Effects of nasal obstruction on Eustachian tube function and middle ear pressure

Balloon Dilation of the Eustachian Tube for Baro-Challenge-Induced Otologic Symptoms in Military Divers and Aviators: A Retrospective Analysis

OBJECTIVE

To evaluate the effectiveness of balloon dilation (tuboplasty) of the Eustachian tube (BET) in active duty military personnel working in hyper- and hypobaric environments suffering from baro-challenge-induced ETD using functional outcomes.

METHODS

Military divers and aviators diagnosed with persistent baro-challenge-induced ETD resulting in disqualification from performing flight and dive duties and who elected for treatment with BET were included for analysis. Posttreatment follow-up assessments were undertaken at 1, 6, and 12 months. Outcome measures included successful hyperbaric chamber testing or return to the hyper- or hypobaric environment without significant baro-challenge-induced ETD symptoms and pre- and postdilation Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores.

RESULTS

Mean pretreatment duration of symptoms was 48 months (range: 3-120 months). Following treatment, 92% (12/13) of patients successfully returned to operational duties with resolution of limiting symptoms. Average return to duty time was 8.5 weeks (range: 6-24 weeks). The ETDQ-7 scores improved from a mean of 4.33 (2.57-6.57) predilation to 2.19 (1.00-4.43) postdilation (Z = 2.73, W = 70, P = .0063). Mean duration of follow-up was 38 weeks (range: 13-70 weeks).

CONCLUSION

Eustachian tube balloon dilation appears to be a safe and highly effective treatment option for baro-challenge-induced ETD in affected military divers and aviators who work in hyper- and hypobaric environments. Further study is needed to determine whether similar results can be achieved in more diverse subject populations and to assess long-term effectiveness.

Predictors of eustachian tube dysfunction improvement and normalization after endoscopic sinus surgery

OBJECTIVE

Studies have demonstrated improvement in Eustachian tube dysfunction (ETD) symptomatology after functional endoscopic sinus surgery (FESS); however, factors associated with ETD symptom alteration have not been elucidated. This study evaluated factors associated with improvement and normalization of ETD symptoms after FESS.

METHODS

A case-control study was performed of FESS patients who had clinically significant ETD symptoms based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7 ≥ 2.1) without middle ear effusion (MEE) preoperatively. Study patients were identified as those with a normalized ETDQ-7 at 2 months postoperatively. Controls were patients whose ETDQ-7 did not normalize at 2 months. Demographics, surgery characteristics, chronic rhinosinusitis phenotype, Lund-Mackay score, temporomandibular joint dysfunction (TMJD), preoperative ETDQ-7 and SNOT-22 scores, and tympanograms were analyzed. Univariate and multivariate analyses were performed comparing study cases and controls.

RESULTS

Data were collected on 165 patients, with 46% patients having clinically significant preoperative ETD and 60 patients meeting final study inclusion/exclusion criteria. FESS was associated with both SNOT-22 and ETDQ-7 improvement (P < 0.001). Nasal polyposis was associated with a higher probability of ETDQ-7 normalization (OR 4.429, P = 0.035). Factors associated with failure of ETDQ-7 normalization included TMJD (OR 0.086, P < 0.001, 95% CI 0.019-0.391) and high preoperative ETDQ-7 (OR 0.140, P = 0.006, 95% CI 0.032-0.613).

CONCLUSION

In patients with clinically significant ETD symptoms without MEE, FESS was associated with ETDQ-7 improvement. Nasal polyposis was associated with an increased probability of normalization of ETD symptoms postoperatively, whereas TMJD had a negative association.

LEVEL OF EVIDENCE

3b Laryngoscope, 2019.

Assessment of nasal functions and their relationship with cholesteatoma formation in patients with unilateral chronic otitis media

OBJECTIVES

To evaluate the nasal functions of patients with unilateral chronic otitis media using rhinomanometry, comparing chronic otitis media sides with healthy sides, chronic otitis media patients with cholesteatoma and without cholesteatoma, and patients with healthy individuals.

METHODS

This prospective study included 102 patients with unilateral chronic otitis media (48 with and 54 without cholesteatoma). The control group comprised 40 individuals without any ear or nasal pathologies. All patients underwent active anterior rhinomanometry to measure nasal airway resistance and a saccharin test to measure mucociliary transport times.

RESULTS

There were no significant differences in nasal airway resistance and mucociliary transport time between the chronic otitis media sides and unaffected sides in the 102 patients (p = 0.72 and p = 0.28, respectively), between the non-suppurative chronic otitis media patients (without cholesteatoma) and chronic otitis media with cholesteatoma patients (p > 0.05), or between the study and control groups (p > 0.05).

CONCLUSION

The present study, with a larger sample size compared to previously published literature, supports the conclusion that unilateral nasal obstruction is unlikely to lead to chronic otitis media on the same side. The results also suggest that nasal functions do not contribute to the development of cholesteatoma.

The Effect of Endoscopic Sinus Surgery on Symptoms of Eustachian Tube Dysfunction

Background

The symptom of eustachian tube dysfunction has been categorized as a “minor” symptom in chronic rhinosinusitis. The aim of this pilot study was to determine the frequency of otologic symptoms in patients with confirmed rhinosinusitis and the likelihood of its resolution in those patients undergoing endoscopic sinus surgery (ESS).

Methods

Questionnaires were obtained from 168 patients who had undergone prior ESS over a 5-year period. Patients were asked to evaluate if they suffered from several different potential symptoms of eustachian tube dysfunction before ESS and whether that symptom changed postoperatively.

Results

Using the binomial test, 95% confidence intervals were determined for the following otologic symptoms of tubal dysfunction: “ear fullness and congestion,” “ear cracking and popping,” “dizziness,” and “ear pain.” ESS was found to have a significant treatment effect for the indicated otologic symptoms of tubal dysfunction.

Conclusion

Tubal dysfunction, as manifested by otologic symptoms, is common in patients with chronic rhinosinusitis undergoing ESS. The classification of this as a “minor” symptom of rhinosinusitis needs to be reevaluated. These symptoms improve or resolve in the majority of patients undergoing ESS.

Should Nasal Function be Considered Prior to Tympanoplasty?

OBJECTIVE

To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM).

MATERIALS AND METHODS

The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month.

RESULTS

Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%.

CONCLUSION

Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

Impact of Septoplasty on Eustachian Tube Functions

OBJECTIVE

To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions.

MATERIAL AND METHODS

The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months.

RESULTS

Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group.

CONCLUSIONS

Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

Middle ear pressure after septoplasty

OBJECTIVES

The aim of this study was to determine the level of middle ear pressure and alterations in middle ear pressure levels after septoplasty among the individuals having advanced degree isolated nasal septal deviation.

METHODS

A prospective randomized study was conducted. The study included 72 adult patients who had severely deviated septum. The middle ear pressure values at both sides of nasal obstruction and opposite side were determined using tympanometry before the surgery and at postoperative week 3. The middle ear pressure values were divided into 2 groups, side of nasal obstruction (group 1) and opposite nonaffected side (group 2). The middle ear pressure values obtained before and after septoplasty were compared.

RESULTS

Before the septoplasty, the median middle ear pressure value was -54 dPa at the side of nasal obstruction, and -46 dPa at the opposite side. Three weeks after the septoplasty, it was -38 dPa at the side of nasal obstruction, and -40 dPa at the opposite side. The middle ear pressure improved by approximately 30% at the side of nasal obstruction and by 11% at the nonaffected side; a statistically significant decrease was found at the side of nasal obstruction (P < 0.05).

CONCLUSIONS

In adult patients with isolated nasal septum deviation, the middle ear pressure is lower at the side of nasal obstruction, but it remains within reference ranges. An approximately 30% improvement occurs in the middle ear pressure after septoplasty.

Nasal obstruction and unilateral chronic otitis media: evaluation by acoustic rhinometry

OBJECTIVES

In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction.

METHODS

Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time.

RESULTS

The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05).

CONCLUSIONS

These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.

Persistent alternobaric vertigo at ground level

We recently encountered a 15-year-old female with bilateral tympanostomy tubes who manifested persistent severe vertigo, at ground level, secondary to a unilateral middle-ear pressure of +200 mm H(2)O elicited by an obstructed tympanostomy tube in the presence of chronic nasal obstruction. We believe this is a previously unreported scenario in which closed-nose swallowing insufflated air into her middle ears, resulting in sustained positive middle-ear pressure in the ear with the obstructed tube. Swallowing, when the nose is obstructed, can result in abnormal negative or positive pressures in the middle ear, which has been termed the Toynbee phenomenon. In patients who have vertigo, the possibility that nasal obstruction and the Toynbee phenomenon are involved should be considered.

Studies in otitis media: Children's Hospital of Pittsburgh-University of Pittsburgh progress report--2004

OBJECTIVES/HYPOTHESIS

The present Progress Report has summarized the key otitis media clinical trials and laboratory studies conducted since 1969 by investigators at the Children's Hospital of Pittsburgh-University of Pittsburgh (Pittsburgh, PA).

STUDY DESIGN

Review.

METHODS

Included in the discussion are the following: 1) studies of the epidemiology and risk factors; 2) anatomy and pathology of the eustachian tube-middle ear from human temporal bone histopathological specimens; 3) physiology and pathophysiology of the eustachian tube-middle ear in humans and animal models; 4) pathogenesis; 5) otitis media in special populations (e.g., patients with cleft palate, Native Americans, patients with Down syndrome); 6) microbiology; 7) diagnosis; 8) outcomes of randomized clinical trials that evaluated efficacy of nonsurgical and surgical methods of treatment and prevention; 9) studies of certain complications and sequelae (e.g., effect of middle-ear effusion on hearing, early child development, and the vestibular system; chronic suppurative otitis media). Also included are relevant summary tables and 256 references.

Sexually dimorphic activation of galanin neurones in the ferret's dorsomedial preoptic area/anterior hypothalamus after mating

Male ferrets in breeding condition possess three times as many galanin-immunoreactive (IR) neurones as oestrous females in the sexually dimorphic dorsomedial preoptic area/anterior hypothalamus (dmPOA/AH). Using Fos-IR as a marker of activation, we investigated whether mating with intromission differentially activates this sexually dimorphic group of galanin-IR neurones in male and female ferrets. Male ferrets that intromitted had a significantly greater percentage of galanin-IR neurones in the dmPOA/AH that were colabelled with nuclear Fos-IR than oestrous females that received an intromission. Intromissive stimulation augmented Fos-IR in an equal percentage of galanin-IR neurones in both sexes in the medial amygdala (MA) and bed nucleus of the stria terminalis (BNST). Peripheral anosmia induced by bilateral occlusion of males' nares did not reduce the mating-induced activation of galanin-IR neurones in the dmPOA/AH, and there was a significant correlation among individual males between intromission duration and the percentage of dmPOA/AH galanin-IR neurones colabelled with Fos-IR. Exposure of castrated, testosterone propionate-treated male ferrets to either soiled bedding or to volatile odours from oestrous females failed to induce nuclear Fos-IR in galanin-IR neurones located in the dmPOA/AH, BNST or MA, suggesting that the mating-induced activation of galanin-IR forebrain neurones in male ferrets depends more on genital-somatosensory than on olfactory inputs. The observed sex dimorphism in the mating-induced activation of galanin-IR neurones in the dmPOA/AH raises the possibility that these neurones perform a mating-dependent function that occurs only in males.

Mating induces gonadotropin-releasing hormone neuronal activation in anosmic female ferrets

In females of both spontaneously and induced ovulating species, pheromones from male conspecifics can directly stimulate GnRH neuronal activity, thereby inducing pituitary LH secretion and stimulating the onset of estrus. However, whether pheromones contribute to the steroid- or mating-induced preovulatory activation of GnRH neurons is less clear. Previous studies in the ferret, an induced ovulator, raised the possibility that olfactory cues contribute to the ability of genital-somatosensory stimulation to activate GnRH neurons in the mediobasal hypothalamus (MBH). In the present study the percentage of GnRH neurons colabeled with Fos-immunoreactivity (IR), used as a marker for neuronal activation, was investigated in the MBH of mated gonadectomized, estradiol-treated female ferrets in which both nares were occluded. In addition, the percentage of GnRH neurons colabeled with Fos-IR was examined in the MBH of gonadectomized, estradiol-treated female ferrets exposed to male bedding. Bilateral nares occlusion successfully blocked mating or odor-induced increments in Fos-IR in central olfactory regions, including the cortical and medial amygdala. By contrast, the percentage of GnRH neurons expressing Fos-IR did not differ between mated nares- and sham-occluded females. Exposure to male bedding alone failed to induce Fos-IR in MBH GnRH neurons. Thus, the mating-induced preovulatory activation of GnRH neurons in the female ferret's MBH appears to rely solely on genital-somatosensory as opposed to olfactory inputs.