eustachian tube function

Eustachian Tube Function and Allergy in Otitis Media. http://pediatrics.aappublications.org/content/61/5/753[r]

tube opening and closing functions is of less prognostic value and yields good success rates when it is combined with Toynbee maneuver, as it shares a common physiological basis. As per Dhingra, failure of the test does not prove blockage of the tube because in only about 65%, subjects can successfully perform this test. According to study by Uzun et al. in 2004, Valsalva maneuver always gives good results when performed both preoperatively and postoperatively in cases of otitis media following surgery in order to assess tubal function irrespective of the graft material used and surgery performed. Pre- operatively, results of this test on assessment of tubal function were 30%. According to the study by Yusuf et al. in 2011, Valsalva maneuver is highly sensitive and specific for the middle ear pressure equalization. Doyle et al. conducted the study in 2013, Valsalva maneuver is the best reliable tool among all tests for Eustachian tube function to evaluate qualitatively and quantitatively the pressure opening and closing functions of the Eustachian tube. As per Doyle in another study has said that, in cleft palate children ability to alter middle ear pressure is deranged. As a result they have high prevalence of developing middle ear disease. So, one of the reasons for functional obstruction of the Eustachian tube is this anatomical abnormality. As cases of mucosal chronic otitis media are more common in our set up, we clinically evaluated all 100 patients with perforated tympanic membrane to look for tubal patency by Valsalva test. In this study, 84 % showed good results in terms of air leak appreciation. The results as per the study were better compared to the study done by Uzun et al. Even in the study there were two cases of cleft palate which correlates with the study as quoted by Doyle et al.

Tobacco smoke Two studies published by Agius and coworkers 27,28 , confirmed that there was a decrease in ciliary beat frequency of the mucosa of the Eustachian tube in smokers compared with nonsmokers. This finding, however, has been tempered by work by Coggins and colleagues 29 and Antonelli and coworkers 30 who found passive tobacco smoke in the animal model to have little effect on otitis media. According to Dubin and coworkers 31 , passive smoke does affect the Eustachian tube function, but may play only part of a role in causing middle ear disease.

Methods: This prospective study involved 60 patients with different nasal pathologies causing nasal obstruction along with complaints of ear fullness. In required cases the nasal pathologies were surgically managed. Pre and postoperative impedance audiometric evaluation and nasal endoscopy were done to assess the eustachian tube function, changes the value of middle ear pressure and ear fullness sensation at 1 month and at 3 months after surgery.

The patients planned for the tympanoplasty is initially investigated with the above tests and classified as the normal, partial, absent Eustachian tube function. Those patients with the partial, absent Eustachian tubal function, with active inflammation and discharge from the middle ear were selected the treatment plan of oral antibiotics, topical ear drops (Neosporin –H), twice a day steam inhalation, twice a day bubble gum chewing, twice a day balloon blowing for the span of four week in order to restore the tubal function as far as possible.

Methods: The present prospective study was conducted in the Department of Otorhinolaryngology and Head and Neck surgery, Sri Maharaja Gulab Singh Hospital, Jammu during the period from November 2016 to October 2017. Patients were diagnosed clinically and also audiometrically by pure tone audiometry and impedance audiometry. Eustachian tube function test- Toynbee test was done in all the patients.

completely dependent on tensor veli palatini contraction as a platform against which the dilator can open the tube. The tensor veli palatini, therefore, has significant control over the efficiency of tubal dilation. Poe et al observed consistent patterns of muscular contraction during swallows and yawns, which normally often open the eustachian tube. The action of the levator veli palatini is to elevate the palate and medially rotate the medial cartilaginous lamina. These actions begin the distal dilation of the eustachian tube and set the stage for the subsequent tensor veli palatini contraction. The tensor veli palatini can be seen to contract by the ripple of tension that lateralizes the lateral membranous wall. Once the entire distal tube is open, the final act appears to be the dilator tubae muscle pulling the valve like convexity of the lateral wall at the isthmus laterally to open the full length of the tube. The bony portion is normally patent at all times. The dilator tubae contraction in many normal subjects was sufficient to completely straighten the lateral wall convexity or make it transiently concave during maximal opening. The lumen of the maximally dilated tube appeared nearly circular. The relaxation sequence in normal subjects consistently began with closure of the isthmus convex valve, and then closure of the tube from distal to proximal, but the final relaxation of the levator veli palatini and lateral pharyngeal wall, and lateral rotation of the medial cartilaginous lamina, occurred in various orders.

completely dependent on tensor veli palatini contraction as a platform against which the dilator can open the tube. The tensor veli palatini, therefore, has significant control over the efficiency of tubal dilation. Poe et al observed consistent patterns of muscular contraction during swallows and yawns, which normally often open the eustachian tube. The action of the levator veli palatini is to elevate the palate and medially rotate the medial cartilaginous lamina. These actions begin the distal dilation of the eustachian tube and set the stage for the subsequent tensor veli palatini contraction. The tensor veli palatini can be seen to contract by the ripple of tension that lateralizes the lateral membranous wall. Once the entire distal tube is open, the final act appears to be the dilator tubae muscle pulling the valve like convexity of the lateral wall at the isthmus laterally to open the full length of the tube. The bony portion is normally patent at all times. The dilator tubae contraction in many normal subjects was sufficient to completely straighten the lateral wall convexity or make it transiently concave during maximal opening. The lumen of the maximally dilated tube appeared nearly circular. The relaxation sequence in normal subjects consistently began with closure of the isthmus convex valve, and then closure of the tube from distal to proximal, but the final relaxation of the levator veli palatini and lateral pharyngeal wall, and lateral rotation of the medial cartilaginous lamina, occurred in various orders.

Tos 55 in his study also showed that ET function changed for a number of patients after surgery. In a long term follow up, patients who persisted to have poor postoperative ET function had a higher chance of developing retractions and adhesions of the tympanic membrane. Choi et al 52 in their study of patients with mucosal CSOM who underwent myringoplasty or tympanoplasty also showed that ET function changed after surgery. It was suggested that removal of mucosal edema and granulations blocking the ET probably resulted in the change in ET function. In contrast, the number of patients with change in ET function in Virtanen‟s 60 study comparing preoperative aspiration deflation with postoperative tympanometry, were not many. His study does not support the hypothesis that ET function changes after surgery. He suggested that this could not occur without intervention at the tubal orifice during surgery. He also suggested that the small pressure range used in tympanometric studies may be insufficient to move a tympanic membrane and hence may be inaccurate in assessing the normal aeration of middle ear.

OSTMANN PAD OF FAT- it is the fat tissue located in the inferolateral portion of the tube and aids in closing the tube. Fat pad increases in volume after birth. BONY PART – also called Protympanic, Aural, Bony, or Middle ear portion of EustachianTube. This segment is completely within the petrous part of temporal bone. The junction of the osseous portion and epitympanum is 4 mm above the floor of tympanic cavity. The lumen is roughlytriangularand measures 2 to 3 mm vertically and 3-4 mmhorizontally. It is 12mm long and lies in the petrous temporal bonenear the tympanic plate. Lateral end is wider, oval in shape, 5*2mm in size, opens in the anteriorwall of middle ear. The medial end (isthmus) is narrow 0.6- 1.2mm in diameter and 1-2mm in lengthattaches with the cartilaginous part.

In an attempt to establish middle ear aeration in these patients with inadequate Eustachian tube function, Silastic® tubes were inserted.. Although these tubes tended to be extruded soon[r]

audiometry, tympanograms and Eustachian tube function tests showed a resumption of tube activity. It is clear that the return to normality of the Eustachian tube function corresponds to the disappearance of the audiological symptoms in 70% of patients and a marked improvement in the remaining 30%.

Conclusion: From this study, we concluded that patients with head and neck tumors treated by radiotherapy (apart from the nasopharynx) have a high incidence of affection of Eustachian tube function namely middle ear effusion and Eustachian tube dysfunction. The possibility for development of middle ear effusion and Eustachian tube dysfunction increases with increased tumor stage. Eustachian tube functions immediately post radiotherapy and after 12 weeks of the end of radiotherapy was affected by different effects according to the tumor site. The Eustachian tube functions significantly improved within 12 weeks after the last dose of radiotherapy, and we recommend audiological follow-up for patients with head and neck tumors treated with radiotherapy.

Histopathological analysis preformed after balloon dilation shows decreased inflammation in the surface epithelium and submucosal tissues. The net reduction of inflamma- tion is the hypothesized mechanism for improvement in clinical Eustachian tube function post-operatively [5]. Re- cent studies have shown promise in both short term and long-term outcomes, but variability in operative approach, sample size, patient follow-up, and outcome measurements make it difficult to interpret with certainty [3, 6–12]. Many studies focus not on tympanometric outcomes, but on ability to valsalva, opening pressures, or subjective out- comes. We feel the most important end-point is whether or not there is return of middle ear ventilation, and have used middle ear pressure as a surrogate measure for this.

pressure and closing pressure, higher clearance of negative pressure, and shorter Mucociliary transit time were indications of better Eustachian tube function. Regardless of delivery method, no significant results were found among the experimental groups to suggest improved Eustachian tube function after drug treatment. Although the middle dose of betahistine dihydrochloride (50 mg/mL) delivered transtympanically followed the expected response outcome, the trend did not achieve statistical significance. Overall, the results of this study are

pressure and closing pressure, higher clearance of negative pressure, and shorter Mucociliary transit time were indications of better Eustachian tube function. Regardless of delivery method, no significant results were found among the experimental groups to suggest improved Eustachian tube function after drug treatment. Although the middle dose of betahistine dihydrochloride (50 mg/mL) delivered transtympanically followed the expected response outcome, the trend did not achieve statistical significance. Overall, the results of this study are

4. Discussion 4.1. General considerations The Eustachian tube represents a key factor for the proper function of the middle ear and subsequently hearing ability by its equalization, mucociliary drainage and protective functions. Impaired Eustachian tube function induces or contributes to the onset of frequent middle ear pathologies such as seromucous otitis, retraction process of tympanic membrane and cholesteatoma. Furthermore, its dysfunction probably leads to poor postoperative outcomes after performing middle ear sur- gery and forces the physician to perform revision procedures.

Abstract: Objective: This study was designed to evaluate the effect of temporomandibular joint (TMJ) bony ankylosis on Eustachian tube (ET) functions. Subjects and Methods: Twelve patients suffering from TMJ bony ankylosis were selected from those attending the out-patient Clinic of Oral and Maxillofacial Surgery Department, Faculty of Oral and Dental Medicine, Cairo University. Twelve subjects (control group) underwent Eustachian tube function test were selected also. Tympanometry was utilized to assess Eustachian tube function. Three pressure reading (P1, P2, and P3) of the middle ear and external ear canal volume were recorded by the use of tympanometry. Comparisons were performed between patient and control group to evaluate the change of pressure. Results: Throughout the results, four ears showed type (C) tympanogram representing Eustachian tube dysfunction, two ears showed type (B) tympanogram which represent otitis media with effusion. While other ears showed type (A) tympanogram. On comparing the pressure values between the patients and the control, significant decrease was recorded in (P2) value in the patients group and no significant difference existed in the external canal volume. Conclusions: The Eustachian tube function is affected in patients of temporomandibular joint bony ankylosis, it cannot adapt to changes in pressure effectively. Patients of TMJ ankylosis are more liable to develop otitis media. Inflation-deflation test is a reliable method for evaluating Eustachian tube function in patients of (TMJ) ankylosis. The external ear canal volume was not affected in this group of patients.

selection of surgical methods for tympanoplasty. 5 A pre- operative test of tubal function is important for achieving a satisfactory result of tympanoplasty. In general, middle ear lesions in patients with chronic otitis media accompany structural changes that affect the sound transmission mechanism from the tympanic membrane to the oval window. These include destruction of the ossicular chain, tympanic membrane perforations, Eustachian tube dysfunction, and cholesteatomas. 6 Mishiro, et al reported that abnormalities of the ossicular chain are the most important factor affecting hearing outcomes after a long-term follow-up of >5 years. 7 In contrast, Kim, et al reported that the preoperative presence of cholesteatoma or otorrhea can affect postoperative hearing outcomes, and other reports also considered whether the status of middle ear mucosa, Eustachian tube function, and revision surgery can affect postoperative hearing. 8,9

Eustachian tube function tests Valsalva maneuver To evaluate the ability to inflate the middle ear actively patients were asked to pinch the nose and inflate the checks through forced expiration with the mouth closed until a sensation of fullness was achieved in the ears. Patients were then instructed to release the nose and refrain from further swallowing or mandibular movement and an experimental tympanogram was obtained in each ear. A Tympanometric peak pressure shift (generally positive) between baseline and experimental tympanogram less than 10 daPa indicated poor ETF, whereas a Tympanometric peak pressure shift greater than 10 daPa indicated a good ETF (Jonathan, 1989).