Can party balloons replace autoinflation balloons to treat glue ear? A technical comparison

Background

Autoinflation balloons are used to treat patients with otitis media with effusion (OME) to help avoid surgery.

Aim

To compare the ability of party balloons with Otovent balloons to produce sufficient pressure for a Valsalva manoeuvre.

Design & setting

Pressure testing was used to determine the number of times each balloon could produce pressures sufficient for a Valsalva manoeuvre. Subsequently, Otovent balloons were compared with spherical party balloons in a pilot clinical trial of 12 healthy adults.

Method

Each balloon was inflated 20 times and the maximum pressure was recorded. Three balloons of each type were tested to 50 inflations to assess pressures over persistent use.

Results

Otovent balloons’ mean inflation pressure was 93 mmHg (95% confidence interval [CI] = 89 to 97 mmHg) on first inflation, dropping to 83 mmHg (95% CI = 80 to 86 mmHg) after 20 inflations. Two types of spherical party balloon required mean inflation pressures of 84 mmHg (95% CI = 77 to 90 mmHg) and 108 mmHg (95% CI = 97 to 119 mmHg) on first inflation, dropping to 74 mmHg (95% CI = 68 to 81 mmHg) and 83 mmHg (95% CI = 77 to 88 mmHg) after 20 inflations. In the pilot trial, there was no difference between the ability of Otovent and spherical balloons (χ² = 0.24, P = 0.89) to produce the sensation of a Valsalva manoeuvre.

Conclusion

Otovent balloons can be used more than the 20 times quoted by the manufacturer. The two spherical balloons produced similar pressures to Otovent balloons, indicating potentially the same clinical effect. The pilot study suggests a potential use of spherical party balloons instead of Otovent balloons as a cost-efficient treatment.

Tensor veli palatini electromyography for monitoring Eustachian tube rehabilitation in otitis media

BACKGROUND

The pathogenesis of otitis media is related to Eustachian tube dysfunction. The tensor veli palatini muscle actively opens the Eustachian tube and promotes middle-ear ventilation. This study describes a technique for paratubal electromyography that uses a surface, non-invasive electrode able to record tensor veli palatini muscle activity during swallowing.

METHODS

Twenty otitis media patients and 10 healthy patients underwent tensor veli palatini electromyography. Activity of this muscle before and after Eustachian tube rehabilitation was also assessed.

RESULTS

In 78.5 per cent of patients, the electromyography duration phase and/or amplitude were reduced in the affected side. The muscle action potential was impaired in all patients who underwent Eustachian tube rehabilitation.

CONCLUSION

This study confirmed that Eustachian tube muscle dysfunction has a role in otitis media pathogenesis and showed that muscle activity increases after Eustachian tube rehabilitation therapy.

Adam politzer (1835-1920) et la trompe d’eustache

Adam Politzer is associated with the Eustachian tube via Politzer's manoeuver or politzerization, a technique of middle ear inflation. In 1863, Politzer invented this technique to assure permeability and pressure equilibrium between the middle ear and the nasopharynx. The technique was progressively improved with clinical experiments and intensively discussed by his colleagues including Josef Gruber. To complete the therapeutic possibilities of his technique, Politzer also proposed a new system of tubal catheterization in 1872. At the end of his life, Politzer completed his research, turning back the clock by publishing a biography of the man who gave his name to the tube: Eustachius. In fact, Politzer was the "Eustachius" of the second half of the 19th century and remains for us the man of the middle ear inflation technique.

Factors affecting the results of nonsurgical treatment of secretory otitis media in adults

OBJECTIVE

There is only limited knowledge of the factors influencing the results of nonsurgical treatment of secretory otitis media (SOM) in adults. The present study was carried out to determine the effect of the middle ear (ME) inflation and to clear up the factors affecting the results of conservative treatment of SOM.

METHODS

A total of 198 adult patients were randomized to either a group receiving treatment with ME inflation for 10 days or to a group receiving ME inflation and antibiotics (oral Amoxicillin 500 mg 3/day) for 10 days or to a control group. A wide variety of anamnestic and clinical pre-treatment variables were assessed by administered questionnaires. Pneumo-otoscopy, tympanometry and pure-tone audiometry were performed before the treatment and at the 3-5th, 10th+/-2 and 60th+/-5 day of the study. For the prognostic factors, univariate analyses were first performed to determine the significant predictors, which were afterwards entered into a stepwise logistic regression model.

RESULTS

The effectiveness of treatment was 50.6% in Group A and 58.7% in Group B (control group-11%, P<0.001). The results of treatment were stable and were found unchanged 6 weeks after the treatment. The most important prognostic criteria were defined by analyzing the dynamics of tympanometry (OR, 2.17) and audiometry (OR, 10.27) during conservative treatment. The results of the treatment were related to the mastoid pneumatization, the pathology of paranasal sinuses, the previous history of SOM, the age, and the pre-treatment otoscopic data.

CONCLUSIONS

The results suggest, that daily ME inflation can be effective treatment for adults patients with SOM having regard to the factors significant for the prognosis of treatment.