In vivo study measuring middle ear pressure during various stages of Eustachian tube balloon dilation

Introduction: Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the most common adverse effects of hyperbaric oxygen (HBO2) treatments. Patients practice equalization maneuvers to prevent ETD and MEB prior to hyperbaric exposure. Some patients are still unable to equalize middle ear pressure. This ETD results in undesirable consequences, including barotrauma, treatment with medications or surgical myringotomy with tube placement and interruption of HBO2. When additional medications and myringotomy are employed, they are associated with additional complications. Methods: A device known as the Ear Popper® has been reported to reduce complications from serous otitis media and reduce the need for surgical interventions (myringotomy). Patients unable to equalize middle ear pressure during initial compression in the hyperbaric chamber were allowed to use the device for rescue. All hyperbaric treatments were compressed using a United States Navy TT9, or a 45-fsw hyperbaric treatment schedule. Patients with persistent ETD and the inability to equalize middle ear pressure were given the Ear Popper upon consideration of terminating their treatment. Results: The Ear Popper allowed all patients to successfully equalize middle ear pressure and complete their treatments. Conclusion: This study substantiates the use of this device to assist in allowing pressurization of the middle ear space in patients otherwise unable to achieve equalization of middle ear pressure during HBO2 treatment in a multiplace chamber.

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Middle Ear Pressure and Dysfunction of the Labyrinth: Is There a Relationship?

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600607 ◽

1997 ◽

Vol 106 (6) ◽

pp. 478-482 ◽

Cited By ~ 11

Author(s):

Wolfgang Maier ◽

Milo Fradis ◽

Uwe Ross ◽

Bernhard Richter

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Sudden Hearing Loss ◽

Cochlear Function ◽

Pressure Equalization ◽

Middle Ear Pressure ◽

Patient Reported ◽

Tube Dysfunction ◽

Ventilation Tubes ◽

Vestibular Neuronitis

Relationships between middle ear pressure and non-infection-related cochleovestibular dysfunction have been suggested by several authors. According to some data, vertiginous attacks can be prevented by the insertion of a ventilation tube in patients suffering from Meniere's syndrome. The aim of our study was to investigate if the incidence of eustachian tube malfunction and pathologic middle ear pressure is frequent, and if routine implantation of ventilation tubes is reasonable in ears with dysfunctions of the labyrinth, including clinical Meniere's syndrome. So, we determined in our pressure chamber all active and passive parameters of eustachian tube function in 40 patients suffering from Meniere's syndrome, sudden sensory hearing impairment (SSHI), or vestibular neuronitis. Our results disclosed no nonrandom incidence of impaired tubal function among our patients compared to healthy control subjects. Pressure equalization was sufficient in most patients suffering from clinical Meniere's syndrome, and only one patient with vestibular neuronitis presented with a patulous tube. Our results show that impairment of vestibular or cochlear function is not regularly accompanied by eustachian tube dysfunction. Furthermore, no patient reported symptoms while pressure variation was performed. We conclude that variation of middle ear pressure does not usually play a role in the genesis of Meniere's syndrome, vestibular neuronitis, or SSHI. Thus, from our data, we cannot recommend routine implantation of tympanic ventilation tubes in patients suffering from Meniere's syndrome, vestibular neuronitis, or sudden hearing loss.

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Does Septoplasty Affect Middle Ear Pressure and Eustachian Tube Function?

Erciyes Medical Journal ◽

10.5152/etd.2014.8745 ◽

2014 ◽

Vol 36 (3) ◽

pp. 115-118 ◽

Cited By ~ 1

Author(s):

Mehmet Ilhan Sahin ◽

Safak Gulec ◽

Umit Perisan ◽

Ismail Kulahli

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Eustachian Tube Function ◽

Middle Ear Pressure ◽

Tube Function

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Measuring dynamic Eustachian tube function using tympanometry in a pressure chamber: the effect of nasal betahistine application

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001270 ◽

2019 ◽

Vol 133 (7) ◽

pp. 580-587 ◽

Cited By ~ 1

Author(s):

B K-H G Franz ◽

R Patuzzi ◽

C J Wraight ◽

G Kay ◽

A Ng ◽

...

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Animal Studies ◽

Pressure Chamber ◽

Chamber Pressure ◽

Eustachian Tube Function ◽

Hyperbaric Chamber ◽

Middle Ear Pressure ◽

Tube Dysfunction ◽

Tube Function

AbstractObjectiveTo assess the effect of topical betahistine on Eustachian tube function in subjectively abnormal subjects in a hyperbaric chamber.MethodActive and passive Eustachian tube function was examined using tympanometry in a pressure chamber.ResultsActive Eustachian tube function was tested against the negative middle ear pressure induced by increasing the chamber pressure to +3 kPa. One voluntary swallow decreased middle-ear pressure by a mean of 1.36 kPa. Passive Eustachian tube function was tested by measuring spontaneous Eustachian tube openings as the chamber pressure dropped from +10 kPa to ambient. Four distinct patterns of Eustachian tube behaviour were seen, three of which indicated Eustachian tube dysfunction. Betahistine had no positive effect on Eustachian tube opening, although previous animal studies had suggested a beneficial effect.ConclusionTopical betahistine had no effect on Eustachian tube function. Combining a hyperbaric chamber with tympanometry proved ideal for evaluating Eustachian tube function.

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Effect of Nasal Packing on Middle Ear Pressure

International Journal of Advanced and Integrated Medical Sciences ◽

10.5005/jp-journals-10050-10019 ◽

2016 ◽

Vol 1 (2) ◽

pp. 52-56

Author(s):

Abhinav Srivastava ◽

Puneet Shukla

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Hearing Threshold ◽

Cross Sectional Study ◽

Nasal Packing ◽

Cross Sectional ◽

Nasal Pack ◽

Middle Ear Pressure ◽

Tube Function

ABSTRACT Introduction Eustachian tube connects nasopharynx with the tympanic cavity. The normal middle ear has an inherent tendency to lose gas to maintain the middle ear pressure by diffusion into the surrounding tissues and circulation. Materials and methods This cross-sectional study was conducted in 2012 to 2014. A total of 100 ears of 50 consecutive cases undergoing nasal surgery followed by bilateral nasal packing were included in the study and the middle ear pressure and hearing threshold were determined in all the subjects in presurgery, and then after 48 hours of surgery with nasal packing in situ and then at 7 and 30 days of nasal pack removal. Conclusion There is an increase in middle ear pressure transiently for few days while the nasal pack is in situ, which returns to normal in a month after pack removal; but, in chronic nasal obstruction cases, such as nasal polyps, there is persistent negative middle ear pressure, probably due to irreversible changes in the Eustachian tube function. How to cite this article Mohan C, Srivastava A, Shukla P. Effect of Nasal Packing on Middle Ear Pressure. Int J Adv Integ Med Sci 2016;1(2):52-56.

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Patent Eustachian Tube in the Underaerated Middle Ear: A Paradox

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948809700301 ◽

1988 ◽

Vol 97 (3) ◽

pp. 219-221 ◽

Cited By ~ 11

Author(s):

Richard A. Buckingham

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Essential Factor ◽

Secretory Otitis Media ◽

Ear Diseases ◽

Tube Obstruction ◽

Middle Ear Pressure

Secretory otitis media, middle ear atelectasis, and retraction type cholesteatomas are the most frequently occurring chronic middle ear diseases; and eustachian tube obstruction and the generation of negative or less than atmospheric middle ear pressure is said to be an essential factor in the pathogenesis of these diseases. It has been found that habitual sniffing causes high degrees of negative middle ear pressure in diseased ears; this finding demonstrates eustachian tube patency rather than obstruction. Ears intubated for chronic secretory otitis media, middle ear atelectasis, and cholesteatoma were examined to identify patent eustachian tubes. More than one third of the patients aspirated a solution into the middle ear with one or more sniffs by aspirating air from their middle ears, demonstrating eustachian tube patency rather than obstruction.

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The Response of the Nasal Airway, Middle Ear, and Eustachian Tube to Experimental Rhinovirus Infection

American Journal of Rhinology ◽

10.2500/105065888781692961 ◽

1988 ◽

Vol 2 (4) ◽

pp. 149-154 ◽

Cited By ~ 29

Author(s):

William J. Doyle ◽

Timothy P. McBride ◽

J. Douglas Swarts ◽

Frederick G. Hayden ◽

Jack M. Gwaltney

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Clearance Rate ◽

Mucociliary Clearance ◽

Nasal Congestion ◽

Eustachian Tube Function ◽

Nasal Patency ◽

Rhinovirus Infection ◽

Middle Ear Pressure ◽

Tube Function

This paper describes the longitudinal changes in nasal patency, mucociliary clearance rate, eustachian tube function, and middle ear pressure in a group of 40 volunteers infected with rhinovirus type 39. Thirty-two (80%) of the volunteers were judged to have had a cold based on the modified Jackson criteria. Common symptoms included malaise, nasal congestion, rhinorrhea, and sneezing that began on the day after challenge and peaked in intensity on days 3–5. Nasal patency evaluated by active posterior rhinomanometry and mucociliary clearance rate evaluated by the dyed sacharrin technique were significantly decreased following challenge. For nasal patency the effect was primarily limited to days 2–8 postchallenge, while abnormalities in clearance rate were documented for as long as 18 days postchallenge. A 50% increased incidence of abnormal eustachian tube function and a 30% increased incidence of abnormal middle ear pressures were observed for days 2–7 postchallenge with a gradual return to baseline by day 16. For mucociliary clearance, eustachian tube function, and middle ear pressure, but not nasal patency, these abnormalities were more pronounced in patients with a symptomatic cold. These results show that changes in nasal physiology resulting from a rhinovirus infection can be objectively quantified and that the resulting pathophysiology extends to anatomically contiguous structures such as the eustachian tube and middle ear.

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Tympanometric changes following adenoidectomy in children with adenoid hypertrophy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180423 ◽

2018 ◽

Vol 4 (2) ◽

pp. 391 ◽

Cited By ~ 2

Author(s):

Rashmi P. Rajashekhar ◽

Vinod V. Shinde

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Maximum Size ◽

Adenoid Hypertrophy ◽

Tube Obstruction ◽

Media Type ◽

Middle Ear Pressure ◽

Pressure Changes

Background: Adenoid Hypertrophy is the commonest disorder in children. The size of adenoids varies from child to child and also in the same individual as he grows and attains maximum size between age of 3 to 7 years. Adenoid hypertrophy plays a significant role in the pathogenesis of otitis media with effusion. Our objective was to study the tympanogram changes following adenoidectomy. i.e to find out the effect of adenoidectomy on Otitis Media with Effusion.Methods: Patients showing >50% of airway obstruction by the adenoids were included in the study. 20 patients with adenoid hypertrophy underwent adenoidectomy. Pre-operative and postoperative tympanograms of 40 ears were studied. Results: Type A curve (normal) was found in 12 ears. Type B Flat tympanogram – 12 ears s/o Gross Serous Otitis Media. Type C tympanogram – 8 ears s/o uncomplicated eustachian tube obstruction. 5 ears showed tympanogram s/o Eustachian tube block without significant collection of middle ear fluid. 3 ears showed tympanogram s/o uncomplicated eustachian tube obstruction. Post adenoidectomy, 32 ears showed normal tympanogram. 8 ears showed tympanogram s/o negative middle ear pressure with normal compliance.Conclusions: Our study shows high prevalence of Otitis Media with Effusion in patients with adenoid hypertrophy. Otitis Media with Effusion is treated by adenoidectomy in most of the patients which is confirmed by post adenoidectomy tympanogram. Also, problem of decreased attention in school due to reduced hearing secondary to OME can be corrected by adenoidectomy. Hence, all patients should undergo pre and post-adenoidectomy tympanometry to know the compliance and pressure changes in the middle ear.

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Effects of freediving on middle ear and eustachian tube function

Diving and Hyperbaric Medicine Journal ◽

10.28920/dhm50.4.350-355 ◽

2020 ◽

Vol 50 (4) ◽

pp. 350-355

Author(s):

Moritz F Meyer ◽

◽

Kristijana Knezic ◽

Stefanie Jansen ◽

Heinz D Klünter ◽

...

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Cumulative Effect ◽

Eustachian Tube Function ◽

Diving Depth ◽

Middle Ear Pressure ◽

Tube Function ◽

Hyperbaric Medicine ◽

The Right ◽

Peak Pressures

(Meyer MF, Knezic K, Jansen S, Klünter HD, Pracht ED, Grosheva M. Effects of freediving on middle ear and eustachian tube function. Diving and Hyperbaric Medicine. 2020 December 20;50(4):350–355. doi: 10.28920/dhm50.4.350-355. PMID: 33325015.) Introduction: During descent in freediving there is exposure to rapidly increasing pressure. Inability to quickly equalise middle ear pressure may cause trauma to the ear. This study aimed to evaluate the occurrence of pressure-related damage to the middle ear and the Eustachian tube during freediving and to identify possible risk factors. Methods: Sixteen free divers performed diving sessions in an indoor pool 20 metres’ freshwater (mfw) deep. During each session, each diver performed four own free dives and up to four safety dives. Naso- and oto-endoscopy and Eustachian tube function tests were performed on the right and left ears before diving, between each session and after the last session. The otoscopic findings were classified according to the Teed classification (0 = normal tympanic membrane to 4 = perforation). Additionally, ENT-related complaints were assessed using a questionnaire. Results: Participants performed 317 dives (on average 20 dives per diver, six per session). The average depth was 13.3 mfw. Pressure-related changes (Teed 1 and 2) were detected in 48 % of ears. Teed level increased significantly with an increasing number of completed sessions (P < 0.0001). Higher pressure-related damage (Teed 2) occurred in less experienced divers, was associated with significantly lower peak pressures in the middle ear and led to more ear-related symptoms. A preference for the Frenzel technique for middle ear pressure equalisation during freediving was shown. Conclusions: Pressure exposure during freediving had a cumulative effect on the middle ear. Factors such as diving depth, diving experience and number of diving sessions correlated with the occurrence of higher Teed levels.

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