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Hsieh CY, Lin WC, Lin CC, Chou YF. Combined balloon Eustachian tuboplasty/endoscopic sinus surgery for patients with chronic rhinosinusitis and Eustachian tube dysfunction. Int Forum Allergy Rhinol 2024; 14:1327-1336. [PMID: 38465787 DOI: 10.1002/alr.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD. METHODS This randomized controlled trial conducted in a single-institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty-five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22, modified Lund-Kennedy score, Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and serial Eustachian tube function test results were analyzed 3 months postoperatively. RESULTS The improvement (12.60 ± 6.50) in the ETDQ-7 score in the BET group was significantly higher than that in the control group (6.60 ± 5.58). The ratio of improvement in the ETDQ-7 score was also significantly higher in the BET than in the control group (92% vs. 68%, p = 0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02-28.79, p = 0.048) and a low post-modified Lund-Kennedy score (OR: 0.15, 95% CI: 0.04-0.54, p = 0.004) were significantly associated with ETDQ-7 score improvement. CONCLUSION Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD.
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Affiliation(s)
- Cheng-Yu Hsieh
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Chieh Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chung-Ching Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Fan Chou
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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2
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Borshchenko M, Eremeeva K, Svistushkin V. CT and MRI in the Preoperative Planning of Balloon Dilation of the Eustachian Tube: Literature Review. Indian J Radiol Imaging 2023; 33:489-495. [PMID: 37811176 PMCID: PMC10556335 DOI: 10.1055/s-0043-1769503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Balloon dilatation of the Eustachian tube (BET) is a surgical treatment method for Eustachian tube dysfunction (ETD), which relieves the symptoms in the majority of cases. However, there are potential intraoperative risks associated with BET; the decision-making process with regard to indications for BET is not standardized up to date. The objective of this study was to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the preoperative planning of BET. The literature review is based on a database search performed in August 2022. BET is classified into transtympanic and nasopharyngeal. CT of the temporal bone provides good visualization of the site of obstruction, which allows to choose the adequate approach. Transtympanic approach is associated with risks of internal carotid artery damage due to possible carotid canal anomalies. This risk can be prevented with preoperative CT scan of the temporal bone. In case of nasopharyngeal BET, there is no sufficient data considering risks of possible artery damage, although CT can provide accurate measurements of ET. MRI is useful for differential diagnosis of conditions imitating ETD, such as endolymphatic hydrops and nasopharyngeal carcinoma. Thus, it is feasible to perform CT and MRI before BET to personalize the management of ETD patients.
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Affiliation(s)
- Maria Borshchenko
- Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - Kseniya Eremeeva
- Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - Valery Svistushkin
- Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
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3
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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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4
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Maddineni S, Ahmad I. Updates in Eustachian Tube Dysfunction. Otolaryngol Clin North Am 2022; 55:1151-1164. [DOI: 10.1016/j.otc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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5
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Jeong SW. Trans-tympanic insertion of an angiocatheter with a stopper for treatment of patulous Eustachian tube. Am J Otolaryngol 2022; 43:103630. [PMID: 36113313 DOI: 10.1016/j.amjoto.2022.103630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Plugging of the Eustachian tube (ET) is an effective method for treating patulous Eustachian tube (PET). However, no material suitable for plugging is commercially available. A plugging material was made using an angiocatheter and a ventilating tube (VT). METHODS An 18-gauge angiocatheter was cut 25 mm from the tip, and the cut end was occluded and widened by melting using a candle. The angiocatheter was inserted into the hole of a Paparella type 1 VT, which was moved to the cut end of the catheter. The VT acted as a stopper at tympanic orifice of ET to prevent the angiocatheter from descending into nasopharynx. Two women with PET received ET-plugging surgery using this plugging material via trans-tympanic approach. RESULTS All symptoms of PET disappeared after surgery. There have been no postoperative complications, and the catheter has functioned well without extrusion. CONCLUSION A plug created from an angiocatheter and a VT is easy to make and is effective for the treatment of PET.
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Affiliation(s)
- Sung Wook Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Republic of Korea.
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6
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Impact of body mass index in patulous Eustachian tube: Does rapid weight loss influence symptom improvement? Am J Otolaryngol 2022; 43:103581. [DOI: 10.1016/j.amjoto.2022.103581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
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Rising Resonance Frequency Is the Sole Sign of Early Middle Ear Disease in Children With Adenoid Hypertrophy. Otol Neurotol 2021; 42:e724-e729. [PMID: 33625192 DOI: 10.1097/mao.0000000000003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study seeks to estimate the potential of multifrequency tympanometry in the diagnosis of primal otologic disorder in children with adenoid hypertrophy (AH). STUDY DESIGN Prospective observational study. SETTING Tertiary pediatric institution. PATIENTS One hundred thirty-one children presenting consecutively at the otolaryngology clinic were divided on the basis of AH into 98 patients and 33 controls. INTERVENTIONS Middle ear status was assessed using pneumatic otoscopy, standard, and wide band tympanometry. MAIN OUTCOME MEASURES Tympanogram type/intratympanic pressure, and resonance frequency (RF) were correlated with each other as well as with a set of clinical parameters. Receiver operating characteristic analysis was employed to reveal the diagnostic value of RF. RESULTS Mean RF declined in chronic otitis media with effusion by 43.25% (p < 0.001). In our entire cohort, children with AH under the age of 7 years presented with a relative risk = 2.43 of producing "B" tympanogram (p = 0.016) than their older peers. In patients' ears with normal, type "A," tympanogram, RF was the sole tympanometric marker of AH, being elevated by 28.26% in mean value (p = 0.010). On receiver operating characteristic analysis of RF's discriminating capability, the area under the curve was equal to 0.647 (p = 0.010). The optimal cut-off value of RF was set at 899 Hz. CONCLUSION AH may induce middle ear stiffening, as RF's increase indicates. Wide band tympanometry output could be a warning sign of ongoing compliance reduction to the sound transmission apparatus, at a time point when physical examination and 226 Hz tympanometry are still unremarkable.
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8
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Khurayzi T, Alenzi S, Alshehri A, Alsanosi A. Diagnostic approaches to and management options for patulous eustachian tube. Saudi Med J 2020; 41:572-582. [PMID: 32518922 PMCID: PMC7502933 DOI: 10.15537/smj.2020.6.25083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives: To systematically review the literature and to summarize all evidence related to the diagnosis and management of patulous eustachian tube. Methods: The present study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Overall, 59 articles were retrieved and included in the analysis. Studies investigating treatments enrolled 1279 patients collectively, with follow-up duration varying from few days and up to 2 years. Eight studies reported medical treatments with intranasal saline instillation as the most frequently studied option. Other studies reported various surgical treatments varying from simple tympanostomy to invasive procedures targeting the orifice of the ET or the anatomical features surrounding it. In addition, 10 studies including 367 subjects investigated different diagnostic methods. Conclusion: Currently, there is a wide spectrum of diagnostic and therapeutic interventions with minimal clinical efficacy, a persistent lack of systematic guidelines, and several gaps in previous research endeavours. PROSPERO REG. NO. CRD: 1644000
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Affiliation(s)
- Tawfiq Khurayzi
- Otorhinolaryngology-Head & Neck Department, King Abdullah Ear Specialist Centre, King Abdulaziz University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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9
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Parsel SM, Unis GD, Souza SS, Bartley H, Bergeron JM, Master AN, McCoul ED. Interpretation of Normal and Abnormal Tympanogram Findings in Eustachian Tube Dysfunction. Otolaryngol Head Neck Surg 2020; 164:1272-1279. [PMID: 33076772 DOI: 10.1177/0194599820965236] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To characterize the relationship between objective tympanogram values and patient-reported symptoms and associations with common comorbid conditions. STUDY DESIGN Cross-sectional study with prospective data collection. SETTING Tertiary medical center. METHODS Patients undergoing routine audiometric evaluation between October 2018 and June 2019 were included. Participants with temporomandibular joint dysfunction, inner ear hydrops, and similar conditions were excluded. Symptoms were assessed with the 7-item Eustachian Tube Dysfunction Questionnaire. Demographics and medical comorbidities were recorded from the medical record. Analysis of tympanometric peak pressure (TPP), demographics, and comorbidities was performed to determine associations with clinically significant eustachian tube dysfunction (ETD) symptoms. RESULTS A total of 250 patients were included with similar demographics: 101 (40.4%) in the asymptomatic group and 149 (59.6%) in the symptomatic group. The median (interquartile range) TPP was -10 (20) daPa and -25 (100) daPa in the asymptomatic and symptomatic groups, respectively. A diagnosis of rhinitis was more likely to be associated with significant ETD symptoms (adjusted odds ratio, 2.61; 95% CI, 1.23-5.63). A subgroup analysis revealed that symptomatic patients with normal TPP values were negatively skewed as compared with asymptomatic patients. This symptomatic group had a higher prevalence of rhinitis and chronic rhinosinusitis than the asymptomatic group. CONCLUSION Patients with symptoms of ETD may have a TPP within a range typically considered normal per conventional standards. This suggests that the currently accepted interpretation of tympanometry findings may be insensitive for the diagnosis of less severe cases of ETD.
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Affiliation(s)
- Sean M Parsel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Graham D Unis
- Ochsner Clinical School, School of Medicine, University of Queensland, New Orleans, Louisiana, USA
| | - Spenser S Souza
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Heather Bartley
- Division of Communication Sciences, Ochsner Health System, New Orleans, Louisiana, USA
| | - Jeffrey M Bergeron
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Adam N Master
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Ochsner Clinical School, School of Medicine, University of Queensland, New Orleans, Louisiana, USA.,Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA
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10
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Comparison of patulous Eustachian tube patients with and without a concave defect in the anterolateral wall of the tubal valve. The Journal of Laryngology & Otology 2020; 134:526-532. [PMID: 32524919 DOI: 10.1017/s0022215120001048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patulous Eustachian tube appears to be caused by a concave defect in the anterolateral wall of the tubal valve of the Eustachian tube. This study aimed to compare the clinical features of patulous Eustachian tube patients with or without a defect in the anterolateral wall of the tubal valve. METHODS Sixty-six patients with a patulous Eustachian tube completed a questionnaire, which was evaluated alongside endoscopic findings of the tympanic membrane, nasal cavity and Eustachian tube orifice. RESULTS Females were more frequently diagnosed with a patulous Eustachian tube, but the valve defect was more common in males (p = 0.007). The ratio of patulous Eustachian tube patients with or without defects in the anterolateral wall of the tubal valve was 1.6:1. Weight loss in the previous six months and being refractory to conservative management were significantly associated with the defect (p = 0.035 and 0.037, respectively). Symptom severity was significantly higher in patients with the defect. CONCLUSION Patulous Eustachian tube patients without a defect in the anterolateral wall of the tubal valve can be non-surgically treated more often than those with the defect. Identification of the defect could assist in making treatment decisions for patulous Eustachian tube patients.
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11
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Bance M, Tysome JR, Smith ME. Patulous Eustachian tube (PET), a practical overview. World J Otorhinolaryngol Head Neck Surg 2019; 5:137-142. [PMID: 31750425 PMCID: PMC6849362 DOI: 10.1016/j.wjorl.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/22/2019] [Indexed: 11/15/2022] Open
Abstract
Symptoms of patulous Eustachian tube (ET), particularly autophony, can overlap with other conditions, and can arise from a variety of causes. We review the pathophysiology of "speech hyper-resonance syndromes", and possible mechanisms, including resonances in the tympanic membrane, Eustachian tube and nasopharynx. Treatment can be directed at the eardrum or the ET depending on site of pathology. We review typical presentations, examination findings, and useful clinical tests to distinguish PET from other disorders, and our philosophy of management.
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Affiliation(s)
- Manohar Bance
- Cambridge Ear Institute, Cambridge University Hospitals Trust, Cambridge UK.,University of Cambridge, Cambridge, UK
| | - James R Tysome
- Cambridge Ear Institute, Cambridge University Hospitals Trust, Cambridge UK.,University of Cambridge, Cambridge, UK
| | - Matthew E Smith
- Cambridge Ear Institute, Cambridge University Hospitals Trust, Cambridge UK
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12
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McCoul ED, Mayer SI, Tabaee A, Bedrosian JC, Marino MJ. Endoscopic Evaluation of the Eustachian Tube: assessment of a novel tool for grading Eustachian tube inflammation. Int Forum Allergy Rhinol 2018; 9:305-310. [DOI: 10.1002/alr.22252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Edward D. McCoul
- Department of Otorhinolaryngology; Ochsner Clinic Foundation; New Orleans LA
- University of Queensland; Ochsner Clinical School; New Orleans LA
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
| | - Scott I. Mayer
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
| | - Abtin Tabaee
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medicine; New York NY
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13
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Prevalence and incidence of clinically significant patulous Eustachian tube: A population-based study using the Korean National Health Insurance Claims Database. Am J Otolaryngol 2018; 39:603-608. [PMID: 30025742 DOI: 10.1016/j.amjoto.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study is to estimate the entire population-based prevalence and incidence of Patulous Eustachian tube (PET) using the Korean National Health Insurance (NHI) claims database. The annual trends of prevalence and incidence of PET were also investigated. METHODS Retrospective analysis of PET patients was performed between 2010 and 2016, from the NHI claims database. PET patients were defined as those who had at least one service claim with a primary diagnosis under an ICD-10-based PET code (H69.0). RESULTS During the study period, there were 20,533 new PET patients in Korea. In 2016 there were 4482 incident cases, and the standardized annual incidence rate was 8.8 per 100,000 persons. The standardized annual prevalence rate increased significantly from 7.2 per 100,000 persons in 2010 to 10.3 per 100,000 persons in 2016. The prevalence increased significantly on annual basis, whereas the incidence rate fluctuated over time. Interestingly, the incidence and prevalence of PET in women was almost twice as high as that in men, and peaked in their 20s. CONCLUSIONS This study demonstrated the substantial annual increase of the NHI claims with PET code (H69.0) in Korea from 2010 to 2016. Statistical results based on the NHI claims, we confirmed the high prevalence and incidence rates of clinically significant PET in women than in men. This study only covered patient using the medical service for PET and missed PET sufferers not seeking medical service. However, this study can provide basic epidemiological information on clinically significant PET.
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14
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Treatment of hypertrophy of adenoids. Balancing between adenotomy and medication. Fam Med 2018. [DOI: 10.30841/2307-5112.3.2018.146896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Jeong J, Nam J, Han SJ, Shin SH, Hwang K, Moon IS. Trans-tympanic Cartilage Chip Insertion for Intractable Patulous Eustachian Tube. J Audiol Otol 2018; 22:154-159. [PMID: 29719947 PMCID: PMC6103493 DOI: 10.7874/jao.2018.00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/09/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Patulous Eustachian tube (PET) causes troublesome autophony. We treated PET using tragal cartilage chip insertion to fill in the concavity within the tubal valve and evaluated the feasibility of this method. Subjects and Methods This study used a prospective design. Eleven patients with PET disorder were included. Tragal cartilage chip insertion via a transcanal approach into the Eustachian tube (ET) was performed in 14 ears of those patients. They were followed-up for at least 12 months after surgery and were evaluated by symptom questionnaire scores. Results The average follow-up was 16.4 months. Thirteen of fourteen ears received immediate complete relief of autophony symptoms. Autophony symptoms at the last follow-up were as follows: four ears (28.6%) had complete relief; five ears (35.7%) showed satisfactory improvement; four ears (28.6%) showed significant but unsatisfactory improvement; and one ear (7.1%) was unchanged. The PET symptom questionnaire in the affected ears showed a significant reduction in autophony (p=0.047) and improvement in breathing sound conduction (p=0.047). There were no complications such as otitis media or occlusion symptom. Conclusions Transtympanic cartilage chip insertion into the ET provides a safe and accessible surgical option for the treatment of PET.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jaesung Nam
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | | | - Seung Ho Shin
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyurin Hwang
- Department of Otolaryngology-Head & Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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16
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Abstract
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.
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Affiliation(s)
- S Schröder
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - J Ebmeyer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
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17
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Sanu SE, Divakaran S, Vijayakumar S, Saxena SK, Alexander A, Gopalakrishnan S. Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function. Int Arch Otorhinolaryngol 2017; 22:141-145. [PMID: 29619102 PMCID: PMC5882376 DOI: 10.1055/s-0037-1603920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction
Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment.
Objective
To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases.
Methods
Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive of middle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology.
Results
A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ
2
) test, showed a significant association between the 2 tests (
p
= 0.017).
Conclusion
There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.
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Affiliation(s)
- Sanoop E Sanu
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India
| | - Shilpa Divakaran
- Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sabarinath Vijayakumar
- Department of ENT, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Sunil Kumar Saxena
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India
| | - Arun Alexander
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India
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Abstract
OBJECTIVES To determine the effectiveness of currently available medical and surgical interventions for treating symptoms of Patulous Eustachian Tube (PET). DATA SOURCES A comprehensive search of MEDLINE (January 1948 to July 8, 2015), EMBASE (January 1974 to July 8, 2015), gray literature, hand searches, and cross-reference checking. STUDY SELECTION Original published reports evaluating an intervention to treat the symptoms of patulous eustachian tube in patients 18 years and older. DATA EXTRACTION Quality-of-case reviews were assessed with the National Institute of Health (NIH) Quality Assessment Tool for Case Series Studies. DATA SYNTHESIS The search strategy identified 1,104 unique titles; 39 articles with 533 patients are included. The available evidence consists of small case series and case reports. The most common medical treatment was nasal instillation of normal saline. Surgical treatments were categorized as mass loading of the tympanic membrane, eustachian tube plugging, and manipulation of eustachian tube musculature. CONCLUSIONS The available evidence for management of patients with PET is poor in quality and consists predominantly of small case series. Further research is needed to determine the comparative efficacy of the current treatments.
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Si Y, Chen Y, Li P, Jiang H, Xu G, Li Z, Zhang Z. Eardrum thickening approach for the treatment of patulous Eustachian tube. Eur Arch Otorhinolaryngol 2016; 273:3673-3678. [PMID: 27048519 DOI: 10.1007/s00405-016-4022-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
This study aims to explore the eardrum thickening approach via cartilage myringoplasty for the cessation of symptoms of patulous Eustachian tube (PET), including autophony, aural fullness and breathing synchronous tinnitus. A total of 12 patients who met the diagnosis criteria of PET were included and given an eardrum patching test preoperatively. Then, myringoplasty with ipsilateral full-thickness tragus cartilage under general anesthesia was performed. All patients were followed up for at least 6 months postoperatively. Gross movements of the eardrum under deep respiration disappeared and symptoms were relieved in all patients during the patching test and at 1 month after surgery. All patients were followed up for a length that varied from 6 months to 5 years postoperatively, which demonstrated sustained satisfactory symptom cessation. PET symptoms may have been possibly caused by the gross outward movements of the acoustic transmission system. The eardrum thickening approach via myringoplasty with full-thickness tragus cartilage can be an accessible choice for PET with permanent satisfactory control of symptoms. Furthermore, the preoperative patching test could be a valid way to predict the outcome of the surgery.
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Affiliation(s)
- Yu Si
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Yubin Chen
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People's Republic of China
| | - Peng Li
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People's Republic of China
| | - Huaili Jiang
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Guo Xu
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Zhuohao Li
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Zhigang Zhang
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China.
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Oh SJ, Lee IW, Goh EK, Kong SK. Endoscopic autologous cartilage injection for the patulous eustachian tube. Am J Otolaryngol 2016; 37:78-82. [PMID: 26954856 DOI: 10.1016/j.amjoto.2015.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/29/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Abstract
Patulous eustachian tube (PET) can have a significant negative impact on a patient's quality of life. Several methods of surgical management can be an option to treat PET, and our objective is to evaluate the safety and efficacy of autologous cartilage injection in patients with PET. Thirty-three ears of twenty-five patients with chronic PET refractory to conservative treatment were enrolled to this study. Autologous tragal cartilage was harvested, and chopped into fine pieces to allow its injection using a 1 cc Bruening syringe. Endoscopic cartilage injection was performed submucosally into the anterior (0.5 mL) and posterior aspects (0.5 mL) of the nasopharyngeal ET under local anesthesia in an operating room. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. The only complication that occurred was temporary otitis media with effusion in one ear. Inferior turbinate reduction was performed in three ears with accompanying nasal septal deviation or turbinate hypertrophy to allow better nasopharyngeal ET visualization. After autologous cartilage injection, the successful treatment rate, as determined by subjective autophony symptoms, was 69.7% (23/33). The average follow-up period was 25.2 months. Autologous cartilage injection is a minimally invasive technique that has been used by the authors to successfully treat patulous eustachian tube. The described procedure was found to provide a good overall success rate without long-term complications.
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Affiliation(s)
- Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Yangsan Pusan National University Hospital, Yangsan, Republic of Korea
| | - Eui-Kyung Goh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
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Oh SJ, Lee IW, Goh EK, Kong SK. Trans-tympanic catheter insertion for treatment of patulous eustachian tube. Am J Otolaryngol 2015; 36:748-52. [PMID: 26545465 DOI: 10.1016/j.amjoto.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/09/2015] [Accepted: 07/05/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the safety and therapeutic efficacy of trans-tympanic catheter insertion (TCI) in patients with refractory patulous eustachian tube (PET). METHODS TCI was attempted in thirty-six ears of twenty-nine patients with chronic PET refractory to conservative treatment. The catheter was inserted under local anesthesia in an operating room through the bony orifice of the eustachian tube (ET) to occlude the isthmus of the tube via a myringotomy site on the tympanic membrane. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. Patients had no concurrent disease and did not undergo any additional surgical procedure. RESULTS TCI was performed in all except one ear, in which it failed because of an abnormally narrow tympanic ET orifice. Follow-up durations ranged from 6 to 37 months, with an average of 19.3 months. Successful treatment of subjective autophony was achieved in twenty-nine (82.4%) of the thirty-five ears. Ventilation tube (VT) placement was performed in the two ears because of otitis media with effusion (OME) after TCI. In one ear, the inserted catheter was finally removed due to additional unilateral mastoiditis after VT extrusion. CONCLUSION TCI seems to be a minimally invasive and was used successfully to treat PET. The procedure had a good overall success rate and complications were rare in the long-term.
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Affiliation(s)
- Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Yangsan Pusan National University Hospital, Yangsan, Republic of Korea
| | - Eui-Kyung Goh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
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Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol 2015; 79:1599-608. [PMID: 26235732 DOI: 10.1016/j.ijporl.2015.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/28/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Mometasone has been reported to improve the symptoms of nasal obstruction in children with adenoidal hypertrophy. This systematic review and meta-analysis were conducted to evaluate the role of mometasone on different nasal symptoms, otitis media with effusion, adenoid size, and quality of life in children with adenoidal hypertrophy. METHODS A comprehensive search of MEDLINE, EMBASE, CINAHL and COCHRANE Collaboration databases was undertaken. We identified all the randomized controlled trials (RCTs) in children with adenoidal hypertrophy that compared the effects of mometasone nasal spray and normal saline nasal spray on different outcomes. The deadline of the search was April 2015. The search was supplemented by hand searching of cross-references in the studies and reviews and by contacting the authors of various studies. Only English language RCTs were considered for the systematic review. The primary outcomes were improvement in symptoms of nasal obstruction, mouth breathing, rhinorrhea, snoring, cough, and total nasal symptoms. The secondary outcomes were improvement in otitis media with effusion, quality of life, and size of adenoid. Quality assessment of RCTs was performed using SIGN 50 and Cochrane risk of bias tools. Risk ratio (RR), weighted mean differences (WMD) and their 95% confidence intervals (CI) were calculated for dichotomous and continuous data, respectively. Random effects model was used for the analyses. Heterogeneity was measured by using the I(2) statistics and p value <0.05. RESULTS Our search generated 87 citations, of which eight RCTs met the inclusion criteria. The methodological quality of all the RCTs was poor. There was no significant difference between mometasone and control groups for the patient's characteristic and grades of different nasal symptoms, otitis media with effusion, obstructive sleep apnea, and quality of life at the basal level. There was also no significant difference in the number of patients with different symptoms at the basal level. After the administration of mometasone, there were significant improvements in grades of nasal obstruction, 0.8±0.5 versus 2.0±0.6, WMD -1.16 [-2.09, -0.23], snoring 0.3±0.4 versus 1.6±0.6, WMD -1.07 [-2.09, -0.05], total nasal symptoms 2.9±1.3 versus 6.9±1.5, WMD -4.09 [-6.64, -1.53], obstructive sleep apnea, 0.6±0.3 versus 1.4±0.4, WMD -0.95 [-1.74, -0.16], as well as the percentage of patients with nasal obstruction, snoring, obstructive sleep apnea, compared to control. There was tendency of improvement in rhinorrhea, and cough with mometasone. Compared to control, mometasone nasal spray significantly improved adenoid size or adenoid/choana ratio 50.9±8.8 versus 74.2±12.6, WMD -21.2 [-34.0, -8.4], change in adenoid/choana obstruction from the basal level (p=0.01), and percentage of patients with adenoid hypertrophy, 26% versus 92%, RR 0.29 [0.18, 0.48]. There was improvement in otitis media with effusion, 40% versus 72%, pure tone audiometry 5.2±11 versus 11.6±11dB, WMD -6.40dB [-12.65, -0.15], and quality of life with mometasone. Subgroup analyses showed that RCTs that followed blinding showed significantly less response compared to RCTs that did not follow it for most of the outcomes. CONCLUSIONS Mometasone caused improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, pure tune audiometry, otitis media with effusion, adenoid size, and quality of life. The data is based on meta-analysis of RCTs of poor methodological quality. A high methodological quality, placebo controlled RCT of different doses and duration of administration of mometasone is required to evaluate its clear efficacy and safety in children with adenoid hypertrophy.
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Schröder S, Lehmann M, Sudhoff H, Ebmeyer J. [The patulous eustachian tube-novel surgical approaches]. HNO 2014; 61:1017-25. [PMID: 24327196 DOI: 10.1007/s00106-013-2773-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A patulous eustachian tube (tuba aperta) may lead to an enormous reduction in quality of life. A patulous eustachian tube can cause symptoms such as autophony, breath synchronous tinnitus, pressure sensation in the ear, and hearing loss. In combination with so-called "sniffing", it can trigger the development of cholesteatoma. Due to the diffuse symptoms the correct diagnosis of this disease can be challenging. A patulous eustachian tube can be best diagnosed through a well-structured examination including patient history, physical examination with thorough observation of movements of the tympanic membrane, and tympanometry with reflex decay. This publication reviews recent literature on the patulous eustachian tube. We focused on the evaluation of the different surgical strategies such as the patulous eustachian tube reconstruction, the Kobayashi plug or the injection of Vox® implants into the torus tubarius.
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Affiliation(s)
- S Schröder
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Deutschland,
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Patulous eustachian tube after percutaneous balloon microcompression for trigeminal neuralgia: case report. The Journal of Laryngology & Otology 2014; 128:478-80. [PMID: 24819466 DOI: 10.1017/s0022215114000814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report a case of patulous eustachian tube which occurred after percutaneous balloon microcompression of the Gasserian ganglion. METHOD Retrospective case review. RESULTS A 41-year-old man was referred to our audiovestibular medicine department following episodes of autophony. These symptoms appeared two weeks after percutaneous balloon microcompression performed to treat severe trigeminal neuralgia secondary to multiple sclerosis. A diagnosis of patulous eustachian tube was indicated by clinical examination and tympanometry. The symptoms were present for less than six months and improved without any specific treatment. CONCLUSION Percutaneous balloon microcompression is a procedure used for refractory trigeminal neuralgia that can cause transient sensory and motor deficits of any of the trigeminal nerve branches. It is proposed that injury to the mandibular division in this case caused temporary tensor veli palatini dysfunction with consequent patulous eustachian tube.
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Ward S, Parnes L, Rotenberg B. Endoscopic transnasal eustachian tube reconstruction via light cable technique: A technical report. ALLERGY & RHINOLOGY 2014; 4:e176-8. [PMID: 24498524 PMCID: PMC3911808 DOI: 10.2500/ar.2013.4.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sarah Ward
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Brian Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
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A novel, computed tomography guided, trans-cutaneous approach to treat refractory autophony in a patient with a patulous eustachian tube. The Journal of Laryngology & Otology 2014; 128:182-4. [PMID: 24467870 DOI: 10.1017/s0022215113003599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report a novel, computed tomography guided treatment for autophony associated with a patulous eustachian tube. METHODS Case report and literature review of the management of patulous eustachian tube. RESULTS A 36-year-old woman presented with disabling autophony. Otoscopic examination revealed a poorly mobile right tympanic membrane. High resolution temporal bone computed tomography excluded superior semicircular canal dehiscence. The patient was diagnosed with patulous eustachian tube but failed to achieve therapeutic benefit from conventional endoscopic placement of a silicone elastomer suspension implant adjacent to the eustachian tube. Subsequently, she underwent further silicone elastomer suspension implant placement via a trans-cutaneous, computed tomography guided approach. The patient achieved prompt symptomatic relief and remained symptom-free at six-month follow up. CONCLUSION This is the first published description of treatment of patulous eustachian tube using a computed tomography guided, trans-cutaneous approach. It serves to highlight to otolaryngologists the fact that computed tomography guided treatment of patulous eustachian tube may control disabling symptoms in patients who have failed to respond to convention endoscopic management.
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Amantadine-induced patulous eustachian tubes in Parkinson's disease. Case Rep Otolaryngol 2013; 2013:426413. [PMID: 24349813 PMCID: PMC3853069 DOI: 10.1155/2013/426413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022] Open
Abstract
Patulous Eustachian tube (PET) is a common condition that produces symptoms of aural fullness and autophony. We describe a Parkinson's disease (PD) patient that experienced a reversible bilateral patulous (hyperpatent) Eustachian tube syndrome induced by treatment with amantadine hydrochloride. The clinical features, relevant anatomy and physiology, and associated risk factors for PET are reviewed.
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Rotenberg BW, Busato GM, Agrawal SK. Endoscopic ligation of the patulous eustachian tube as treatment for autophony. Laryngoscope 2012; 123:239-43. [DOI: 10.1002/lary.23635] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/15/2012] [Accepted: 07/10/2012] [Indexed: 11/09/2022]
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Lin FY, Gurgel RK, Popelka GR, Capasso R. The effect of continuous positive airway pressure on middle ear pressure. Laryngoscope 2012; 122:688-90. [DOI: 10.1002/lary.22442] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 11/07/2022]
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Başoğlu MS, Eren E, Aslan H, Kolatan HE, Ozbay C, Inan S, Karaca F, Oztürkcan S, Katılmış H. Increased expression of VEGF, iNOS, IL-1β, and IL-17 in a rabbit model of gastric content-induced middle ear inflammation. Int J Pediatr Otorhinolaryngol 2012; 76:64-9. [PMID: 22018731 DOI: 10.1016/j.ijporl.2011.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/27/2011] [Accepted: 10/02/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1β, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure. METHODS Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1β, and IL-17 expression. Experimental and control animals were examined using the same protocol. RESULTS The expression levels of VEGF, iNOS, IL-1β, and IL-17 differed significantly between the experimental and control groups (p=0.018, p=0.010, p=0.002, and p=0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p=0.132). CONCLUSION This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1β, IL-17, and iNOS.
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Affiliation(s)
- M Sinan Başoğlu
- Department of Otolaryngology Head & Neck Surgery, Atatürk Research and Education Hospital, İzmir, Turkey
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Lükens A, Dimartino E, Günther RW, Krombach GA. Functional MR imaging of the eustachian tube in patients with clinically proven dysfunction: correlation with lesions detected on MR images. Eur Radiol 2011; 22:533-8. [PMID: 21993981 DOI: 10.1007/s00330-011-2303-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/11/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To visualise the function of the Eustachian tube by MRI and assess the effect of surrounding lesions. METHODS Using 1.5 T MRI, 32 Eustachian tubes of 16 patients with clinically proven dysfunction (clinical symptoms, such as autophonia and fullness and non-opening at tympanometry) were investigated. For depiction of the anatomy and associated abnormalities, coronal and axial T2-weighted turbo spin echo sequences and a T1-weighted-2D-gradient echo sequences were acquired. Eustachian tube opening was analysed with real time turbo-gradient echo sequences during a Valsalva manoeuvre. RESULTS Dysfunction, that is, failure of opening of the Eustachian tube as shown by MRI, correlated in all patients with tympanometry. Lesions detected included nasopharyngeal carcinoma in 4 patients. Mucosal swelling in the paranasal sinus was present in 9 patients. One patient had postoperative defects. In two patients both pharyngotympanic tubes did not open although no structural abnormalities could be depicted. CONCLUSIONS The opening of the Eustachian tubes during the Valsalva manoeuvre is assessable on MRI. Failure of opening may be due to swelling of the mucosa and may be also associated with tumours. MRI assessment may be helpful in patients with chronic otitis media, where the information about tubal function is important in preoperative planning. KEY POINTS •Eustachian tube opening during Valsalva manoeuvre can be visualised with MRI •Lesions hampering tubal opening can be delineated at the same MRI examination •Functional MRI of the Eustachian tubes might determine the cause of dysfunction.
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Affiliation(s)
- Anna Lükens
- Department of Diagnostic Radiology, University Hospital, University of Technology (RWTH) Aachen, Aachen, Germany
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Scadding G. Non-surgical treatment of adenoidal hypertrophy: the role of treating IgE-mediated inflammation. Pediatr Allergy Immunol 2010; 21:1095-106. [PMID: 20609137 DOI: 10.1111/j.1399-3038.2010.01012.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Adenoidal hypertrophy (AH) and adenotonsillar hypertrophy are common disorders in the pediatric population and can cause symptoms such as mouth breathing, nasal congestion, hyponasal speech, snoring, and obstructive sleep apnea (OSA), as well as chronic sinusitis and recurrent otitis media. More serious long-term sequelae, typically secondary to OSA, include neurocognitive abnormalities (e.g. behavioral and learning difficulties, poor attention span, hyperactivity, below average intelligence quotient); cardiovascular morbidity (e.g. decreased right ventricular ejection fraction, left ventricular hypertrophy, elevated diastolic blood pressure); and growth failure. Adenoidectomy (with tonsillectomy in cases of adenotonsillar hypertrophy) is the typical management strategy for patients with AH. Potential complications have prompted the investigation of non-surgical alternatives. Evidence of a pathophysiologic link between AH and allergy suggests a possible role for intranasal corticosteroids (INS) in the management of patients with AH. This article reviews the epidemiology and pathophysiology of AH with a particular focus on evidence of its association with allergy and allergic rhinitis. Current treatment options are briefly considered with discussion on the rationale and evidence for the use of INS.
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Muñoz D, Aedo C, Der C. Patulous eustachian tube in bariatric surgery patients. Otolaryngol Head Neck Surg 2010; 143:521-4. [DOI: 10.1016/j.otohns.2010.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 06/18/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE: Patulous eustachian tube (PET) is associated with several factors, including weight loss. Rapid and significant weight loss in bariatric surgery patients may be risk factors for developing PET. The aim of this study is to provide information about the prevalence of PET after bariatric surgery and its association to weight loss. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary center. SUBJECTS AND METHODS: We recruited 163 patients who had undergone bariatric surgery at the Clinical Hospital of the University of Chile between 2006 and 2009. One hundred fortyone patients were finally analyzed by clinical interview and physical examination. Two groups were formed, with and without PET. The degree, time, and velocity of weight loss were compared between groups. Demographic information and clinical presentation are also presented. RESULTS: The mean age was 38.9 years, and 76.6 percent of the patients were female. We found PET in 21.28 percent of the patients. Autophony was present in 96.6 percent of patients diagnosed with PET. Patients without PET experienced weight loss at an average of 39.54 kg during 16.59 months, while patients with PET experienced weight loss at an average of 48.63 kg in 12.11 months. The weight loss velocity in the PET group had a mean of 5.34 ±3.4 kg/month versus 2.98 ±1.3 kg/month in patients without PET. Time ( P = 0.0037), magnitude ( P = 0.0002), and velocity ( P = 0.0005) of weight loss was higher in patients with PET. CONCLUSION: Our case series shows a significant prevalence of PET in bariatric surgery patients, which has a correlation with weight loss velocity and magnitude.
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Affiliation(s)
- Daniel Muñoz
- Department of Otolaryngology–Head and Neck Surgery, Clinical Hospital of the University of Chile, Santiago, Chile
- Biostatistics Department, School of Public Health, University of Chile, Santiago, Chile
| | - Cristian Aedo
- Department of Otolaryngology–Head and Neck Surgery, Clinical Hospital of the University of Chile, Santiago, Chile
| | - Carolina Der
- Department of Otolaryngology–Head and Neck Surgery, Clinical Hospital of the University of Chile, Santiago, Chile
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Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B. Medical treatment of adenoid hypertrophy with "fluticasone propionate nasal drops". Int J Pediatr Otorhinolaryngol 2010; 74:773-6. [PMID: 20430451 DOI: 10.1016/j.ijporl.2010.03.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 03/20/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented. STUDY DESIGN The prospective, randomized, placebo-controlled study. SETTING Tertiary referral center. PATIENTS AND METHODS Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400 microg/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks. RESULTS At the end of 8 weeks, statistically significant improvement (p<0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated group's score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed. CONCLUSIONS In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.
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Affiliation(s)
- Hasan Demirhan
- Haseki Education and Research Hospital, Ear Nose Throat (ENT), 1st Otorhinolaryngology Clinic, Istanbul, Turkey.
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Schellenberg K, Bedlack R, Tucci D. Roaring in the ears: Patulous Eustachian tube in bulbar amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2010; 11:395-6. [DOI: 10.3109/17482960903501931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Chadha NK, Zhang L, Mendoza-Sassi RA, César JA. Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: does it work? Otolaryngol Head Neck Surg 2009; 140:139-47. [PMID: 19201278 DOI: 10.1016/j.otohns.2008.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 11/05/2008] [Accepted: 11/05/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review the evidence for the usage of nasal steroids to improve symptoms of nasal airway obstruction in children with adenoidal hypertrophy. DATA SOURCES Published studies indexed in the MEDLINE (1951 to 2008), EMBASE (1974 to 2008), and the Cochrane databases (Issue 3, 2008). REVIEW METHODS Data from the included trials were extracted and trial quality was assessed. Meta-analysis was not applicable and data were summarized in a narrative format. Evidence from excluded studies was also discussed. RESULTS Seven studies (six randomized controlled trials and one cohort study) met the inclusion criteria of the review, including a total of 493 patients. Six of these studies demonstrated significant efficacy of various nasal steroids (mometasone, beclomethasone, flunisolide) in improving nasal obstruction symptoms and in reducing adenoid size, as measured with symptom scores and fiber-optic nasopharyngeal endoscopy, respectively. The response appeared to be a group effect and may be maintained longer-term by continuing nasal steroids at a lower maintenance dose. The treatment was safe and well-tolerated with few minor adverse events. CONCLUSION The available evidence suggests that nasal steroids may significantly improve nasal obstruction symptoms in children with adenoid hypertrophy. This improvement appears to be associated with a reduction of adenoid size. Evidence of long-term efficacy is limited but suggests that in many children maintenance therapy is needed if symptom-relief is to persist. Further studies are required to support the use of nasal steroids as a first-line approach in these children.
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Affiliation(s)
- Neil K Chadha
- Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada.
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The Patulous Eustachian Tube Complicated With Amyotrophic Lateral Sclerosis: A Video Clip Demonstration. Laryngoscope 2008; 118:2057-8. [DOI: 10.1097/mlg.0b013e3181817b87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pathophysiological mechanisms of extraesophageal reflux in otolaryngeal disorders. Eur Arch Otorhinolaryngol 2008; 266:17-24. [DOI: 10.1007/s00405-008-0770-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 07/03/2008] [Indexed: 12/19/2022]
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Zhang L, Mendoza-Sassi RA, César JA, Chadha NK. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008; 2008:CD006286. [PMID: 18646145 PMCID: PMC8923350 DOI: 10.1002/14651858.cd006286.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adenoidal hypertrophy is generally considered a common condition of childhood. When obstructive sleep apnoea or cardio-respiratory syndrome occurs, adenoidectomy is generally indicated. In less severe cases, non-surgical interventions may be considered, however few medical alternatives are currently available. Intranasal steroids may be used to reduce nasal airway obstruction. OBJECTIVES To assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. SEARCH STRATEGY Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), MEDLINE (1951 to 2007) and EMBASE (1974 to 2007). All searches were initially performed in May 2007 and updated in April 2008. SELECTION CRITERIA Randomised controlled trials comparing intranasal corticosteroids with placebo or no intervention or other treatment in children aged 0-12 years with moderate to severe adenoidal hypertrophy. DATA COLLECTION AND ANALYSIS Data from the included trials were extracted and trial quality was assessed by two authors independently. Meta-analysis was not applicable and data were summarised in a narrative format. MAIN RESULTS Five randomised trials, including a total of 349 patients, met the inclusion criteria of the review. All trials except one showed significant efficacy of intranasal corticosteroids in improving nasal obstruction symptoms and in reducing adenoid size. The first eight-week cross-over study showed that treatment with beclomethasone (336 micrograms/day) yielded a greater improvement in mean symptom scores than placebo (-18.5 vs. -8.5, P < 0.05) and a larger reduction in mean adenoid/choana ratio than placebo (right, -14% vs. +0.4%, p=0.002; left, -15% vs. -2.0%, p=0.0006) between week 0 and week 4. The second four-week cross-over study demonstrated that the nasal obstruction index decreased by at least 50% from baseline in 38% of patients treated with beclomethasone (400 micrograms/day) between week 0 and week 2, whereas none of the patients treated with placebo had such improvement (p<0.01). The third randomized, parallel-group trial showed that 77.7% of patients treated with mometasone (100 micrograms/day) for 40 days demonstrated an improvement in nasal obstruction symptoms and a decrease in adenoid size, such that adenoidectomy could be avoided, whereas no significant improvement was observed in the placebo group. The fourth randomized, parallel-group trial showed that eight-weeks of treatment with flunisolide (500 micrograms/day) was associated with a lager reduction in adenoid size than isotonic saline solution (p<0.05). In contrast, one randomised, parallel-group trial did not find significant improvement in nasal obstruction symptoms and adenoid size after eight weeks of treatment with beclomethasone (200 micrograms/day). AUTHORS' CONCLUSIONS Limited evidence suggests that intranasal corticosteroids may significantly improve nasal obstruction symptoms in children with moderate to severe adenoidal hypertrophy, and this improvement may be associated with a reduction of adenoid size. The long-term effect of intranasal corticosteroids in these patients remains to be defined.
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Affiliation(s)
- Linjie Zhang
- Department of Maternal and Child Health, Federal University of Rio Grande, Rua Visconde Paranaguá 102, Centro, Rio Grande, RS, Brazil, 96201-900.
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Kirsch CFE, Suh JD, Lufkin RB, Canalis RF. False-positive positron-emission tomography-CT of a Teflon granuloma in the parapharyngeal space occurring after treatment for a patulous eustachian tube. AJNR Am J Neuroradiol 2007; 28:1371-2. [PMID: 17698543 PMCID: PMC7977639 DOI: 10.3174/ajnr.a0554] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This report presents a 55-year-old woman who underwent 2 Teflon injections in 1971 for a patulous eustachian tube. The patient returned in 2006 with a bloody left otorrhea. A positron-emission tomography-CT scan demonstrated a 2-cm hypermetabolic parapharyngeal mass, initially interpreted as a skull base tumor. Repeat neck CT confirmed a 2-cm hyperattenuated left parapharyngeal granulomatous mass. This is the first reported case of a Teflon granuloma presenting as a false-positive parapharyngeal mass.
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Affiliation(s)
- C F E Kirsch
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-1721, USA.
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Bentdal YE, Nafstad P, Karevold G, Kvaerner KJ. Acute otitis media in schoolchildren: allergic diseases and skin prick test positivity. Acta Otolaryngol 2007; 127:480-5. [PMID: 17453473 DOI: 10.1080/00016480600895128] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSIONS Single and repeated episodes of acute otitis media (AOM) in 10-year-old children were associated with reported allergic disease. Further, skin prick test (SPT)-negative children with reported asthma and allergic rhinoconjunctivitis had increased risk of AOM. We suggest that optimal treatment of allergic symptoms may have an effect on AOM in school children. OBJECTIVE The objective of the study was to estimate associations between AOM, allergic diseases and SPT positivity in 10-year-old children. MATERIALS AND METHODS Population-based cross-sectional study of 3406 10-year-old children living in Oslo. Main outcome measures were questionnaire-based information on AOM and reported physician-diagnosed allergic diseases with symptoms during the last year. In addition, 2657 children were skin prick tested. Logistic regression analyses were performed to estimate associations and control for potential confounders. RESULTS One or more episodes of AOM were present in 13.8% (n=470) of the children; 9.7% (n=331) had single episodes, while 4.1% (n=139) had two or more infections. We found a statistically significant association between AOM and reported allergic diseases, strongest for AOM and asthma with odds ratio 2.7 (95% confidence interval 1.8-4.0) and 2.3 (95% confidence interval 1.3-4.3) for single and two or more episodes of AOM, respectively. The risk for AOM was increased in asthmatic SPT-negative children compared with asthmatic SPT-positive children, the odds ratios were 3.0 (1.7-5.4) and 1.5 (0.8-2.8), respectively. The same tendency was found for allergic rhinoconjunctivitis.
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Affiliation(s)
- Yngvild E Bentdal
- Department of Otorhinolaryngology, Faculty Division of Akershus University Hospital, University of Oslo, Sykehusvagen 27, 1478 Lørenskog, Norway.
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