scholarly journals The Relation of Allergy to Eustachian Tube Dysfunction and the Subsequent Need for Insertion of Pressure Equalization Tubes

2020 ◽  
Vol 99 (1_suppl) ◽  
pp. 39S-47S
Author(s):  
David S. Hurst ◽  
Carter M. Denne
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Basic Question ◽  
Pressure Equalization ◽  
Immune Mediated ◽  
Tube Dysfunction ◽  
Mucosal Edema ◽  
Middle Ear Disease

Introduction: The most basic question to be answered in each case in which the choice of using a pressure equalization tube (PET) is being considered is: “what is the underlying pathophysiology of the middle ear disease being addressed?” Methods: We will evaluate the hypothesis that the Eustachian Tube (ET) may become “dysfunctional” due to allergic mucosal edema and obstruction. We review the literature that evaluates the role of ET, the proposed affect that allergy may contribute to ET dysfunction (ETD), and the relation of allergic rhinitis to otitis. Results: Proof that allergy affects the middle ear was supported by (1) over a dozen investigators using objective immunotherapy demonstrating over the past 70 years that 72% to 100% of the children with otitis media with effusion (OME) are atopic, (2) an association of allergic Th2 immune-mediated histochemical reactivity within the target organ itself, (3) establishment that inflammation within the middle ear is truly allergic in nature, and (4) direct evidence of a dose–response curve and consistency of results, which confirm that OME resolves on allergy immunotherapy. Conclusion: Current medical evidence should heighten the awareness of physicians of the physiology that underlies ETD. The evidence supports the link between allergy and OME. The middle ear behaves like the rest of the respiratory tract, and what has been learned about the atopic response in the sinuses and lungs may be applied to the study of the immunologic mechanisms within the middle ear that lead to ETD requiring the use of PET.

The Role of Eustachian Tube Dysfunction in Immune-Mediated Middle Ear Effusion and Inflammation

1985 ◽  
Vol 12 ◽  
pp. S203-S205 ◽  
Author(s):  
Allen F. Ryan ◽  
Jeffrey P. Harris ◽  
Antonino Catanzaro ◽  
Stephen I. Wasserman
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Eustachian Tube Dysfunction ◽  
Middle Ear Effusion ◽  
Immune Mediated ◽  
Tube Dysfunction ◽  
Ear Effusion

Biological Mediators of Inflammation in Middle Ear Effusions

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 90-96 ◽  
Author(s):  
Joel M. Bernstein
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Potential Role ◽  
Otitis Media With Effusion ◽  
Chemotactic Factor ◽  
Mediators Of Inflammation ◽  
Tube Dysfunction ◽  
Middle Ear Cleft

Four biological mediators of inflammation have been found in middle ear effusions from patients with otitis media with effusion. They are chemotactic factor(s), macrophage inhibition factor(s), activated complement and prostaglandins. The potential role of these mediators has been discussed in relation to their potential for maintaining inflammation in the middle ear cleft after Eustachian tube dysfunction.

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

1997 ◽  
Vol 106 (6) ◽  
pp. 478-482 ◽  
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.

Evacuation of the Middle Ear by Sniffing: A Cause of High Negative Pressure and Development of Middle Ear Disease

1984 ◽  
Vol 92 (3) ◽  
pp. 312-318 ◽  
Author(s):  
Bernt Falk ◽  
Bengt Magnuson
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Negative Pressure ◽  
Experimental Studies ◽  
Eustachian Tube Function ◽  
Middle Ear Effusion ◽  
Pressure Equalization ◽  
Tube Function ◽  
Middle Ear Disease ◽  
Ear Effusion

Previous research on eustachian tube function has been devoted mainly to the study of the tubal opening ability and pressure equalization. This article summarizes a series of experimental studies focusing on the closing ability of the tube. Results support the belief that the purpose of the tube should be seen primarily as protecting the middle ear from the extensive pressure variations that physiologically take place in the nasopharynx. A number of studies of diseased ears have shown that tubal malfunction was characterized mainly by a reduced ability to withstand negative pressure in the nasopharynx. Sniffing can evacuate the middle ear, causing high negative intratympanic pressure. It seems likely that this mechanism is involved in the development of middle ear effusion and manifest retraction-type middle ear disease.

The Role of Soluble Interleukin-4 Receptor and Interleukin-5 Antibody in Preventing Late-Phase Allergy-Induced Eustachian Tube Dysfunction

2002 ◽  
Vol 127 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Hoke W. Pollock ◽  
Charles S. Ebert ◽  
Marc G. Dubin ◽  
David R. White ◽  
Jiri Prazma ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Late Phase ◽  
Allergic Response ◽  
Eustachian Tube Dysfunction ◽  
Middle Ear Effusion ◽  
Tube Dysfunction ◽  
The Relationship ◽  
Ear Effusion

OBJECTIVES: We investigated the role of soluble interleukin (IL)-4 receptors (sIL-4R) and IL-5 antibodies (IL-5Ab) in preventing allergic eustachian tube dysfunction (ETD) and middle ear effusion (MEE). STUDY DESIGN: Brown-Norway rats were sensitized to ovalbumin (OVA) and challenged transtympanically. Two groups of rats received either IL-4R or IL-5Ab transtympanically 1 hour before challenge. Three additional groups were used as controls. Following the second transtympanic challenge, the ventilatory and clearance functions of the eustachian tube (ET) were assessed at 0, 2, and 8 hours. Histology was prepared using cut paraffin sections stained with hematoxylin and eosin. RESULTS: sIL-4R-pretreated rats showed no significant changes in ventilatory or clearance functions of the ET or inflammatory changes in ET mucosa, whereas IL-5Ab pretreatment showed significant late ventilatory and clearance dysfunction as well as inflammatory mucosal changes. CONCLUSION: These data demonstrate that the late-phase allergic inflammatory response that leads to subsequent formation of ETD and MEE is prevented by pretreatment with sIL-4R and, more modestly, with IL-5Ab. Otitis media with effusion (OME) remains a significant problem in the pediatric population today. Despite advances in screening and treatment, the incidence has steadily risen over the past 20 years. It is now estimated that more than 80% of all children with have at least 1 episode of OME by age 3 and 40% will have 3 or more episodes. 1 Furthermore, earaches/ear infections represent the single greatest reason for a visit to the pediatrician after well-child visits. 2 Numerous studies have investigated the sequelae for children exposed to multiple episodes of OME, with conclusions ranging from no significant permanent deficits to impairments in receptive language skills, 1 balance and coordination, 3 and school readiness measures. 4 There remain several important controversies with regards to the pathogenesis and treatment of OME. One of these is the relationship between OME and allergy. A link between OME and allergy has existed for some time, 5 and one of the older empiric observations on the relationship between children with recurrent OME and allergy has resurfaced in recent years to explain the large number of patients with no other causative factor for fluid in the middle ear space. Bernstein 6 has demonstrated in a study of 100 patients with recurrent OME that almost a third can be attributed directly to allergy. Indeed, some consider this number a very conservative estimate. It is the intent of this study to examine the role of newer therapies such as antagonists to interleukin (IL)-4 and IL-5 for preventing the late-phase allergic reaction and their effect of preventing eustachian tube dysfunction and formation of middle ear effusion. IL−4 and −5 are 2 of a host of mediators that comprise the late-phase allergic response. Produced by a variety of cell types, their principal functions are to control subsequent cascades that are a response to antigenic challenge. Tissue inflammation, edema formation, mucus production, and eosinophilia are controlled by these cytokines. Our hypothesis is that administration of antagonists of both IL−4 and IL−5, in the form of sIL-4R and IL−5Ab, respectively, will result in a decreased allergic response to challenged tissue.

Type II Collagen Mediated Autoimmune Middle Ear Disease: Eustachian Tube Disease, Otitis Media with Effusion and Tympanosclerosis

1985 ◽  
Vol 12 ◽  
pp. S91-S93 ◽  
Author(s):  
Tai-Jun Yoo ◽  
Naohiro Sudo ◽  
Koichi Tomoda ◽  
Yoshiro Yazawa ◽  
Tsukasa Ishibe ◽  
...  
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Type Ii Collagen ◽  
Type Ii ◽  
Middle Ear Disease

The Role of IgE-Mediated Hypersensitivity in Otitis Media with Effusion: A 1987 Update

1987 ◽  
Vol 1 (2) ◽  
pp. 67-72
Author(s):  
Joel M. Bernstein
Keyword(s):  
Allergic Rhinitis ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Eustachian Tube Dysfunction ◽  
Upper Respiratory Tract ◽  
Direct Role ◽  
Tube Dysfunction ◽  
Ige Mediated

The role of IgE-mediated hypersensitivity in the development of middle ear disease has not been completely resolved. However, on the basis of our investigations and those of other laboratories, we would suggest that approximately two-thirds of patients with chronic recurrent otitis media (OM) are not allergic. The other third may have allergic rhinitis, and this allergic rhinitis may play a direct role in producing eustachian tube dysfunction in recurrent OM. However, viral infections of the upper respiratory tract may also induce IgE-mediated release of mast cell inflammatory mediators and could cause OM on the basis of viral infection alone. The role of allergic rhinitis on eustachian tube dysfunction is now well documented, and finally, the possible role of food allergy and OM must be seriously considered, particularly in the young OM-prone child with chronic recurrent rhinitis and OM.

Unlearning the ABCs of Tympanometry

2021 ◽  
pp. 019459982199582
Author(s):  
Edward D. McCoul
Keyword(s):  
Clinical Diagnosis ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Surgical Intervention ◽  
Peak Pressure ◽  
Severe Disease ◽  
Tube Dysfunction ◽  
Middle Ear Disease ◽  
Type C ◽  
Definition Of

Interpretation of tympanometry commonly relies on the historical convention of classifying findings according to large and arbitrary threshold shifts of tympanometric peak pressure (TPP). This convention had value for prior generations of otolaryngologists in diagnosing severe, chronic middle ear disease requiring surgical intervention but may not be well suited for the present-day evaluation of less severe disease. The existing definition of a type C curve (less than –100 daPa) is likely insensitive to detect subtle abnormalities, including some presentations of obstructive eustachian tube dysfunction. The accuracy of clinical diagnosis may be improved by reporting the absolute values of TPP and moving beyond classification according to arbitrary thresholds.

Immune Modulatory Oligonucleotides in Prevention of Nasal Allergen—Induced Eustachian Tube Dysfunction in Rats

2007 ◽  
Vol 137 (2) ◽  
pp. 250-255 ◽  
Author(s):  
Charles S. Ebert ◽  
Austin S. Rose ◽  
Deidra A. Blanks ◽  
Rose P. Eapen ◽  
Ekambar R. Kandimalla ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Randomized Study ◽  
Allergic Inflammation ◽  
Eustachian Tube Dysfunction ◽  
Brown Norway ◽  
Tube Dysfunction ◽  
Dynamic Measures ◽  
Phosphate Buffered Saline

OBJECTIVES: Develop a model of nasal allergen-induced Eustachian tube dysfunction (ETD) in a rat and investigate the role of immune modulatory oligonucleotides (IMOs) in the prevention of nasal allergen-induced ETD. STUDY DESIGN AND SETTING: Prospective, randomized study. Brown Norway rats were sensitized to ova albumin (OVA) and randomized to receive pretreatment with IMOs or phosphate-buffered saline. All animals were challenged intranasally with aerosolized OVA. Dynamic measures of Eustachian tube (ET) function were analyzed. RESULTS: Animals that were OVA-sensitized and IMO-pre-treated had significantly lower mean passive opening (95% confidence interval [95% CI] 15.0,19.4) and closing (95% CI 4.8,7.8) ET pressures compared with those of (95% CI 24.1,32.7) and (95% CI 12.1,18,8) OVA-sensitized untreated rats, respectively. In addition, the IMO-pretreated animals demonstrated the ability to actively clear a significantly higher proportion of negative pressure (95% CI 0.64,0.96) compared with the untreated animals (95% CI 0.09,0.39). IMO-pretreated animals also demonstrated significantly improved mean mucociliary clearance times in seconds (95% CI 115,195) than those in untreated animals (95% CI 308,668). CONCLUSIONS: Pretreatment with IMOs prevented allergen-induced allergic inflammation around the Eustachian tube (ET) and resulted in improved ventilatory function of the ET compared with sensitized untreated animals. IMOs offer considerable promise in the management of nasal allergic disease as well as otitis media with effusion.

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