Group A was further subgrouped as A1 (COM with cholesteatoma) and A2 (COM without cholesteatoma). The TTA and PTD in COM with cholesteatoma in the affected ear were 147.98 ± 5.89° and 2.84 ± 0.82 mm respectively, and in the unaffected ear, 144.81 ± 6.43° and 3.32 ± 1.19 mm respectively. In Group A, the TTA and PTD in the affected ear of unilateral COM were 146.17 ± 6.11°, 2.97 ± 0.87 mm and in Group B, it was 143.17 ± 6.01° and 3.48 ± 0.85 mm respectively. All these were statistically significant (p value < 0.05). Increased TTA and reduced PTD of ET may be a predisposing factor for the development of COM and cholesteatoma.

[Two-year experience in the balloon dilatation treatment of children with persistent auditory tube dysfunction]

OBJECTIVE

Is to study the effectiveness of the of balloon dilatation of the auditory tube in children with persistent dysfunction of the auditory tube. Examination and treatment of 28 children aged 5 to 16 years with persistent dysfunction of the auditory tube was performed. To diagnose and objectify the results of the treatment, taking of complaints and medical history of the patient, examination of ENT organs, endoscopic examination of the nose, nasopharynx and otoendoscopy, functional multispiral computed tomography of the auditory tubes, audiological examination (tympanometry, tonal threshold audiometry) were performed. Treatment included balloon dilatation of the auditory tubes. In 25 (89.3%) children, upon repeated examination after 2, 6, 12 months, the clinical, radiological, and audiological parameters were normal.

Clinical Consensus Statement: Balloon Dilation of the Eustachian Tube

OBJECTIVE

To develop a clinical consensus statement on the use of balloon dilation of the eustachian tube (BDET).

METHODS

An expert panel of otolaryngologists was assembled with nominated representatives of general otolaryngology and relevant subspecialty societies. The target population was adults 18 years or older who are candidates for BDET because of obstructive eustachian tube dysfunction (OETD) in 1 or both ears for 3 months or longer that significantly affects quality of life or functional health status. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus.

RESULTS

After 3 iterative Delphi method surveys, 28 statements met the predefined criteria for consensus, while 28 statements did not. The clinical statements were grouped into 3 categories for the purposes of presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes.

CONCLUSION

This panel reached consensus on several statements that clarify diagnosis and perioperative management of OETD. Lack of consensus on other statements likely reflects knowledge gaps regarding the role of BDET in managing OETD. Expert panel consensus may provide helpful information for the otolaryngologist considering the use of BDET for the management of patients with OETD.

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Objective

To evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM).

Methods

A retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too.

Results

The mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter).

Conclusions

Eustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.