In Vivo Measurement of Middle Ear Pressure Changes during Balloon Eustachian Tuboplasty

Background. Balloon Eustachian tuboplasty (BET) is known as a treatment for chronic obstructive Eustachian tube dysfunction (OETD). The precise mechanism of action is not fully understood. Observations in sheep cadavers and human cadavers have shown specific middle ear pressure changes related to BET. Methods. In this prospective study using a microfibre optical pressure sensor, pressure changes during BET were for the first time monitored transtympanically in five normal human middle ears in vivo. Results. Middle ear pressure changes during 21 BETs consisted of five stages (insertion, inflation, deflation, withdrawal, and recovery). The highest pressure change occurred in most of the cases during the withdrawal of the balloon catheter. Withdrawal pressure yielded a mean middle ear pressure of 4.76 mmHg (61.89 daPa) with a maximum of 13.88 mmHg (179.55 daPa). Pressure amplitudes capable of causing barotrauma to ear structures were not detected. Internal carotid artery dehiscences were detected as causative of sinusidual pressure changes. Conclusion. The middle ear pressure changes detected in vivo during BET can be attributed to the balloon inflation. Further human studies with patients affected by OETD are necessary to gain more insight into the mechanism of action of BET to clarify a possible pressure related second mechanism of action of BET.

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Middle Ear Pressure Changes during Balloon Eustachian Tuboplasty

Otolaryngology ◽

10.1177/0194599816672842 ◽

2016 ◽

Vol 156 (1) ◽

pp. 161-165 ◽

Cited By ~ 1

Author(s):

Matthew E. Smith ◽

James R. Tysome

Keyword(s):

Middle Ear ◽

Balloon Catheter ◽

Pressure Change ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Middle Ear Pressure ◽

Tube Dysfunction ◽

Fresh Frozen ◽

Balloon Eustachian Tuboplasty ◽

Pressure Changes

Objective Balloon eustachian tuboplasty (BET) has entered clinical use as a treatment for eustachian tube dysfunction. Some surgeons perform myringotomy prior to BET due to concerns that the increase in middle ear (ME) pressure caused by BET may cause otic barotrauma. We investigated the ME pressure changes occurring during BET in cadavers. Study design Human cadaver investigation of a surgical technique Setting Laboratory study at a tertiary referral center. Subjects and Methods ME pressures were recorded from fresh-frozen cadavers, and BET was performed with the Bielefeld balloon catheter inflated to 10 bar. Peak ME pressures were recorded during catheter insertion, inflation, deflation, and removal. A second pressure measurement was taken 15 seconds after each stage to assess the residual pressures. All BET procedures were repeated at least once. Where transmastoid recordings were made, BET was repeated, measuring pressure via a myringotomy to ensure equivalence. Results Data from 25 procedures in 13 ears (9 heads) were analyzed. A consistent pattern of ME pressure change was observed in all cases. Positive pressures occurred on insertion (maximum, 26 daPa) and inflation (maximum, 99 daPa) and negative pressures on deflation (maximum, –46 daPa) and removal (maximum, –42 daPa). There were no significant pressure differences between first and second procedures, except at 15 seconds after insertion ( P = .04). Conclusion In adult cadaveric specimens, BET induces ME pressures within the normal physiologic range. On this basis, routine myringotomy prior to BET in adults is not necessary.

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Detection of tympanic membrane movement using film patch with integrated strain gauge, assessed by optical coherence tomography: experimental study

The Journal of Laryngology & Otology ◽

10.1017/s0022215110002859 ◽

2011 ◽

Vol 125 (5) ◽

pp. 467-473 ◽

Cited By ~ 8

Author(s):

T Just ◽

T Zehlicke ◽

O Specht ◽

W Sass ◽

C Punke ◽

...

Keyword(s):

Experimental Study ◽

Optical Coherence Tomography ◽

Tympanic Membrane ◽

Middle Ear ◽

Strain Gauge ◽

Ex Vivo ◽

Optical Coherence ◽

Middle Ear Pressure ◽

Pressure Changes

AbstractObjective:We report an ex vivo and in vivo experimental study of a device designed to measure tympanic membrane movement under normal and pathological conditions, assessed using optical coherence tomography.Materials and methods:We designed two types of flexible, round film patch with integrated strain gauge, to be attached to the tympanic membrane in order to measure tympanic membrane movement. Tympanic membrane attachment was assessed using optical coherence tomography. The devices were tested experimentally using an ex vivo model with varying middle-ear pressure.Results:Optical coherence tomography reliably assessed attachment of the film patch to the tympanic membrane, before and after middle-ear pressure changes. Strain gauge voltage changes were directly proportional to middle-ear pressure recordings, for low pressure changes. Tympanic membrane perforations smaller than 2 mm could be sealed off with the film patch.Conclusion:Attachment of the film patch with integrated strain gauge to the tympanic membrane was not ideal. Nevertheless, the strain gauge was able to precisely detect small pressure changes within the middle ear, in this experimental model.

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Barotitis in children after aviation; prevalence and treatment with Otovent®

The Journal of Laryngology & Otology ◽

10.1017/s0022215100134450 ◽

1996 ◽

Vol 110 (7) ◽

pp. 625-628 ◽

Cited By ~ 16

Author(s):

Sven-Eric Stangerup ◽

Örjan Tjernström ◽

Jonathan Harcourt ◽

Mads Klokker ◽

Jens Stokholm

Keyword(s):

Middle Ear ◽

Pressure Change ◽

Civil Aviation ◽

Treatment Modalities ◽

Valsalva Manoeuvre ◽

Traditional Treatment ◽

Prophylactic Measure ◽

Middle Ear Pressure ◽

Valsalva's Manoeuvre ◽

Pressure Changes

AbstractBarotitis is an acute or chronic inflammation caused by environmental pressure changes. The most common cause is the pressure change during descent in civil aviation. To prevent barotitis the middle ear pressure has to be equalised several times during descent. This can be achieved by performing the Valsalva manoeuvre, but for children, many of whom have a dysfunction of the Eustachian tube, this is difficult to perform and they are therefore at high risk of developing barotitis during flight. The traditional treatment modalities of barotitis are inflation by a Politzer balloon, myringotomy or prophylactic grommet insertion. An alternative treatment or prophylactic measure is autoinflation using the Otovent® treatment set. This prophylaxis/treatment can be performed by the child with assistance from its parents as soon as possible or rather before the descent has started. The prevalence of barotitis amongst transit passengers was found to be highest in young children, 25 per cent, compared with adults, five per cent. Only 21 percent of the youngest children with negative middle ear pressure after flight managed a successful Valsalva's manoeuvre, whereas 82 per cent could increase the middle ear pressure inflating the Otovent® set. In conclusion we recommend autoinflation using the Otovent® set by children and adults with problems clearing the ears during flight.

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Measurement of middle ear pressure changes during balloon eustachian tuboplasty: a pilot study

Acta Oto-Laryngologica ◽

10.1080/00016489.2016.1253870 ◽

2016 ◽

Vol 137 (5) ◽

pp. 471-475 ◽

Cited By ~ 3

Author(s):

Ingo Todt ◽

Tarek Abdel-Aziz ◽

Philipp Mittmann ◽

Martin Lehmann ◽

Jörg Ebmeyer ◽

...

Keyword(s):

Pilot Study ◽

Middle Ear ◽

Middle Ear Pressure ◽

Balloon Eustachian Tuboplasty ◽

Pressure Changes

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Anatomical Effects of Sudden Middle Ear Pressure Changes

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947908800313 ◽

1979 ◽

Vol 88 (3) ◽

pp. 368-376 ◽

Cited By ~ 5

Author(s):

A. Axelsson ◽

J. Miller ◽

M. Silverman

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Round Window ◽

Applied Pressure ◽

Positive Pressure ◽

Air Bubbles ◽

Scala Tympani ◽

Middle Ear Pressure ◽

Contralateral Ear ◽

Pressure Changes

Acute middle ear (ME) and inner ear changes following brief unilateral phasic ME pressure changes (up to ± 6000/mm H2O) were studied in the guinea pig. Middle ear findings included perforation of the tympanic membrane, serous and serosanguinous exudate and hemorrhage of tympanic membrane and periosteal vessels. Changes were related to magnitude of applied pressure. Perforation and hemorrhage were more commonly seen with negative rather than positive pressure. Air bubbles behind the round window were seen with positive pressures. Occasional distortion, but never perforation of the round window, was noted. Hemorrhage of the scala tympani was observed with both positive and negative pressures; scala vestibuli hemorrhage was found with negative ME pressure. In some instances pressure direction and magnitude related changes were seen in the contralateral ear.

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Study of Toynbee Phenomenon by Combined Intranasopharyngeal and Tympanometric Measurements

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948809700220 ◽

1988 ◽

Vol 97 (2) ◽

pp. 199-206 ◽

Cited By ~ 9

Author(s):

Yehuda Finkelstein ◽

Yuval Zohar ◽

Yoav P. Talmi ◽

Nelu Laurian

Keyword(s):

Middle Ear ◽

Negative Pressure ◽

Pressure Change ◽

Positive Pressure ◽

New Information ◽

Pressure Changes ◽

Rapid Pressure

The Toynbee maneuver, swallowing when the nose is obstructed, leads in most cases to pressure changes in one or both middle ears, resulting in a sensation of fullness. Since first described, many varying and contradictory comments have been reported in the literature concerning the type and amount of pressure changes both in the nasopharynx and in the middle ear. In our study, the pressure changes were determined by catheters placed into the nasopharynx and repeated tympanometric measurements. New information concerning the rapid pressure variations in the nasopharynx and middle ear during deglutition with an obstructed nose was obtained. Typical individual nasopharyngeal pressure change patterns were recorded, ranging from a maximal positive pressure of + 450 to a negative pressure as low as −320 mm H2O.

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