Association of Pre-operative Eustachian Tube Function with the Graft Uptake After Tympanoplasty

To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results-i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery.

Impact of palatoplasty techniques on tympanic membrane findings and hearing prognosis in children with cleft palate

OBJECTIVE

Children with cleft palate (CP) are at high risk of developing otitis media with effusion (OME) due to Eustachian tube (ET) dysfunction. Palatoplasty has been reported to decrease the frequency of middle ear disease and improve ET function, and although various techniques have been developed, there is no consensus on the differences in the impact of different techniques on the middle ear. The purpose of this study was to determine the differential effects of palatoplasty on middle ear function and hearing.

METHODS

We performed a retrospective observational survey of pediatric patients who underwent palatoplasty for CP between June 2010 and October 2018 at Tohoku University Hospital. Cases were divided into three groups depending on the palatoplasty procedures performed: the push-back palatoplasty group, the two-flap palatoplasty group, and the Furlow double-opposing Z-plasty group. We examined the differences in clinical characteristics between patients who underwent each procedure. The primary outcome variable was tympanic membrane (TM) findings, and the secondary outcome was hearing test results.

RESULTS

Children who underwent the two-flap palatoplasty had a higher tympanostomy tube (TT) insertion rate and a higher total number of TT insertions than those who underwent the Furlow double-opposing Z-plasty or the push-back palatoplasty. The TM retraction rate tended to be lower in the Furlow double-opposing Z-plasty group than in the push-back palatoplasty group or the two-flap palatoplasty group. The hearing test results at the last visit were not significantly different among the three groups.

CONCLUSIONS

Children who underwent the two-flap palatoplasty had a higher rate of TT insertions, potentially increasing the risk of TM perforation. In contrast, the Furlow double-opposing Z-plasty group had a lower tendency for TM regression, possibly due to improved ET function and reduced incidence of OME. It is important to understand the advantages and disadvantages of each technique before selecting one suitable for the child's cleft and arch width. Additionally, it is important to conduct regular follow-up of TM findings and hearing test results even after palatoplasty.

Eustachian Tube Function in Flight Attendants

Eustachian tube (ET) function is of utmost importance in people who are under constant barometric pressure changes in their daily lives. Proper functioning is essential in avoiding pressure related injuries. We aimed to investigate how well the ET functions in flying personnel and how it compares to the non-flying population.Prospective study. Acibadem University Atakent Hospital. 115 participants were included in the study. Each underwent a thorough otorhinolarynglogic examination then undertook a tympanogram followed by eustachian tube function (EtFT) test. A statistically significant difference in ear volume was observed in flight personnel. EtFT results showed the ability to equalize pressure after Valsalva manouvre was also significantly higher in flight personnel. Flight attendants that are subject to pressure changes throughout their careers do seem to be more capable of equalizing pressure through manoeuvres such as the Valsalva. This may be due to the fact that continuous pressure changes creates a more pliable tympanic membrane.

[Evaluation of Eustachian tube function in children with adenoid hypertrophy by nasopharyngeal digital photography and ETDQ-7 scores]

Objective:To evaluate the Eustachian tube function of children with simple adenoid hypertrophy and adenoid hypertrophy with secretory otitis media（OME） by using the A/N value of lateral radiograph of nasopharyngeal X-ray and EDQ-7 scale scores. Methods:Sixty cases of children with adenoid hypertrophy admitted from February 2019 to August 2021 were all underwent nasopharyngeal X-ray lateral radiographs to determine the adenoid/nasopharyngeal cavity ratio（A/N ratio） and then determine the size of adenoids. The Eustachian tube function ETDQ-7 survey was used to evaluate the patient's self-evaluation of the severity of the disease and ear symptoms, and the degree of influence were scored. Subsequently, the correlation between adenoid hypertrophy with OME and ETDQ-7 scores was statistically analyzed by using the Spearman rank correlation statistical method. Results:In adenoid hypertrophy with OME group, the ETDQ-7 scores of A/N≤0.60, A/N 0.61-0.70 and A/N≥0.71 were 4.15±1.75, 14.55±6.67 and 23.95±6.63, respectively. The higher the grade of adenoid hypertrophy, the higher the ETDQ-7 scores. In adenoid hypertrophy with OME group, the degree of adenoid hypertrophy was positively correlated with the ETDQ-7 scores（P<0.05）. Conclusion:Adenoid hypertrophy is also one of the potential factors causing OME in children.

Comparison of Eustachian tube ventilation function between cleft palate and normal patients using sonotubometry

Objective

To compare Eustachian tube ventilation function between cleft palate subjects and normal subjects using sonotubometry.

Method

A comparative cross-sectional study was conducted at the Department Otolaryngology-Head and Neck Surgery of Ciptomangunkusumo National Hospital, Universitas Indonesia, Jakarta, from June 2013 to January 2014.There were 31 subjects with cleft palate and 62 healthy subjects aged ≤18 years, and both groups were matched according to age. Each subject underwent ear, nose, and throat examination with Veau classification and sonotubometry, a new assembly test in Indonesia. The results of the sonotubogram (the number of Eustachian tube openings, amplitude enhancement in dB, and the duration of Eustachian tube opening in ms) were then analyzed with SPSS using chi-square and Mann–Whitney tests.

Results

Subjects with cleft palate had lower Eustachian tube function than healthy subjects using three sonotubometry parameters (p < 0.001). The proportion of Eustachian tube dysfunction based on the Veau classification was significant (p < 0.001). In multivariate analysis, several determinant factors of Eustachian tube dysfunction were found, such as adenoid hypertrophy (risk factor6.46), the number of Eustachian tube openings (risk factor 36.21), and higher Veau classification (risk factor 10.41).

Conclusion

Sonotubometry could be used to assess parameters of Eustachian tube function. Subjects with cleft palate have a higher risk of having Eustachian tube dysfunction, as do subjects with adenoid hypertrophy.

Role of Eustachian Dysfunction and Primary Sclerotic Mastoid Pneumatisation Pattern in Aetiology of Squamous Chronic Otitis Media: A Correlative Study

Squamous chronic otitis media (COM) implies formation of a retraction pocket (inactive form) or frank cholesteatoma (active form) in pars tensa or pars flaccida of tympanic membrane. A retraction pocket or frank cholesteatoma are believed to occur due to tubal dysfunction. The present study was undertaken to investigate the pattern of mastoid pneumatisation and Eustachian dysfunction by dynamic slow motion videoendoscopy (DSVE) in cases of both, active and inactive type of squamous chronic otitis media (COM). 52 patients (65 ears) comprising of twenty-six ears with pars flaccida squamous disease and 39 ears with Pars Tensa squamous disease were enrolled for the study. DSVE findings, in terms of grade and type of Eustachian dysfunction were noted. Mastoid pneumatization pattern on CT-scans, and peroperative status of mastoid pneumatisation, especially contracted mastoid with anteriorly placed sigmoid sinus or low lying dura were also recorded for every case while performing tympano-mastoidectomy. Primary sclerotic/diploic type of mastoid pneumatisation pattern and Eustachian dysfunction were found to have inverse relationship in the cases of squamous otitis media. Eustachian dysfunction, diagnosed on DSVE, had significant association with both pars flaccida (P = 0.0001) and pars tensa disease (P = 0.0007). Primary sclerotic or diploic mastoid were found to be more common in ears with pars flaccida squamous disease than pars tensa COM (46.15% vs. 38.46%, P < 0.05).

Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media

To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016-July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12 months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.

A Novel Imaging Method for the Cartilaginous Eustachian Tube Lumen: Computerized Tomography During the Forced Response Test

OBJECTIVES

In vivo imaging of the open cartilaginous Eustachian tube (ET) lumen by computed tomography (CT) scan during ET function (ETF) testing to establish new methodology.

METHODS

Five adults underwent unilateral ETF testing of an ear with a nonintact tympanic membrane using the forced response test (FRT) to measure the opening pressure (PO), steady state pressure (PS), and flow conductance (CS). Then at baseline and during the PS phase of the FRT, a temporal-bone CT scan with continuous 0.625 mm thickness was obtained. Multiplanar oblique reformats along the axis of the ET were created, and point value and region of interest (ROI) Hounsfield unit measurements were recorded from the location of the ET lumen.

RESULTS

At the FRT flow rate of 11 ml/min, the average PO, PS, and CS were 370.5 daPa, 119.6 daPa, and 0.16 ml/min/daPa, respectively. For flow rates of 23 and 46 ml/min, these values were 236.2, 204.2, 0.12 and 385.5, 321.1, 0.18, respectively. Although areas with lower attenuation were suggestive of air density, a distinct air-filled cartilaginous ET lumen could not be confirmed.

CONCLUSIONS

While the current imaging parameters failed to resolve the air-soft tissue interface throughout the open cartilaginous ET, further advances in imaging may obviate this limitation.

Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function

Introduction  Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment.

Objective  To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases.

Methods  Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive of middle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology.

Results  A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ ² ) test, showed a significant association between the 2 tests ( p  = 0.017).

Conclusion  There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.

Cross-platform data integration of paratubal electromyography and sonotubometry for eustachian tube: a pilot study

CONCLUSION

The sensitive sonotubometry and MATLAB provide a new tool to study the eustachian tube (ET) function and contribute more to reliable data and precise analysis. The levator veli palatini muscle (mLVP) and the salpingopharyngeus muscle (mSP) may, respectively, be the most important and least important muscle for ET function.

OBJECTIVES

The ET lumen dilation is a result of the contraction of the paratubal muscles, the tensor veli palatini muscle (mTVP), mLVP and mSP. To trace the dynamic ET muscle/lumen activities, the present study aimed to optimize sonotubometry and achieve cross-platform data integration of electromyography (EMG) and sonotubometry using MATLAB (matrix laboratory).

METHOD

Seventeen healthy volunteers (34 ears) were chosen for the concurrent recordings of the paratubal EMG and sonotubogram under dry and water swallowing.

RESULTS

The optimized sonotubometry based on computer sound card showed satisfied sensitivity. For both EMGs and sonotubogram, dry swallowing generated significantly greater amplitude and longer duration compared to water swallowing. Moreover, statistically significant differences (p < 0.05) were detected in the comparison of the amplitude, duration, and latency for the mTVP, mLVP, and mSP. The mSP activity was the weakest and even inactive in some cases, the mLVP presented the most powerful and long lasting activity during ET-opening.

Eustachian tube function as a predictor of the recurrence of middle ear effusion in children

OBJECTIVES/HYPOTHESIS

In children with ventilation tubes (VTs) inserted for chronic otitis media with effusion (COME), the authors sought to determine whether any parameter of Eustachian tube (ET) function measured by the forced response test (FRT) predicts disease recurrence after the VT becomes nonfunctional.

STUDY DESIGN

Prospective study of those factors that predict disease recurrence in children with VTs inserted for COME.

METHODS

Forty-nine subjects (73 ears; 28 male, 34 white, aged 5.3 ± 1.2 years) with COME had VTs inserted and were evaluable for disease status after the VT(s) became nonfunctional. The FRT was done when the VTs were patent, and results for the last test before the VT became nonfunctional were used in the analysis. After each VT became nonfunctional, the children were followed for disease recurrence over a 12-month period. Logistic regression was used to determine whether the ET opening pressure, closing pressure, and/or dilatory efficiency predicted disease recurrence. That model was expanded to include age, sex, race, history of adenoidectomy, previous VTs, and duration of VT patency as potential predictive factors.

RESULTS

Twenty-nine (40%) ears had recurrence of significant disease within 12 months after the VT became nonfunctional. For the complete logistic regression model, male gender (P = .03), nonwhite race (P = .02), shorter period of VT patency (P = .01), and low dilatory efficiency (P = .01) were significant predictors of disease recurrence.

CONCLUSIONS

A measure of active ET function, dilatory efficiency, but not measures of passive function predicted disease recurrence within the 12 months after the VT became nonfunctional in children with COME.

Clinical Profile of Tubotympanic CSOM and Its Management With Special Reference to Site and Size of Tympanic Membrane Perforation, Eustachian Tube Function and Three Flap Tympanoplasty

Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world wide especially in developing countries where large percentage of the population lack specialized medical care, suffer from malnutrition and live in poor hygienic environmental conditions. It has been a general view that the hearing loss increases with the size of the perforation, more so if it is in the posterio inferior quadrant. It was found that the maximum average loss occurred at 250 Hz. The hearing loss is less in small perforations (less than 2 mm diameter) then in larger ones; less in perforations touching the manubrium than in those away from it, and also less in perforations of the anterioinferior quadrant than in those on posterio-inferior quadrant. A normally functioning eustachian tube is also an essential physiologic requirement for a healthy middle ear and normal hearing.

The Bortnick Miller apparatus: a useful alternative to impedance audiometer for assessment of eustachian tube function in chronic suppurative otitis media

Eustachian tube function was assessed by impedance audiometer and Bortnick Miller apparatus in 60 ears with central perforation in pars tensa. Result of both the instruments were compared and presented.