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Boullaud L, D'Andrea G, Fabre R, AlShukry A, Castillo L, Guevara N, Vandersteen C. Mid-term evaluation of the surgical management of patulous Eustachian tube dysfunction: a STROBE observational study. Eur Arch Otorhinolaryngol 2024; 281:2883-2891. [PMID: 38151540 DOI: 10.1007/s00405-023-08388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Patulous Eustachian tube (PET) is a condition affecting approximately 0.3% to 6.6% of the population, with autophony being the predominant complain. The management of PET lacks a well-defined standard in the literature as no effective medical treatments have been documented but various surgical options are available. This study aims to report mid-term outcomes following surgical management of PET. MATERIALS AND METHODS All patients who underwent surgical intervention for PET between September 2017 and June 2022 were enrolled. Data encompassing general demographics, quality of life (GBI), and procedure-specific data were collected. RESULTS A total of 30 PET cases (in 19 patients) underwent surgical intervention including 9 injections of hyaluronic acid, 13 fat injections, 6 endoscopic shim insertions, 1 cartilage graft, and 1 injection of hydroxy apatite. After an average follow-up of 22 ± 14 months, 16 cases (53%) achieved complete symptom relief, while 8 cases (26.6%) reported partial relief. Additionally, 11(36%) cases required multiple surgeries. No specific surgical technique demonstrated superiority. Quality of life improved in 77% of cases based on 10 out of 13 GBI collected. Recurrence of PET symptoms occurred on average 10.6 ± 9.7 months after initial surgery, with an estimated global risk of 75% at 3 years. Transient serous otitis media was observed in only 4 cases (13.3%). CONCLUSION Surgical intervention for PET was found to be effective, achieving complete symptom relief in 53% of cases and significantly improving quality of life 2 years post-surgery. However, a substantial portion of cases necessitated one or more re-interventions. The durability of effectiveness appears to diminish over time.
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Affiliation(s)
- Luc Boullaud
- Service d'ORL et Chirurgie Cervico-Faciale, CHU Tours, 2 Boulevard Tonnellé, 37000, Tours, France.
| | - Gregoire D'Andrea
- Institut de La Face et du Cou, Centre Hospitalier Universitaire de Nice, Centre Antoine Lacassagne, 31 Avenue de Valombrose, CS63415, 06 103, Nice Cedex 3, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Institut Universitaire de La Face et du Cou, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Université Nice Côte d'Azur, Nice, France
- Fédération Hospitalo-Universitaire INOVPAIN, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06001, Nice, France
| | - Abdullah AlShukry
- Institut de La Face et du Cou, Centre Hospitalier Universitaire de Nice, Centre Antoine Lacassagne, 31 Avenue de Valombrose, CS63415, 06 103, Nice Cedex 3, France
| | - Laurent Castillo
- Institut de La Face et du Cou, Centre Hospitalier Universitaire de Nice, Centre Antoine Lacassagne, 31 Avenue de Valombrose, CS63415, 06 103, Nice Cedex 3, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Institut Universitaire de La Face et du Cou, Nice, France
| | - Nicolas Guevara
- Institut de La Face et du Cou, Centre Hospitalier Universitaire de Nice, Centre Antoine Lacassagne, 31 Avenue de Valombrose, CS63415, 06 103, Nice Cedex 3, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Institut Universitaire de La Face et du Cou, Nice, France
| | - Clair Vandersteen
- Institut de La Face et du Cou, Centre Hospitalier Universitaire de Nice, Centre Antoine Lacassagne, 31 Avenue de Valombrose, CS63415, 06 103, Nice Cedex 3, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Institut Universitaire de La Face et du Cou, Nice, France
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Hussain SZM, Hashmi S, Qayyum A. Informed consent in balloon Eustachian tuboplasty: a systematic review of possible complications and preventive measures. J Laryngol Otol 2024; 138:474-479. [PMID: 37973529 DOI: 10.1017/s0022215123001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To systematically identify the complications associated with balloon Eustachian tuboplasty and their frequency of occurrence. This study will also highlight the measures that can be employed to avoid these complications and perform this procedure more safely. METHODS Systematically reviewed relevant papers published until January 2023. Each reference was checked and evaluated for any potential manuscripts. There was no registered protocol; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. RESULTS Sixty-nine publications were found, from which 14 publications met our inclusion criteria: 2 randomised clinical trials, 5 retrospective studies, 2 systematic reviews, 2 case series and 3 case reports. Studies with balloon Eustachian tuboplasty procedure only were included, regardless of ethnicity, gender and age. All studies were excluded in which more than one procedure was performed. CONCLUSION Balloon Eustachian tuboplasty is a relatively safe procedure with an overall complication risk of 1.66 per cent. Major complication rate was 0.43 per cent. Surgical emphysema was the most common, around 0.40 per cent.
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Affiliation(s)
| | | | - Asad Qayyum
- Peterborough City Hospital, Peterborough, UK
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Gul F, Kocak O, Babademez MA. Eustachian Tube Function Symptoms in Palatal Surgeries for OSA: 3-Month Postoperative Analysis. Laryngoscope 2024; 134:2471-2477. [PMID: 37905770 DOI: 10.1002/lary.31124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/24/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To assess the influence of different soft palate surgeries for obstructive sleep apnea (OSA) on eustachian tube function symptoms, considering various potential factors. METHODS A prospective, cohort study was conducted on patients who underwent isolated palatal surgeries for OSA at a single academic medical center between 2017 and 2022. Eustachian Tube Dysfunction Questionnaire (ETDQ-7) were assessed at baseline, 1-month, 2-month, and 3-month time points. Patients with retropalatal obstruction underwent tailored surgeries: anterior palatoplasty (AP), expansion sphincter palatoplasty (ESP), or barbed palatoplasty (BP). Baseline OSA severity between baseline and follow-up time points were also examined. RESULTS In this study, 96 patients with OSA were enrolled and allocated to three surgical groups: AP (n = 30), ESP (n = 32), and BP (n = 34). The mean age was 44.3 ± 10.2 years, with 86% male participants. No significant differences were found between the groups in terms of age, sex, and BMI. A two-way repeated measures ANOVA revealed a significant main effect of time on ETDQ-7 scores (p < 0.001), but no significant main effect of groups (p = 0.109) or interaction between time and groups (p = 0.082). Subgroup analysis showed a significant interaction for the 3-month change in ETDQ-7 scores by OSA severity (p = 0.046). In post hoc analysis, the BP group exhibited a higher mean ETDQ-7 score compared with the AP group at the 3-month follow-up. CONCLUSION This study highlights the importance of considering individual patient factors, such as OSA severity and eustachian tube function symptoms, when selecting the most appropriate surgical treatment to optimize outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2471-2477, 2024.
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Affiliation(s)
- Fatih Gul
- Department of Otorhinolaryngology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Ozgenur Kocak
- Department of Otorhinolaryngology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Mehmet A Babademez
- Department of Otorhinolaryngology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
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Fisher EW, Fishman J. Balloon Eustachian tuboplasty, revision sinus surgery, mental health in paediatric cochlear implant patients and medico-legal aspects of laryngoscopy. J Laryngol Otol 2024; 138:473. [PMID: 38690628 DOI: 10.1017/s0022215124000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
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Song H, Jia J, Zhao D, Guo M, Wang F, Hou K, Jiang N, Fu Z, Zhou J, Zhang H, Ding Y, Yang Y, Chen C, Jia X, Hou Z, Yang S. Endoscopic Balloon Dilatation of the Eustachian Tube via the Soft Palate Approach in Miniature Pigs. J Vis Exp 2024. [PMID: 38682934 DOI: 10.3791/66609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
The eustachian tube (ET) is one of the most complex organs in the human body, and its dysfunction may lead to a variety of diseases. In recent years, an increasing number of scholars have opted to conduct ET-related studies using large experimental animals such as miniature pigs or sheep, yielding promising results. Typically, conventional endoscopic procedures are performed through the nasal approach for large experimental animals. However, due to the elongated and narrow nasal cavity in these animals, transnasal surgeries are challenging. To address this issue, we explored an ET surgery approach via the soft palate. The animal was placed in a supine position. After endotracheal intubation under general anesthesia, a mouth opener was used to fully expose the upper palate. Local infiltration with diluted adrenal fluid was performed for anesthesia of the area. A sickle knife was then used to make a longitudinal soft palate incision at the junction of the soft and hard palates. After hemostasis, an endoscope was inserted into the nasopharynx cavity, allowing the visualization of the pharyngeal opening of the ET on the posterior lateral wall of the nasal cavity. Subsequently, a specialized pusher was used to insert a balloon into ET. The balloon was inflated, maintained at 10 bar for 2 min, and then removed. The incision in the soft palate was then sutured to ensure proper alignment. The soft palate healed well after the operation. This surgical approach is suitable for ET-related procedures in large experimental animals (e.g., miniature pigs, sheep, and dogs). The surgical procedure is simple, with a short surgical time, and wound healing is rapid. Under endoscopy, the pharyngeal opening of the ET is visible, and it is thus a good choice for procedures such as balloon dilation of the ET.
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Affiliation(s)
- Hui Song
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Jianping Jia
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Danheng Zhao
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Mengyuan Guo
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Fangyuan Wang
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Kun Hou
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Nan Jiang
- Liaoning University of Traditional Chinese Medicine
| | - Zhenhao Fu
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Jingcheng Zhou
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Haoze Zhang
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Yulin Ding
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Yuting Yang
- Liaoning University of Traditional Chinese Medicine
| | - Chen Chen
- Liaoning University of Traditional Chinese Medicine
| | - Xinyuan Jia
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment
| | - Zhaohui Hou
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment;
| | - Shiming Yang
- Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School; National Clinical Research Center for Otolaryngologic Diseases; Key Laboratory of Hearing Science, Ministry of Education; Beijing Key Laboratory of Hearing Impairment for Prevention and Treatment;
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Sudhoff H. Permanent occlusion of the Eustachian tube: a retrospective study on reopening procedures. Eur Arch Otorhinolaryngol 2024; 281:1693-1700. [PMID: 37847285 PMCID: PMC10942873 DOI: 10.1007/s00405-023-08271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE This study retrospectively evaluated the efficacy and versatility of reopening procedures for the permanent occlusion of the cartilaginous Eustachian tube (POET) by analyzing four consecutive cases. METHODS The study included all patients diagnosed with POET who suffered from Eustachian tube occlusion and glue ear. A combined approach of endoscopic transnasal/transoral laser surgery was utilized to reopen the POET. This was subsequently followed by balloon dilation (BET) and stenting for a duration of six weeks. In one distinct case, the Eustachian tube orifice was approached via a transtympanic method, where a balloon catheter was placed. The primary outcome measures targeted the success rate of reopening, which was quantified using audiological outcomes and Eustachian tube patency verified by a positive Valsalva maneuver. RESULTS Four patients, with an age range of 14-62 years (mean age of 29.3 years), were subject to Eustachian tube reopening. The duration of follow-up varied between 10 and 24 months, averaging at 16.2 months. Notably, 75% of the surgically treated ears displayed no evidence of glue ear upon their last follow-up and showed restoration of Eustachian tube patency. The procedures were executed without any surgical complications. The causes for POET in these patients were heterogeneous: two were attributed to scarring post adenoidectomy, one to occlusion following orthognathic surgery and the remaining one due to prior radiotherapy treatment for squamous cell carcinoma located at the soft palate. DISCUSSION Total occlusion of the cartilaginous Eustachian tube may be linked to persistent middle ear diseases. It is imperative to conduct nasopharyngeal endoscopy in these cases. The findings from this study suggest that the Eustachian tube reopening procedure is predominantly effective and safe for patients with POET stemming from a variety of pathologies. Future research should focus on exploring advanced stenting devices and necessitate longer follow-up periods for comprehensive understanding.
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Affiliation(s)
- Holger Sudhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty OWL, Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.
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Laakso JT, Oehlandt H, Kivekäs I, Harju T, Jero J, Sinkkonen ST. Balloon Eustachian Tuboplasty-A Feasible Double-Blinded Sham Surgery Randomized Clinical Trial Protocol to Study Efficacy. Laryngoscope 2024; 134:1874-1881. [PMID: 37776248 DOI: 10.1002/lary.31092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Balloon Eustachian tuboplasty (BET) is used to treat obstructive Eustachian tube dysfunction (OETD) and recurrent otitis media with effusion (OME). However, there are no indisputable evidence of its efficacy. Here, we present a multicenter, double-blinded, randomized, placebo-controlled trial (MDRCT) design to evaluate the efficacy of BET, and the results of a pilot trial with 3- and 12-months' follow-up. MATERIAL AND METHODS This was a prospective MDRCT. For a pilot study, OETD (n = 10) and OME (n = 5) patients were recruited and followed. Detailed inclusion and exclusion criteria were used. Participants were randomized at beginning of the operation to active or sham surgery. All procedures were performed under local anesthesia. Controls were performed in double-blinded manner (both patient and physician), at 3 and 12 months after the procedure. RESULTS Altogether, 20 ears were treated and followed for 12 months, including 14 active BETs and 6 sham surgeries. Both the active and sham surgery were performed under local anesthesia without problems or deviations from the protocol. There were no differences in the preoperative symptoms (ETDQ-7) or objective measures (tympanometry, Valsalva and Toynbee maneuvers, tubomanometry, Eustachian tube score) between active and sham surgery arms. During follow-up, we noticed largely similar reduction in subjective symptoms and improvement in Eustachian tube score both in active and sham surgery arms. CONCLUSIONS The pilot study demonstrates that our MDRCT protocol is feasible, and that blinded RCTs are dearly needed to objectively measure the efficacy of BET. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1874-1881, 2024.
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Affiliation(s)
- Juha T Laakso
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heidi Oehlandt
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Teemu Harju
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Gürtler N, Honegger F. Eustachian Tube Balloon Dilation in Children: Short- and Long-Term Outcome. Ann Otol Rhinol Laryngol 2024; 133:369-374. [PMID: 38197378 PMCID: PMC10898197 DOI: 10.1177/00034894231221888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Eustachian Tube Balloon Dilation (ETBD) represents an innovative therapeutic approach for chronic Eustachian tube dysfunction (CETD), a common disease in children. Some evidence of a benefit of ETBD in the adults exist in contrast to sparse reports in children. The objective was to analyze short- and long-term outcome of ETBD in children with CETD. METHODS A retrospective chart-review was performed in a cohort of 19 children (mean age 13 years, 7-17) who underwent ETBD. The following parameters were analyzed: tubomanometry (R-value), tympanogram, hearing (CPT-AMA, Air-bone gap [ABG]), Eustachian Tube Score (ETS and ETS-7), and Eustachian Tube Disease questionnaire (ETDQ). RESULTS Twenty-four ears were dilated (in 5 patients subsequently after successful first intervention) and grouped as A (17) without and B (7) with additional T-tube insertion. Most children suffered from either chronic otitis media with effusion or chronic perforation (12, 63%), the remainder comprising recurrent otitis media, adhesive otitis media and CETD with barotrauma. Mean duration of symptoms were 7/8.2 years and mean follow-up 13.7/11.1 months. Eighty percent of patients reported a subjective benefit. Accordingly, the R-value, ETS, and ETS-7 were significantly (P < .05) improved. Tympanometry, CPT-AMA and ABG showed a positive trend, but the result was not significant. Tympanic retraction remained largely the same; a spontaneous closure of a chronic tympanic perforation was seen in 1 of 3 cases. CONCLUSIONS The high subjective benefit and some significant objective improvement warrants further analysis of ETBD as part of the therapeutic management in pediatric CETD.
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Affiliation(s)
- Nicolas Gürtler
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University of Basel, Basel, Switzerland
- Hals-Nasen-Ohren-Klinik, University Children’s Hospital Basel, Basel, Switzerland
| | - Flurin Honegger
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University of Basel, Basel, Switzerland
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Grimm D, Daum R, Castro Silva BR, Lee CK, Fernandez-Miranda JC, Nayak JV, Patel ZM, Hwang PH, Chang MT. Eustachian tube dysfunction symptoms after endonasal skull base surgery. Int Forum Allergy Rhinol 2024; 14:853-857. [PMID: 37694445 DOI: 10.1002/alr.23266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
KEY POINTS ETD symptoms are present in 16% patients with underlying skull base pathology. Preoperative ETD symptoms improve following surgical treatment of skull base pathology. ETD symptoms may worsen in patients with central, posterior, or malignant skull base pathology.
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Affiliation(s)
- David Grimm
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel Daum
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Bruna R Castro Silva
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Christine K Lee
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jayakar V Nayak
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Zara M Patel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michael T Chang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Hsue VBC, Wong YT, Wu A, Tang D. Reconstruction of an obliterated Eustachian tube: transnasal lighted guidewire catheter stenting. BMJ Case Rep 2024; 17:e256748. [PMID: 38490712 PMCID: PMC10946367 DOI: 10.1136/bcr-2023-256748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
An obliterated Eustachian tube (ET) is a rare occurrence that can lead to chronic otitis media (OM) and aural fullness even with treatment. Our study presents a review of the literature on methods of stenting the ET. We additionally present a case of a man with mucoepidermoid carcinoma of the ET who underwent a radical nasal pharyngectomy with reconstruction and adjuvant radiation, and who had symptoms of intolerable otorrhea after tympanostomy tube placement to treat aural fullness and mucoid OM. We used a novel method of stenting the ET using a transnasal lighted guidewire catheter and steroid eluting stents placed along the entire medial ET. Previously described methods in the literature were unable to be used due to the complex middle ear anatomy filled with granulation tissue and the lack of a visible nasopharyngeal ET ostium available for straightforward placement of the stent. The procedure was successful, and postoperatively, the patient experienced decreased otorrhea.
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Affiliation(s)
| | - Yu-Tung Wong
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Arthur Wu
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis Tang
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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11
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Daum R, Grimm D, Castro Silva BR, Huang AE, Lee JY, Nayak JV, Patel ZM, Hwang PH, Chang MT. Surgical Correction of Nasal Obstruction and Its Effect on Eustachian Tube Dysfunction Symptoms. Otolaryngol Head Neck Surg 2024; 170:944-951. [PMID: 38037398 DOI: 10.1002/ohn.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To investigate how eustachian tube dysfunction symptoms change following surgical treatment of nonsinusitis-related nasal obstruction. STUDY DESIGN Retrospective chart review. SETTING Single academic center. METHODS We assessed patients who underwent septoplasty, turbinate reduction, or both for nasal obstruction. Chronic sinusitis patients were excluded. Eustachian tube dysfunction (ETD) symptoms were studied using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), collected preoperatively and postoperatively (1 week, 1 month, 3 months, 6 months postop). Patients with preoperative ETDQ-7 > 14.5 were considered to have clinically significant symptoms. Sinonasal outcomes test scores were also assessed. Pre- and postoperative ETDQ-7 scores were compared using t test. Multivariate linear regression analysis identified factors associated with ETDQ-7 change. RESULTS We analyzed 259 patients. Preoperatively, 37.5% of patients with nasal obstruction had clinically significant ETD symptoms. These patients exhibited significant improvement in ETDQ-7 at all postoperative timepoints from 23.3 ± 7.6 at baseline to 19.1 ± 9.1 at 1 week, 16.5 ± 8.0 at 1 month, 16.2 ± 7.8 at 3 months, and 16.7 ± 10.4 at 6 months (all P < .01). In patients without baseline ETD symptoms, (baseline ETDQ-7: 9.1 ± 2.3) ETDQ-7 scores did not change significantly at postoperative timepoints, except for an acute worsening at 1 week postoperatively (10.7 ± 5.1, P < .001). Regression analysis showed that higher preoperative ETDQ-7 score (β = -0.84, 95% confidence interval [CI]: -1.10 to -0.59) and postoperative antihistamine spray usage (β = -8.70, 95% CI: -14.20 to -3.20) were associated with ETDQ-7 improvement, while comorbid GERD (β = 7.50, 95% CI: 3.42-11.58) and asthma (β = 5.62, 95% CI: 0.80-10.45) were negatively associated with improvement. CONCLUSION Surgical correction of nasal obstruction may improve ETD symptoms.
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Affiliation(s)
- Rachel Daum
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David Grimm
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Bruna R Castro Silva
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alice E Huang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer Y Lee
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Zara M Patel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michael T Chang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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12
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Axiotakis LG, Spielman DB, Gudis DA, Yang N, Yan CH, Soler ZM, Levy JM, Rowan NR, Irace AL, Vilarello BJ, Jacobson PT, Overdevest JB. Accessing the Eustachian tube: Conventional nasal spray vs. exhalation delivery system and the impact of targeted endoscopic sinus surgery on topical distribution patterns. Int Forum Allergy Rhinol 2024; 14:660-667. [PMID: 37533194 DOI: 10.1002/alr.23248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS). METHODS Sixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0- to 3-point scale, with ratings averaged for analysis. RESULTS Interrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19 ± 0.81 vs. 0.78 ± 1.06; p = 0.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21-10.09; p = 0.021) and post-ESS (OR, 9.00; 95% CI, 1.95-41.5; p = 0.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44-104.85; p = 0.001). CONCLUSIONS EDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery.
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Affiliation(s)
- Lucas G Axiotakis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
| | - Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
| | - Nathan Yang
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
| | - Carol H Yan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Mt. Pleasant, South Carolina, USA
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandria L Irace
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Brandon J Vilarello
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
| | - Patricia T Jacobson
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York, USA
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13
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Zhang H, Zhang Q, He K, Chen M, Chen Y, Su D, Tang H, Lin W, Chen S. Dilatation Eustachian tuboplasty with a Eustachian tube video endoscope and supporting balloon. J Laryngol Otol 2024; 138:246-252. [PMID: 38084610 PMCID: PMC10876451 DOI: 10.1017/s0022215123001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate the feasibility and safety of employing a Eustachian tube video endoscope with a supporting balloon as a viable treatment and examination option for patients with Eustachian tube dysfunction. METHODS A study involving nine fresh human cadaver heads was conducted to investigate the potential of balloon dilatation Eustachian tuboplasty using a Eustachian tube video endoscope and a supporting balloon catheter. The Eustachian tube cavity was examined with the Eustachian tube video endoscope during the procedure, which involved the dilatation of the cartilaginous portion of the Eustachian tube with the supporting balloon catheter. RESULTS The utilisation of the Eustachian tube video endoscope in conjunction with the supporting balloon catheter demonstrated technical ease during the procedure, with no observed damage to essential structures, particularly the Eustachian tube cavity. CONCLUSION This newly introduced method of dilatation and examination of the Eustachian tube cavity using a Eustachian tube video endoscope and the supporting balloon is a feasible, safe procedure.
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Affiliation(s)
- Huasong Zhang
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
- Department of Otolaryngology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen Key Laboratory of ENT, Institute of ENT, Shenzhen, China
| | - Qing Zhang
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Kunwu He
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Minqi Chen
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Yucheng Chen
- School of Medicine, University of Central Lancashire, Preston, Lancashire, UK
| | - Dongliang Su
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Haobin Tang
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Weifen Lin
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Shuhua Chen
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
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14
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Zhang X, Yang L, Chen P, Liu Y, Yang J, Li Y, Zhao S. Congenital enlargement of the bony Eustachian tube: A retrospective study of the clinical and radiological features in nine patients. Clin Otolaryngol 2024; 49:247-253. [PMID: 37945001 DOI: 10.1111/coa.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Xiangbao Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, No. 2 Hospital, Ningbo, China
| | - Lin Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
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Pöyhönen L, Silvola J, Poe D, Rautiainen M, Kivekäs I. Balloon dilation improves both the hearing level and the quality of life in patients suffering from obstructive Eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2024; 281:1259-1265. [PMID: 37725135 PMCID: PMC10858106 DOI: 10.1007/s00405-023-08231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Chronic obstructive Eustachian tube dysfunction (OETD) can lead to tympanic membrane (TM) retraction and middle ear effusion (MEE) which can cause conductive hearing impairment, which among other ear symptoms can lower the quality of life (QoL). In this prospective study we assess hearing results and subjective changes in QoL following balloon Eustachian tuboplasty (BET) in treatment of OETD. METHODS Totally 25 ears with TM retraction and 18 ears with MEE due to chronic OETD underwent BET as the sole intervention. Outcomes including otoscopy, ability to perform the Valsalva maneuver, tympanometry, audiometry, Eustachian tube inflammation scale and the Glasgow Benefit Inventory questionnaire (GBI) were obtained on all patients preoperatively and 6 months postoperatively. RESULTS Hearing thresholds improved statistically significantly (p < 0.05) with means of 3 dB in the TM retraction group and 9 dB in the MEE group. Total GBI results indicated a positive influence on patients' QoL. Valsalva success rate was 80% in patients with TM retraction and 67% in patients with MEE. Tympanometry results improved in 50% of TM retraction patients and in 33% of MEE patients. CONCLUSIONS Here we demonstrated that the BET has a positive impact on patients' conductive hearing loss and QoL in patients with TM retraction or MEE. Results were better in TM retraction group than in MEE group.
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Affiliation(s)
- Leena Pöyhönen
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
| | - Juha Silvola
- Department of Otorhinolaryngology, Faculty of Medicine, Akershus University Hospital, Akershus and University of Oslo, Campus AHUS, Oslo, Norway
| | - Dennis Poe
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | - Markus Rautiainen
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.
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Pool C, Liu G, Yoo F, Garg R, Keschner D. Endoscopic endonasal recanalization of the obliterated eustachian tube via ureteral stent. Int Forum Allergy Rhinol 2024; 14:138-140. [PMID: 37365856 DOI: 10.1002/alr.23223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
KEY POINTS Eustachian tube recanalization is a feasible procedure but additional studies are needed to determine its safety. Eustachian tube closure can result from different etiologies and can cause severe symptoms. Ureteral stents have appropriate shape and pliability for placement and long-term healing. Multidisciplinary team approach allows for simultaneous endonasal and otologic approaches.
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Affiliation(s)
- Christopher Pool
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - George Liu
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - Rohit Garg
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
| | - David Keschner
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Irvine, California, USA
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17
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Shenouda K, Poillon G, Gargula S, Hervé C, Escalard S, Ayache D, Daval M. Complication of Ear Impression: Foreign Body in the Eustachian Tube Eroding the Carotid Canal. Laryngoscope 2023; 133:3358-3360. [PMID: 37602765 DOI: 10.1002/lary.30932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
The realization of customized earing plugs and earmolds for hearing aids requires an impression of the external auditory canal to obtain a siliconized mold. Silicone used for ear impressions is known to be safe and inert but deposition of silicone in the middle ear can middle and inner ear damages. We present a case of accidental injection of silicone in the middle ear and the Eustachian tube resulting in an erosion of the carotid canal. Laryngoscope, 133:3358-3360, 2023.
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Affiliation(s)
- Kerolos Shenouda
- Department of Otolaryngology Head and Neck Surgery, Hôpital Fondation A. de Rothschild, Paris, France
| | - Guillaume Poillon
- Department of Medical Imaging, Hôpital Fondation A. de Rothschild, Paris, France
| | - Stéphane Gargula
- Department of Otolaryngology Head and Neck Surgery, Hôpital Fondation A. de Rothschild, Paris, France
| | - Camille Hervé
- Department of Otolaryngology Head and Neck Surgery, Hôpital Fondation A. de Rothschild, Paris, France
| | - Simon Escalard
- Department of Interventional Neuroradiology, Hôpital Fondation A. de Rothschild, Paris, France
| | - Denis Ayache
- Department of Otolaryngology Head and Neck Surgery, Hôpital Fondation A. de Rothschild, Paris, France
| | - Mary Daval
- Department of Otolaryngology Head and Neck Surgery, Hôpital Fondation A. de Rothschild, Paris, France
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18
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Hubbell RD, Toivonen J, Kawai K, Kim HJ, Nieman CL, Ward BK, Poe DS. Patulous Eustachian Tube Dysfunction Symptoms Following Balloon Dilation. Laryngoscope 2023; 133:3152-3157. [PMID: 36929856 DOI: 10.1002/lary.30659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/01/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management. Reported complications have been limited and include patulous Eustachian tube dysfunction (PETD). This multicenter study investigates the incidence of PETD and associated factors. METHODS Consecutive patients at three academic centers undergoing BDET (January 2014-November 2019) for OETD refractory to medical therapy were included. PETD was diagnosed by patient-reported symptoms of autophony of voice and/or breathing. Associated factors studied include age, sex, comorbidities, balloon size, duration of inflation, repeat BDET, and adjunctive procedures. RESULTS BDET procedures (n = 295 Eustachian tubes) were performed on 182 patients. Mean age was 38.4 years (SD 21.0; range 7-78) and 41.2% were female. Twenty cases of PETD (6.8% of procedures; 9.3% of patients) occurred following BDET. Risk of PETD did not vary by institution, comorbidities, or adjunctive procedure. Age ≤18 years (adjusted risk ratio [RR] = 3.26; 95% confidence interval [CI]: 1.24, 8.54; p = 0.02), repeat BDET (RR = 3.26; 95% CI: 2.15, 4.96; p < 0.001), and severe preoperative Eustachian tube inflammation (RR = 2.83; 95% CI: 1.10, 7.28; p = 0.03) were associated with increased risk of developing PETD in the multivariable model. Most symptoms were reported as mild or intermittent. CONCLUSION BDET caused PETD symptoms in approximately 7% of dilated Eustachian tubes in this study with increased risk for younger patients and those with severe inflammation or undergoing repeat dilations. Although most cases were self-limited, symptoms can persist. Awareness of risk factors may aid clinicians in limiting this complication. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3152-3157, 2023.
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Affiliation(s)
- Richard D Hubbell
- Department of Otolaryngology-Head and Neck Surgery, Loyola Stritch School of Medicine, 23 West Chicago Avenue, Apt 3606, Chicago, Illinois, 60654, USA
| | - Joonas Toivonen
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - H Jeffrey Kim
- Department of Otolaryngology-Head and Neck surgery, Georgetown University Medical Center, Washington, D.C., USA
| | - Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dennis S Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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Hussain SZM, Hashmi S, Qayyum A. Delayed extensive surgical emphysema after Valsalva manoeuvre post Eustachian tuboplasty. J Laryngol Otol 2023; 137:1293-1296. [PMID: 37194501 DOI: 10.1017/s0022215123000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This paper reports a case of balloon Eustachian tuboplasty with delayed presentation of extensive surgical emphysema. METHODS This is a clinical case report with a review of literature. RESULTS Eustachian tube dysfunction is a functional disorder that results in inadequate middle-ear ventilation, causing aural fullness and tinnitus. A 36-year-old male presented with the sudden onset of an isolated, painful, left-sided neck swelling. The patient underwent balloon Eustachian tuboplasty, which was uneventful, but subsequently developed a sudden onset of isolated left-sided neck swelling on the 5th post-operative day during Valsalva manoeuvre. Neck examination revealed extensive crepitus on the left side of the neck. Examination findings were confirmed by imaging. The patient was conservatively managed and subsequently discharged home. CONCLUSION Balloon Eustachian tuboplasty is a safe procedure; however, extra care must be taken to avoid possible complications. Patients should be counselled against Valsalva manoeuvre and heavy weightlifting. They also should be instructed to sneeze with an open mouth and consider the use of stool softeners.
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Affiliation(s)
- S Z M Hussain
- ENT Department, Peterborough City Hospital, Peterborough, UK
| | - S Hashmi
- ENT Department, Peterborough City Hospital, Peterborough, UK
| | - A Qayyum
- ENT Department, Peterborough City Hospital, Peterborough, UK
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Lin JT, Hsu HJ, Ho CY, Tsai SW, Li YL, Wu JL. Balloon Dilation Eustachian Tuboplasty for Dilatory Dysfunction With and Without Effusion: A Comprehensive Outcome Analysis. Otolaryngol Head Neck Surg 2023; 169:1179-1186. [PMID: 37264984 DOI: 10.1002/ohn.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study aimed (1) to demonstrate the efficacy of balloon dilation Eustachian tuboplasty (BDET) for dilatory Eustachian tube dysfunction (ETD) and (2) to determine whether adjunctive ventilation tube insertion (VTI) is superior to myringotomy in relieving symptoms for patients with ETD and concurrent middle ear effusion (MEE) treated with BDET. STUDY DESIGN A retrospective cohort study. SETTING Tertiary care academic center. METHODS Patients with dilatory ETD undergoing BDET with a ≥6-month follow-up period were enrolled and evaluated mainly using Eustachian tube function (ETF) tests and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). Participants with concurrent MEE were further classified into 2 subgroups, BDET with VTI and BDET with myringotomy. An intergroup comparison and comprehensive outcome evaluation were performed. RESULTS In total, 35 patients with 50 symptomatic ears were enrolled. According to ETF test results, the normalized ETF rate was 94% on the last visit. The mean ETDQ-7 scores decreased significantly from 3.7 ± 1.4 to 2.0 ± 0.9 after interventions, with the most improvement in symptoms occurring for "ear fullness" and "muffled hearing." For the final visit, strong correlations among ETF tests, tympanometry, and Valsalva results were noted. The aforementioned assessment results did not significantly differ between (1) the patients with MEE and patients without MEE and (2) "BDET with VTI" subgroup and "BDET with myringotomy" subgroup. CONCLUSION BDET was effective for dilatory ETD, even in cases with concurrent MEE. For patients with ETD and MEE, further research is required to evaluate the benefits of adjunctive myringotomy with or without VTI.
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Affiliation(s)
- Jung-Ting Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Otolaryngology, Kuo General Hospital, Tainan City, Taiwan
| | - Chen-Yu Ho
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Otolaryngology, Kuo General Hospital, Tainan City, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yi-Lu Li
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Miller EM, Raymond MJ, Ottinger AM, Yazdani M, Meyer TA. Outcomes of Spontaneous Cerebrospinal Fluid Leak Repair With Concurrent Eustachian Tube Dysfunction. Otol Neurotol 2023; 44:896-902. [PMID: 37590873 DOI: 10.1097/mao.0000000000003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To compare the presentation and outcomes of patients with and without obstructive eustachian tube dysfunction (oETD) undergoing repair of lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adults with lateral skull base sCSF leaks who underwent repairs from January 1, 2011, to December 31, 2020, were collected. MAIN OUTCOME MEASURE Comparative statistics and effect sizes were used to compare clinical features, operative findings, and outcomes between groups. RESULTS Of 92 ears from 89 patients included, 51.1% (n = 47) had oETD. There were no differences in demographics between patients with and without oETD. Mean age was 60.7 ± 13.1 versus 58.5 ± 12.8 years ( d = -0.17 [-0.58 to 0.24]), mean body mass index was 33.8 ± 8.5 versus 36.0 ± 8.0 kg/m 2 ( d = 0.27 [-0.14 to 0.68]), and female sex preponderance was 59.6% (n = 28) versus 68.8% (n = 31; Φ = -0.09), respectively. There were no differences in the radiologic number, size, and locations of defects. Patients with oETD had less pneumatized mastoids than those without oETD ( p = 0.001; Φ = 0.43). Mean change from preoperative to postoperative air pure-tone average for those with and without oETD was -1.1 ± 12.6 versus 0.1 ± 17.2 dB ( d = 0.09 [-0.04 to 0.58]), respectively. Six ears (6.5%; three with and three without oETD) underwent revisions for rhinorrhea/otorrhea between 5 and 28 months postoperatively, during which four leaks were found, the two patients without leaks had oETD. CONCLUSIONS The presentation of sCSF leaks and outcomes of repairs in patients with oETD do not differ from those without oETD. Although postoperative otorrhea might represent an inflammatory or infectious process in patients with oETD, reexploration is warranted if patients do not improve with conservative treatment.
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Affiliation(s)
- Emma Marin Miller
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Allie M Ottinger
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Milad Yazdani
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Sandoval M, Navarro JJ, Martínez-Beneyto P, Herrera M, Alfaro J, López F, Marco J, Plaza G. Balloon Eustachian tuboplasty for obstructive Eustachian tube dysfunction: retrospective multicentre cohort study of 248 patients. Eur Arch Otorhinolaryngol 2023; 280:4045-4055. [PMID: 36976369 PMCID: PMC10382357 DOI: 10.1007/s00405-023-07906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To present the results after balloon eustachian tuboplasty (BET) in patients with obstructive Eustachian tube dysfunction (OETD) grouped up into: baro-challenge, chronic serous otitis media and adhaesive otitis media. METHODS A retrospective study was carried out on patients who underwent BET surgery. As outcome measures, otoscopy, tympanometry, Eustachian tube dysfunction questionnaire-7 (ETDQ-7) and ability to perform the Valsalva manoeuvre were recorded at baseline and at 3, 12 and 24 months after BET. A p value of 0.05 was used to indicate a statistically significant difference for all statistical tests. RESULTS Three hundred and nineteen ears (248 patients) were included with a 3-month follow-up, 272 ears had a 12-month follow-up, and 171 ears had 24-month follow-up. Globally, a statistical significance improvement in all groups in all outcome measures was found. According to BET indication, in the baro-challenge group, there was no improvement in otoscopy, but ETDQ-7, Valsalva manoeuvre and tympanogram improved significantly. In the chronic serous otitis media group, otoscopy, ETDQ-7 and Valsalva manoeuvre were significantly improved in all the three timelines, including the avoidance of a new transtympanic tube after the BET in over 80% of cases. In the adhaesive otitis media group, Valsalva manoeuvre improved significantly, ETDQ-7 decreased and tympanogram improved but not significantly. Few mild complications were reported. CONCLUSIONS BET is an effective method for the treatment of OETD in all etiologic groups. The greatest benefit was observed in patients with baro-challenge. A long-term follow-up is recommended since the benefit seems to increase over time.
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Affiliation(s)
- Marta Sandoval
- Department of Otolaryngology, Hospital Clínic Barcelona, Universitat de Barcelona (UB), C. Villarroel 170, 08036 , Barcelona, Spain.
- Departament de Medicina i Especialitats Médicoquirúrgiques, Facultat de Medicina, Universitat de Barcelona (UB), C. Casanova 143, 08036, Barcelona, Spain.
| | - Juan-J Navarro
- Department of Otolaryngology, Hospital Universitario de Donostia, Donostia-San Sebastian, Spain
| | | | - Mayte Herrera
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jorge Alfaro
- Department of Otolaryngology, Hospital Quirónsalud Zaragoza, Zaragoza, Spain
| | - Felipe López
- Department of Otolaryngology, Hospital Sant Joan Despí-Moisès Broggi, Barcelona, Spain
| | - Jaime Marco
- Department of Otolaryngology, Hospital Clínico Universitario, Valencia, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
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Scagnelli R, Ramsey T, Grube J, Foyt D. Transnasal Foreign Body Eustachian Tube Disimpaction: First-Described Novel Technique. Otolaryngol Head Neck Surg 2023; 169:447-448. [PMID: 36939630 DOI: 10.1002/ohn.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Robert Scagnelli
- Department of Otolaryngology, Albany Medical Center, Albany, New York, USA
| | - Tam Ramsey
- Department of Otolaryngology, Albany Medical Center, Albany, New York, USA
| | - Jordon Grube
- Department of Otolaryngology, Albany Medical Center, Albany, New York, USA
| | - David Foyt
- Department of Otolaryngology, Albany Medical Center, Albany, New York, USA
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24
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Zhang M, Liu X, Wang B, Jin Z, Xu X. Qualification of Pilots with Aero-Otitis Media After Balloon Eustachian Tuboplasty. Aerosp Med Hum Perform 2023; 94:629-633. [PMID: 37501290 DOI: 10.3357/amhp.6165.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND: Aero-otitis media (AOM), also known as aural barotrauma or barotitis media, is categorized into primary AOM and secondary AOM. Because conservative treatment was ineffective, primary AOM was one of the main reasons for grounding. In 2014, the team successfully treated a pilot with primary AOM using balloon Eustachian tuboplasty (BET). Now, this case is reported.CASE REPORT:The patient was a 40-yr-old male transport pilot who joined a flight after catching a cold. During the descent, the right ear appeared to have stuffiness and hearing loss, accompanied by tinnitus and ear pain. The local hospital's acoustic immittance test showed an "A" curve in the left ear and a "B" curve in the right ear. According to "secretory otitis media", right tympanic membrane puncture and drugs were performed. After he recovered, he continued to fly, and the symptoms reappeared again. Then he was transferred to our hospital, and right BET was performed. Equalization of ear pressure in the hypobaric chamber returned to normal 2 mo after the operation. The pilot was found fit to fly. The pilot is still qualified, with more than 6000 h of flight time.DISCUSSION: AOM is linked to Eustachian tube dysfunction. BET has been a minimally invasive treatment of Eustachian tube lesions in recent years. If conservative treatments for primary AOM are ineffective, BET can be selected. While the postoperative symptoms disappeared, pure tone audiometry, tympanometry, and ear pressure function tests met the standards for the physical examination of pilots, allowing the determination of flight qualification.Zhang M, Liu X, Wang B, Jin Z, Xu X. Qualification of pilots with aero-otitis media after balloon Eustachian tuboplasty. Aerosp Med Hum Perform. 2023; 94(8):629-633.
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25
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Chen J, Xiong H, Chen Y, Yang H. Autologous Fat Injection for the Treatment of Patulous Eustachian Tube. J Int Adv Otol 2023; 19:311-317. [PMID: 37528596 PMCID: PMC10544000 DOI: 10.5152/iao.2023.221009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Patulous eustachian tube is a disorder that leads to disturbing symptoms such as autophony, respiratory noise, and aural fullness. There has not been an established treatment found for this disorder. This study aims to assess the efficacy of autologous fat injection for a novel treatment of patients with patulous eustachian tube. METHODS Twenty-eight patients with refractory patulous eustachian tube were recruited for the study. Endoscopic autologous fat injection was performed submucosally into the anterior and posterior portion of the pharyngeal orifice of the eustachian tube. The outcomes were quantitatively assessed by comparing the difference between pre- and postoperative scores with the visual analog scale on 4 criteria: aural fullness, respiratory noise, tinnitus, and autophony. RESULTS Autologous fat injection was performed successfully in all patients without major complications. According to the combined visual analog scale scores, after the treatments, 20 patients showed significant improvement and 6 showed moderate improvement. The overall success rate of the treatment was 92.9%. CONCLUSION Autologous fat injection is an effective and safe procedure for the treatment of patulous eustachian tube.
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Affiliation(s)
- Juan Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Xiong
- Institute of Hearing and Speech-Language Science, Xinhua College of Sun Yat-sen University, Guangzhou, China
| | - Yuebo Chen
- Institute of Hearing and Speech-Language Science, Xinhua College of Sun Yat-sen University, Guangzhou, China
| | - Haidi Yang
- Institute of Hearing and Speech-Language Science, Xinhua College of Sun Yat-sen University, Guangzhou, China
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26
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Oorsprong CW, Ter Haar G. Rigid normograde rhinoscopy-assisted traction-avulsion removal of small middle ear polyps from the auditory tube in five cats. J Feline Med Surg 2023; 25:1098612X231179077. [PMID: 37384389 DOI: 10.1177/1098612x231179077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
CASE SERIES SUMMARY This study aims to describe a novel minimally invasive technique for the removal of small middle ear polyps from the auditory tube openings in cats. Five cats with clinical signs of otitis externa and/or otitis media, and/or upper respiratory tract inflammation were included. All cats underwent pharyngolaryngoscopy under anaesthesia, CT scan of the head, neck and thoracic cavity, video-otoscopic examination, retrograde nasopharyngoscopy and normograde rhinoscopy. The five cats described in this study were all found to have significant respiratory tract inflammation (rhinitis, sinusitis, nasopharyngitis, otitis media) with small polypous protrusions from the auditory tube openings. A normograde rhinoscopy-assisted traction-avulsion (RATA) removal of these small polyps was performed in all cases without complications. The rostral nasopharynx was visualised by a unilaterally normograde advanced rigid endoscope passing the choana, and polyps were removed using a grasping forceps introduced in the contralateral nostril. Telephone follow-up revealed clear improvement in all cases. One of the cases was re-evaluated with a CT scan and endoscopy 4 weeks after treatment. The CT scan showed a significant improvement with no abnormalities in both external ear canals and air opacity in both tympanic bullae. Video-endoscopic examination revealed intact tympanic membranes with mild chronic abnormalities and patent auditory tube openings upon normograde rhinoscopy. RELEVANCE AND NOVEL INFORMATION Rigid normograde RATA is a novel, minimally invasive and effective technique for the removal of small middle ear polyps from auditory tube openings in cats with otitis media.
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Affiliation(s)
| | - Gert Ter Haar
- AniCura Specialistische Dierenkliniek Utrecht, Utrecht, The Netherlands
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杨 惠, 谢 乐, 孙 宇. ["Step-up"surgical treatment strategy for patulous Eustachian tube]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:494-498. [PMID: 37253528 PMCID: PMC10495791 DOI: 10.13201/j.issn.2096-7993.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Indexed: 06/01/2023]
Abstract
Patients with patulous Eustachian tubes(PET) usually suffer from annoying symptoms, such as tinnitus, autophony and aural fullness, due to the excessive opening of the Eustachian tube. There is no uniform standard of treatment, and conservative therapy combined with"Stepup"surgical intervention strategy is the main treatment. In this article, we reviewed various surgical treatments of patulous Eustachian tube in recent years, including key points of surgical operation, effectiveness, safety and complications. Full communication and evaluation are needed to establish appropriate patients' expectations preoperatively. A "Stepup" treatment strategy will be carried out, including conservative treatment, tympanic membrane surgery, Eustachian tube pharyngeal orifice constriction surgery, Eustachian tube tympanic orifice plug surgery and Eustachian tube muscle surgery, which aims to maintain normal Eustachian tube function and good middle ear ventilation.
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Affiliation(s)
- 惠文 杨
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科(武汉,430022)Department of Otolaryngology, Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - 乐 谢
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科(武汉,430022)Department of Otolaryngology, Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - 宇 孙
- 华中科技大学同济医学院附属协和医院耳鼻咽喉科(武汉,430022)Department of Otolaryngology, Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Treble A, Do T, Sarkis L, Newey A, Naidoo SY, Saxby A, Kong J, Patel NP, Jufas N. Caution in Transnasal Balloon Dilation of the Eustachian Tube: Middle Ear Penetration of Catheter Tip in a Cadaveric Model. Otol Neurotol 2023; 44:241-245. [PMID: 36622652 DOI: 10.1097/mao.0000000000003802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the degree to which transnasal eustachian tube (ET) dilation balloon catheters are able to be passed through the ET in a cadaver model. PATIENTS AND INTERVENTIONS A cadaveric study of 8 cadaver heads (16 ears), which underwent transnasal ET insertion with a 3 × 20-mm balloon catheter with transtympanic endoscopic visualization and grading. RESULTS Catheter tip incursion into the protympanum or mesotympanum occurred in all ears. Radiological validation was obtained with correlation to published ET length data. CONCLUSION Middle ear incursion of balloon catheter tips can be demonstrated in a cadaver model and highlights the ongoing need for both caution in novel surgical techniques and evolution in device design.
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Affiliation(s)
- Alexander Treble
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital
| | - Timothy Do
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital
| | - Leba Sarkis
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital
| | - Allison Newey
- Department of Radiology, Royal North Shore Hospital and North Shore Private Hospital, St Leonards
| | - Soo Yee Naidoo
- Department of Radiology, Royal North Shore Hospital and North Shore Private Hospital, St Leonards
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Chung MY, Shin MJ, Cha SH, Lee JY. Transient asystole during balloon dilation of the Eustachian tube: A case report. Medicine (Baltimore) 2022; 101:e31720. [PMID: 36343080 PMCID: PMC9646581 DOI: 10.1097/md.0000000000031720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE Neurally mediated reflexes can induce cardiac arrest during head and neck surgery through mechanisms including direct vagal stimulation, trigeminocardiac reflex, and baroreceptor reflex. Balloon dilation of the Eustachian tube (BDET) is a safe procedure without serious complications, including cardiac arrest. PATIENT CONCERNS Transient asystole developed during BDET under general anesthesia in a 33-year-old woman as soon as the balloon in the Eustachian tube (ET) was inflated. DIAGNOSES Monitoring records were reviewed. The asystolic period was recorded on the patient monitor as an event, which we recalled and printed. The asystole lasted for 13 seconds. INTERVENTIONS The patient recovered sinus rhythm spontaneously after the balloon was deflated before resuscitation. The BDET was successfully performed after prophylaxis with vagolytic drugs. OUTCOMES The patient recovered uneventfully after anesthesia. LESSONS BDET, previously known to be a relatively safe procedure, induces asystole via balloon dilation. It is thought to be a neurally mediated vagal reflex, and both anesthesiologists and otologic physicians should pay proper attention to monitoring during the procedure.
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Affiliation(s)
- Mee Young Chung
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Jung Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hee Cha
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Yung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * Correspondence: JiYung Lee, Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeoungdeungpo-gu, Seoul 07345, Korea (e-mail: )
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Kjær Krogshede S, Kirchmann M, Peter Schjellerup Jørkov A, Glad H. Balloon Dilation of the Eustachian Tube: A Randomized Controlled Trial with 6 Months Follow-Up. J Int Adv Otol 2022; 18:501-506. [PMID: 36349672 PMCID: PMC9682787 DOI: 10.5152/iao.2022.21198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/01/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Obstructive Eustachian tube dysfunction in adults is common. The purpose of this study was to examine whether balloon dilation of the Eustachian tube can improve ventilation of the middle ear among adult patients with mild chronic Eustachian tube dysfunction. METHODS This study included patients aged ≥18 years with unilateral chronic Eustachian tube dysfunction confirmed with an abnormal tympanometry and a retracted tympanic membrane. Patients were treated daily with nasal steroid spray and Valsalva maneuver for 2 months. If Eustachian tube dysfunction persisted, they were enrolled in the study and randomized to balloon dilation of the Eustachian tube or control. All patients underwent otomicroscopy, tympanometry, pure-tone audiometry and the Eustachian Tube Dysfunction Questionnaire-7. Follow-up visits were completed at 3 weeks, 3 months, and 6 months. RESULTS In total, 24 patients completed the study (13 balloon dilation of the Eustachian tube, 11 control). The balloon dilation of the Eustachian tube group showed normalization from retraction or serous otitis media in 9 out of 13 patients (P = .0006) compared to 0 out of 11 patients in the control group. In the balloon dilation of the Eustachian tube group, 9 out of 13 patients showed an improvement in tympanometry from B to C/A or from C to A (P = .04) compared to 3 out of 11 patients in the control group. The audiometric data showed no difference (P = .38). There was no significant difference in mean Eustachian Tube Dysfunction Questionnaire-7 score between the two groups (P = .35). In the balloon dilation of the Eustachian tube group, 69% answered that they had benefitted from the treatment. CONCLUSION The procedure is feasible and no complications were reported. The study indicates that balloon dilation of the Eustachian tube may be a beneficial treatment in a selected group of adult patients with mild chronic Eustachian tube dysfunction.
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Affiliation(s)
- Sara Kjær Krogshede
- The Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Malene Kirchmann
- The Department of Otorhinolaryngology, North Zealand Hospital, Hillerød, Denmark
| | | | - Henrik Glad
- The Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Jee Kang Y, Bum Kim M, Duk Hong S, Cho YS. Mucosal Melanoma of Eustachian Tube: A Case Report. J Int Adv Otol 2022; 18:455-458. [PMID: 36063100 PMCID: PMC9524376 DOI: 10.5152/iao.2022.21573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Mucosal melanoma originating from the eustachian tube is very rare, and only 15 cases were reported so far. In this study, we report a case of mucosal melanoma from the eustachian tube which was surgically managed, followed by chemoradiotherapy. A 53-year-old man presented with a history of recurrent idiopathic hemotympanum and a dark red mass in the nasopharynx protruding from the eustachian tube orifice. Under an impression of mucosal melanoma from the eustachian tube, en-bloc surgical removal was performed using the infratemporal fossa approach type C combined with a transnasal endoscopic approach followed by postoperative chemoradiotherapy. However, the disease progressed to lung metastasis, and the patient died of the disease at 13 months postoperatively. The presenting case showed a poor progression despite a margin-free surgical resection followed by chemoradiotherapy. Additional trial of new treatment options is necessary to improve the poor prognosis.
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Affiliation(s)
- Yung Jee Kang
- Department of Otolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University Faculty of Medicine, Seoul, Korea
| | - Min Bum Kim
- Department of Otolaryngology-Head and Neck Surgery, Jeju Medical Center, Jeju University Faculty of Medicine, Jeju, Korea
| | - Sang Duk Hong
- Department of Otolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University Faculty of Medicine, Seoul, Korea
| | - Yang-Sun Cho
- Department of Otolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University Faculty of Medicine, Seoul, Korea
- Corresponding author: Yang-Sun Cho, e-mail:
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Chen WC, Yang KL, Lin WC, Fang KC, Wu CN, Luo SD. Clinical outcomes of Eustachian tube dysfunction in chronic rhinosinusitis following endoscopic sinus surgery. J Chin Med Assoc 2022; 85:782-787. [PMID: 35507042 DOI: 10.1097/jcma.0000000000000734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The effects of endoscopic sinus surgery (ESS) on the symptom burden of Eustachian tube dysfunction (ETD) in chronic rhinosinusitis (CRS) patients were investigated. METHODS Ninety-two patients with CRS following ESS were prospectively enrolled and followed up every 3 months for 1 year. The 7-item ETD Questionnaire (ETDQ-7) and 22-item Sino-Nasal Outcome Test (SNOT-22) were administered before ESS and at each visit following ESS. RESULTS Before surgery, 25% of patients reported ETDQ-7 scores ≥ 14.5, indicating the presence of ETD. The mean preoperative ETDQ-7 and SNOT-22 scores were 13.3 and 40.0, respectively. The mean ETDQ-7 and SNOT-22 scores were significantly decreased to 8.2 and 17.0 at 1 year following ESS, respectively. Most patients reported alleviation of their symptoms within the first 3 months, and the prevalence of ETD had decreased to 3.3% at 1 year. Patients who received revision surgery had higher ETDQ-7 scores during the follow-up period. Additionally, 5.4% of patients reported worsening of their symptoms. CONCLUSION ETD symptoms can be effectively alleviated in most patients within 3 months following ESS. However, 5.4% of patients reported worsening of their symptoms at the 1-year follow-up. Additional objective studies should be conducted to evaluate Eustachian tube function thoroughly in CRS patients.
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Affiliation(s)
- Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Kun-Lin Yang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Kuan-Chung Fang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
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Xu Z, Shen L, Liu D, Yao H, Shen B, Fu Y, Li Q, Wang Z. [Application of Eustachian tube balloon dilatation in the treatment of otitis media with effusion in children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:243-246. [PMID: 35511613 PMCID: PMC10128181 DOI: 10.13201/j.issn.2096-7993.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Indexed: 04/30/2023]
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Freeman MH, Gafford JB, Fichera L, Noble J, Webster RJ, Labadie RF. Transeustachian Middle Ear Endoscopy Using a Steerable Distal-Camera Tipped Endoscope. Otol Neurotol 2022; 43:206-211. [PMID: 34669684 PMCID: PMC8752488 DOI: 10.1097/mao.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear. PATIENTS Three cadaveric temporal bone specimens were used in this work. INTERVENTION Diagnostic transeustachian endoscopy of the middle ear was performed. MAIN OUTCOME MEASURE Diagnostic image quality. RESULTS A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity. CONCLUSIONS A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.
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Affiliation(s)
- Michael H. Freeman
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua B. Gafford
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN
| | - Loris Fichera
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA
| | - Jack Noble
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN
| | - Robert F. Labadie
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN
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李 秋, 姜 子, 田 晓, 李 晓, 李 曼. [Clinical observation of chronic recurrent secretory otitis media in adults treated by balloon dilatation of Eustachian tube combined with myringotomy and catheterization]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:1073-1084. [PMID: 34886619 PMCID: PMC10127653 DOI: 10.13201/j.issn.2096-7993.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 06/13/2023]
Abstract
Objective:To explore the clinical effect of balloon dilatation of the Eustachian tube combined with myringotomy and catheterization in treating chronic recurrent secretory otitis media in adults. Methods:100 cases(135 ears) of chronic recurrent secretory otitis media in our hospital from January 2018 to May 2020 were selected as the research objects, and were divided into two groups according to the random number table method, 50 cases(68 ears) in the control group and 50 cases(67ears) in the observation group. The control group received tympanostomy and catheterization, while the observation group received tympanostomy with catheterization and balloon dilatation of the Eustachian tube. The total effective rates, Eustachian tube dysfunction scores, Eustachian tube pressure R scores, pure tone thresholds, complication rates, scores of life quality and recurrence rates 1 year after operation were compared between the two groups. Results:The total effective rate was higher in the observation group than the control group(P<0.05). Compared with pre-operation, the score of Eustachian tube dysfunction, the pure tone listening threshold of each frequency were lower and the Eustachian tube pressure R scores were higher in the two groups at 3 months, 6 months and 12 months after operation(P<0.05); 3 months, 6 months and 12 months after operation, the scores of Eustachian tube dysfunction, the pure tone listening threshold of each frequency in the observation group were lower than those in the control group(P<0.05), and Eustachian tube pressure R scores were higher than those in the control group(P<0.05). Compared with the control group, the incidence of complications and recurrence rate 1 year after operation were lower in the observation group(P<0.05). Compared with before operation, the scores of life quality in the two groups were higher at 3 months, 6 months and 12 months after operation(P<0.05); 3 months, 6 months and 12 months after operation, the scores of life quality were higher in the observation group than the control group(P<0.05). Conclusion:Tympanotomy combined with balloon dilatation of Eustachian tube can effectively improve the Eustachian tube function of adult patients with chronic recurrent secretory otitis media, it has impressiveclinical effects. On the one hand,it can be better to promote the recovery of patients' hearing and improve the clinical cure rate of patients; On the other hand, it reduce the occurrence of complications and disease recurrence greatly, so the quality of the patients' life were improved significantly.
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Affiliation(s)
- 秋焕 李
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, the First Hospital of Qinhuangdao, Qinhuangdao, 066000, China
| | - 子刚 姜
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, the First Hospital of Qinhuangdao, Qinhuangdao, 066000, China
| | - 晓斌 田
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, the First Hospital of Qinhuangdao, Qinhuangdao, 066000, China
| | - 晓晶 李
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, the First Hospital of Qinhuangdao, Qinhuangdao, 066000, China
| | - 曼曼 李
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, the First Hospital of Qinhuangdao, Qinhuangdao, 066000, China
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Abstract
OBJECTIVE Despite the efforts to treat patients with patulous Eustachian tube (PET), intractable symptoms of PET may require surgical intervention. In this study, we introduce our surgical technique of "transtympanic tripod-shaped angiocatheter" (TTA) insertion and evaluate the safety and efficacy of the procedure in patients with intractable PET. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Thirty-two cases (26 patients) diagnosed with intractable PET between the years 2011 and 2019 were included in this study. INTERVENTION All cases were surgically treated with TTA insertion. MAIN OUTCOME MEASURES The clinical characteristics, surgical results, complication rates, and the level of satisfaction by questionnaires were analyzed for evaluation. RESULTS The mean age of enrolled patients was 40.9 ± 19.5 years, with slight male gender predominance (59.4% vs. 40.6%). Both ears were operated in six patients, simultaneously in three. All patients successfully received the insertion of TTA, with no immediate complication. Eleven cases were re-inserted after the first insertion due to the recurrence of symptoms or spontaneous extrusion of TTA. No major complications were observed during the follow-up period of 1 to 115 months (mean 37.7 mo). The average Visual Analogue Scale score of PET symptoms was significantly decreased (p < 0.05), along with 92% of patients with relief from autophony symptoms. CONCLUSIONS TTA insertion is a relatively simple procedure that can be performed in a short period under local anesthesia. Surgical intervention of TTA insertion for patients with intractable PET symptoms seems promising with a high success rate.
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Affiliation(s)
- Jung Mee Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Gangneung Asan Hospital, College of Medicine University of Ulsan, Gangneung
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital
| | - Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital
| | - So Young Park
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shi Nae Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital
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Bamezai S, Wilseck ZM, Stucken E, Gemmete JJ. Endoscopic and fluoroscopic-guided closure of the eustachian tube using a biliary cytology brush and liquid embolic agent for a persistent CSF leak after schwannoma resection. BMJ Case Rep 2021; 14:e241861. [PMID: 34376411 PMCID: PMC8356153 DOI: 10.1136/bcr-2021-241861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
Vestibular schwannoma is a known cause of progressive sensorineural hearing loss. Treatment options include observation, radiation therapy and surgical resection. Cerebrospinal fluid (CSF) fistula is a known postsurgical complication that can lead to CSF otorrhoea, rhinorrhoea or CSF leakage from the surgical wound. We present a case report of a patient who underwent vestibular schwannoma resection and postoperatively developed CSF rhinorrhoea, which was refractory to multiple attempts at surgical repair. This was successfully treated under endoscopic and fluoroscopic guidance using a biliary cytology brush to disrupt the surface of the eustachian tube followed by injection of n-Butyl cyanoacrylate.
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Affiliation(s)
- Sharika Bamezai
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Zachary M Wilseck
- Radiology, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Emily Stucken
- Otolaryngology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Radiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
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Scibilia A, Cebula H, Esposito F, Angileri FF, Raffa G, Todeschi J, Koch G, Clavert P, Debry C, Germanò A, Proust F, Chibbaro S. Endoscopic Endonasal Approach to the Ventral-Medial Portion of Posterior Paramedian Skull Base: A Morphometric Perspective of Surgical and Radiologic Anatomy. World Neurosurg 2021; 149:e687-e695. [PMID: 33540106 DOI: 10.1016/j.wneu.2021.01.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aims to provide morphometric analysis of endoscopic endonasal approach (EEA) to the ventral-medial portion of posterior paramedian skull base. Furthermore, it aims to investigate the surgical exposure obtained through EEA with and without eustachian tube (ET) removal, emphasizing the role of contralateral nostril (CN) access. METHODS Five fresh adult head specimens were prepared for dissection. A predissection and a postdissection computed tomography study was performed. A surgically oriented classification into 4 regions was used: 1) tubercular region; 2) occipital condyle region; 3) parapharyngeal space (PPhS) region; and 4) jugular foramen (JF) region. The Student t-test was used to compare angulations and measures of EEA with access from the ipsilateral and CN, respectively, with and without ET removal. RESULTS EEA to the ventral-medial portion of posterior paramedian skull base encompasses 2 medial trajectories (transtubercular and transcondylar) and 2 lateral pathways to the PPhS and JF. The CN access, without removal of the ET, allows a complete exposure of the petrous and intrajugular portion of the JF and superior PPhS without exposition of the parapharyngeal segment of internal carotid artery. The ipsilateral nostril approach with ET removal allows to obtain a wider exposure, reaching the medial sigmoid part of the JF. No significant differences exist in regard to transtubercular and transcondylar approaches. CONCLUSIONS This study suggests that EEA to posterior paramedian skull base allows the realization of a corridor directed to the jugular tubercle, occipital condyle, medial PPhS, and ventral-medial JF. The CN approach with ET preservation can expose the petrous and intrajugular parts of the JF and PPhS. Case series are needed to demonstrate benefits and drawbacks of these approaches.
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Affiliation(s)
- Antonino Scibilia
- Division of Neurosurgery, University of Messina, Messina, Italy; Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Hélène Cebula
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Felice Esposito
- Division of Neurosurgery, University of Messina, Messina, Italy; Division of Neurosurgery, Federico II University of Naples, Naples, Italy.
| | | | - Giovanni Raffa
- Division of Neurosurgery, University of Messina, Messina, Italy
| | - Julien Todeschi
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Guillame Koch
- Department of Normal Human Anatomy, University of Strasbourg, Strasbourg, France
| | - Philippe Clavert
- Department of Normal Human Anatomy, University of Strasbourg, Strasbourg, France
| | - Christian Debry
- Division of ENT Surgery, University of Strasbourg, Strasbourg, France
| | | | - François Proust
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
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Battaglia P, Eesa M, Pietrobon G, Karligkiotis A, Castelnuovo P, Turri-Zanoni M. Practical Guide for Identification of Internal Carotid Artery During Endoscopic Nasopharyngectomy. Laryngoscope 2020; 131:E755-E758. [PMID: 32569391 DOI: 10.1002/lary.28778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mohamed Eesa
- Department of Otorhinolaryngology-Head and Neck Surgery, Zagazig University, Zagazig, Egypt
| | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Division of otolaryngology, Head and neck surgery, European institute of oncology IRCCS, Milan, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Abstract
Middle ear barotrauma due to dilatory Eustachian tube dysfunction (ETD) is probably the most common medical disorder related to diving. Moreover, ETD makes divers prone to other diving-related accidents, including inner ear barotrauma and alternobaric vertigo. Until the development of Eustachian tube balloon dilation no diving-compatible surgical options existed to effectively and safely prevent recurrence. We present a case of an Israeli Navy SEAL diver who dives in extreme strenuous combat-related closed-circuit rebreather (CCR) dives. Due to repeated middle ear barotrauma, the patient underwent Eustachian tube balloon dilation of the affected side. Following surgery, the patient returned to both CCR and scuba dives but still suffered from middle ear symptoms and repeated barotrauma hence was eventually disqualified from further combat diving.
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Affiliation(s)
- Nir Tsur
- Israeli Naval Special Warfare Unit, Israeli Navy, Israeli Defense Forces
- Department of Otolaryngology and Head and Neck Surgery, Beilinson Medical Center, Petach-Tiqwa, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Ronen Bar
- Israeli Naval Medical Institute, Israeli Navy and Medical Corps, IDF
- Department of Otolaryngology - Head and Neck Surgery, Hillel-Yaffe Medical Center, Hadera; Affiliated with the Rappaport Faculty of Medicine, the Technion, Haifa, Israel
| | - Ohad Hilly
- Department of Otolaryngology and Head and Neck Surgery, Beilinson Medical Center, Petach-Tiqwa, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Ophir Handzel
- Sackler School of Medicine, Tel Aviv University, Israel
- Department of Otolaryngology, Head, Neck And Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Li YQ, Chen YB, Yin GD, Zeng XL. Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media. Eur Arch Otorhinolaryngol 2019; 276:2715-2720. [PMID: 31197531 DOI: 10.1007/s00405-019-05512-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). MATERIALS AND METHODS A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24 months. The scores of eustachian tube (ET) function preoperation, 1 month, 6 months, 12 months, and 24 months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. RESULTS The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6 months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. CONCLUSION BET combined with TTI surgery is an effective therapy for patients with CRSOM.
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Affiliation(s)
- Yong-Qi Li
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Yu-Bin Chen
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Gen-di Yin
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiang-Li Zeng
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
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Colella-Santos MF, Donadon C, Sanfins MD, Borges LR. Otitis Media: Long-Term Effect on Central Auditory Nervous System. Biomed Res Int 2019; 2019:8930904. [PMID: 31032365 PMCID: PMC6458954 DOI: 10.1155/2019/8930904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To analyze the central auditory nervous system function through behavioral and electrophysiological tests in children with a history of otitis media and subsequent bilateral tubes placement surgery. METHODS The participants were divided into two groups between eight and 14 years old: control group (CG) consisted of 40 children with no history of otitis media; experimental group (EG) consisted of 50 children with documented history of otitis media and undertook a surgery for bilateral tubes placement. All children completed audiological evaluation (audiometry, speech audiometry, and immittance audiometry), behavioral evaluation (tests: dichotic digits, synthetic sentence identification with ipsilateral competing message, gaps-in-noise, frequency pattern), and electrophysiological evaluation (Auditory Brainstem Response, ABR, Frequency Following Response, FFR (verbal), and Long Latency Auditory Evoked Potential, LLAEP). RESULTS The EG group showed significantly poorer performance (p<0.001) than the CG for all auditory abilities studied. The results revealed significant latency delays and reduced amplitude (p<0.05) of waves III and V for ABR; significant latency delay was seen of potentials P2, N2, and P300 for LLAEP; significant latency delays and reduced amplitude (p<0.05) were observed for FFR in children with a history of otitis media. CONCLUSION The results demonstrate negative effect of otitis media in the auditory abilities and electrophysiological measures in children with a history of otitis media.
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Affiliation(s)
- Maria Francisca Colella-Santos
- Department of Human Development and Rehabilitation (DDHR), School of Medical Sciences, State University of Campinas (FCM/UNICAMP), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz”, 13083-887 Campinas, SP, Brazil
| | - Caroline Donadon
- Child and Adolescent Health Program, Center for Investigation in Pediatrics, School of Medical Sciences, State University of Campinas (FCM/UNICAMP), Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
| | - Milaine Dominici Sanfins
- Child and Adolescent Health Program, Center for Investigation in Pediatrics, School of Medical Sciences, State University of Campinas (FCM/UNICAMP), Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
| | - Leticia Reis Borges
- Child and Adolescent Health Program, Center for Investigation in Pediatrics, School of Medical Sciences, State University of Campinas (FCM/UNICAMP), Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
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Lee HM, Yi KI, Jung JH, Lee IW. Hearing aid silicone impression material as a foreign body in the middle ear. Am J Otolaryngol 2017; 38:108-111. [PMID: 27751620 DOI: 10.1016/j.amjoto.2016.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022]
Abstract
We report an extremely rare case of hearing aid silicone impression material as a foreign body in the middle ear. Symptoms of the patient were otorrhea and vertigo after taking of a mold impression on his only hearing ear, and the symptoms mimicked chronic otitis media. A temporal bone CT scan revealed foreign body material in the middle ear and Eustachian tube. An intact canal wall mastoidectomy with a facial recess approach and type IV tympanoplasty was performed to remove the silicone impression material. In addition to the case report, we review the literature regarding impression material foreign bodies.
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Affiliation(s)
- Hyun-Min Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Keun-Ik Yi
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae-Hoon Jung
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Food and Drug Administration, HHS. Medical Devices; Ear, Nose, and Throat Devices; Classification of the Eustachian Tube Balloon Dilation System. Final order. Fed Regist 2016; 81:73028-30. [PMID: 27901563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Food and Drug Administration (FDA) is classifying the Eustachian tube balloon dilation system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the Eustachian tube balloon dilation system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.
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Altuna X, Navarro JJ, Goiburu M, Palicio I. Management of chronic otitis media by subtotal petrosectomy. Acta Otorrinolaringol Esp 2016; 67:249-53. [PMID: 26753917 DOI: 10.1016/j.otorri.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Subtotal petrosectomy is the complete exenteration of all air cell tracts of the temporal bone. The isthmus of the Eustachian tube is obliterated and the external auditory canal is closed. The aim of this study was to describe the use of this technique in the management of certain cases of chronic otitis media. MATERIAL AND METHODS We conducted a retrospective revision of the patients treated in our Institution with this technique for chronic otitis media in a 5-year period (2008-2012). All charts were reviewed and data from the otomicroscopy, audiometry, radiology, surgical findings, postoperative complications and follow-up (including diffusion magnetic resonance imaging, MRI) of a minimum of 24 months were collected. RESULTS In this period petrosectomy was performed on 28 patients for chronic otitis media. We treated 13 cases as primary cases, while 15 cases were secondary (patients that had already undergone another procedure in that ear). Fifteen cases had no serviceable hearing. Only 1 case had an immediate postoperative complication (infection); during the posterior follow-up, 2 cases had to be reoperated for diffusion restriction in the mastoid area revealed in the MRI 2 years after surgery. CONCLUSIONS A subtotal petrosectomy is rarely performed for the treatment of chronic otitis media. However, it is a technique that we have to keep in mind for the treatment of certain cases where there is recurrence and deep hearing loss, as well as in cases with good cochlear reserve if the disease coexists with other complications.
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Affiliation(s)
- Xabier Altuna
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España.
| | - Juan José Navarro
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España
| | - Miren Goiburu
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España
| | - Idoia Palicio
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España
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Vishnyakov VV, Pravednikova YS. [Comparative analysis of the effectiveness of bypass surgery and laser myringotomy used to treat exudative otitis medium]. Vestn Otorinolaringol 2016; 81:39-42. [PMID: 27367348 DOI: 10.17116/otorino201681339-42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objective of the present study was the comparative analysis of the surgical method employed for the treatment of exudative otitis medium, such as bypass surgery and laser myringotomy. The study included 125 patients suffering from the said pathology. The following two methods were used in cases of poor efficiency of conservative therapy: laser myringotomy with the use of a LUMENISc CO2-laser operated at a wavelength of 10.6 mcm with the SurgiTouch scanner and bypass of the tympanic cavity. Each of these methods was applied to treat 38 patients. It was shown that discharge from the treated tympanic cavity stopped sooner after laser myringotomy than after surgical bypass. The recovery of hearing ability according to the results of tonal threshold audiometry also took less time after laser myringotomy than after surgical bypass. The same is true with respect to the restoration of the drainage function of the Eustachian tubes. The frequency of recurrent exudate formation (in percent) in the patients undergoing laser myringotomy was significantly lower than after surgical bypass.
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Affiliation(s)
- V V Vishnyakov
- A.I. Evdokimov Moscow State Medical Stomatological University, Russian Ministry of Health, Moscow, Russia, 127473
| | - Yu S Pravednikova
- A.I. Evdokimov Moscow State Medical Stomatological University, Russian Ministry of Health, Moscow, Russia, 127473
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Burova OV, Bogomil'sky MR, Polunin MM, Soldatsky YL. [Balloon dilatation of the cartilaginous portion of the Eustachian tube in the children presenting with relapsing exudative otitis media]. Vestn Otorinolaringol 2016; 81:59-60. [PMID: 27213659 DOI: 10.17116/otorino201681259-60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of the present study was to evaluate the effectiveness and the safety of balloon dilatation of the cartilaginous portion of the Eustachian tube in the children presenting with relapsing exudative otitis media. A total of 15 children (22 ears) at the age from 3 to 16 years suffering from relapsing exudative otitis media over 18 months in duration were available for the examination. Neither conservative nor surgical treatment produced any stable beneficial effect in these patients. Acoustic impedancometry yielded type B tympanograms. All the children were treated with the use of balloon dilatation of the cartilaginous portion of the Eustachian tube under endotracheal anesthesia. The follow-up examination carried out within 6--8 weeks after the treatment revealed the complete recovery of the function of the middle ear (type A tympanograms) in 11 (73.3%) children. Partial restoration of this function (as evidenced by type C tympanogram) was documented in 4 children. These patients underwent the second course of conservative therapy that resulted in the complete restoration of the function of the middle ear. It is concluded that balloon dilatation of the cartilaginous portion of the Eustachian tube in the children presenting with relapsing exudative otitis media provides the efficient and safe approach to the management of this condition. Being a minimally invasive method, it has good prospects for the practical application and is worth further investigation.
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Affiliation(s)
- O V Burova
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - M R Bogomil'sky
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - M M Polunin
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - Yu L Soldatsky
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997; Morozovskaya City Children's Clinical Hospital, Moscow Health Department, Moscow, Russia, 119049
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Yu H, Sun F, Diao X, Xia Q, Zhang Z. [The application research of eustachian tuboplasty assisted with hypothermy plasma ablation in the threatment of adult refractory otitis media with effusion]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1988-1991. [PMID: 26911065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Through the application of eustachian tuboplasty assisted with hypothermy plasma ablation, we evaluate its efficacy in the threatment of adult refractory otitis media with effusion. METHOD We retrospectively reviewed the charts of 48 cases (61 ears) suffering from adult refractory otitis media with effusion from January 2012 to December 2013. According to the admission date, the patients were divided into the control group (17 cases, 22 ears) and the treatment group (31 cases, 39 ears). In the control group, the patients were treated with drugs and physical therapy. In the treatment group, the hypothermy plasma ablation technology was used to ablates the hypertrophic tissues around the eustachian orifice besides the pharmaedogical interventions. The recurrence rate of the two groups were analyzed and compared in 1 year after treatment. Pure tone audiometry and acoustic immittance measurement were taken for the two groups in differernt periods (one week prior to operation, one months, three months, six months and one year after operation respectively) to evaluate their hearing change and the recurrence rate (within six months after treatment and one year respectively) objectively. RESULT In the control group, 2 cases (2 ears) were lost to follow-up, and the recurrence rate was 65% (13/20) in 1 year. In the treatment group, four case were lost to follow-up,and the recurrence rate was 14.3% (5/35) in 1 year. The difference was statistically significant (P<0. 01). There were similar hearing improvement in the two groups after treatment in 1 month, but the hearing improvement in the treatment group increased with time. There were no complications occuring during the operation and post-operation. Within a month after operation, the majority of ears(28/35) obtained significant hearing improvement with the decreasing air-bone-gap comparision with the pre-operation (P < 0.01), and the preoperative tympanogram of 16 ears with type B or C turned to type A (P < 0.01). There were no both statistical significance in the variation of air-bone-gap and tympanogram of comparison with results between three months and six months, six months and one year postoperatively (P > 0.05). CONCLUSION This study confirmed the efficacy of eustachian tuboplasty assisted with hypothermy plasma ablation in the threatment of adult refractory otitis media with effusion caused by eustachian tube opening disorder was significant. It can reduce the recurrence rate significantly in one year and allow sustained hearing improvement within three months postoperatively.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
CONCLUSION The present study demonstrates a mouse model of chronic Eustachian tube (ET) dysfunction using a surgical technique that is reproducible and effective with low mortality and morbidity. OBJECTIVE To create a reproducible and effective mouse model of ET obstruction with a low operative morbidity. METHODS Forty healthy, male CBA/CaJ mice underwent the procedure. ET obstruction was performed on one side under general anesthesia; A small piece of dental material (Gutta Percha Points, Meta Biomed, Chungbuk, Korea) was placed via the tympanic orifice of the ET to occlude the entire ET. The contralateral ears of animals served as a control. One month after the operation, all ears were inspected under an operating microscope for signs of ET dysfunction. Primary outcome measures were the signs of ET dysfunction inspected through tympanic membrane (TM) 4 weeks after the operation and confirmation of ET occlusion by post-mortem dissection. RESULTS Forty (100%) of the treated mice ears developed ET dysfunction, as confirmed by the middle ear appearance on otoscopy and dissection post-mortem and 0% of the control ears at 4 weeks. The most common otoscopic signs were thickened TMs and middle ear effusions. No mortality or morbidity occurred either from anesthesia or surgery.
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Affiliation(s)
- Yasin K Varsak
- a Department of Otolaryngology , Head and Neck Surgery, Stanford University , Palo Alto , CA , USA and
- b Department of Otolaryngology , Head and Neck Surgery, Konya Numune Hospital , Konya , Turkey
| | - Peter L Santa Maria
- a Department of Otolaryngology , Head and Neck Surgery, Stanford University , Palo Alto , CA , USA and
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