Proof of concept study using a modified Politzer inflation device as a rescue modality for treating Eustachian tube dysfunction during hyperbaric oxygen treatment in a multiplace (Class A) chamber

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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The effect of total compression time and rate (slope) of compression on the incidence of symptomatic Eustachian tube dysfunction and middle ear barotrauma: a Phase II prospective study

Undersea and Hyperbaric Medicine ◽

10.22462/05.06.2021.1 ◽

2021 ◽

pp. 209-219

Author(s):

Owen J. O’Neill ◽

◽

David Dayya ◽

Lince Varughese ◽

Jo Anne Marker ◽

...

Keyword(s):

Phase I ◽

Hyperbaric Oxygen ◽

Phase Ii ◽

Eustachian Tube ◽

Middle Ear ◽

Phase I Trial ◽

Eustachian Tube Dysfunction ◽

Patient Treatment ◽

Time Interval ◽

Tube Dysfunction

Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are common reported complications during hyperbaric oxygen treatment. Our Phase I study data was the first to demonstrate a statistically significant decrease in the occurrence of symptomatic ETD and MEB. The Phase I Trial suggested the total time interval and rate (slope) of compression (ROC) may be a determining factor in ETD and MEB. This Phase II study investigates an optimal rate of compression to reduce ETD and MEB when considering each multiplace treatment (with multiple patients) as the unit of observation as a group, rather than for each individual patient. Data were collected prospectively on 1,244 group patient-treatment exposures, collectively including 5,072 individual patient-treatment/exposures. We randomly assigned patient-treatment group exposures to four different time interval and rate (slope) of compression. These compression rates and slopes were identical to those used in the Phase I trial. All patients experiencing symptoms of MEB requiring compression stops were evaluated post treatment for the presence of ETD and MEB using the O’Neill Grading System (OGS) for ETD. Data were analyzed using the IBM-SPSS statistical software program. A statistically significant decrease in the number of compression holds was observed in the 15-minute compression schedule, correlating to the results observed in the Phase I trial. The 15-minute linear compression profile continues to demonstrate the decreased need for patient symptomatic compression stops (as in the Phase I trial) using a USN TT9 during elective hyperbaric oxygen treatments in a Class A multiplace hyperbaric chamber. Trial Registration: ClinicalTrials.gov Identifier: NCT04776967

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

Auris Nasus Larynx ◽

10.1016/s0385-8146(85)80149-8 ◽

1985 ◽

Vol 12 ◽

pp. S203-S205 ◽

Cited By ~ 1

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

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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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Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001554 ◽

2017 ◽

Vol 131 (9) ◽

pp. 817-822 ◽

Cited By ~ 1

Author(s):

O Ilan ◽

E-L Marcus ◽

Y Cohen ◽

T Farkash ◽

R Levy ◽

...

Keyword(s):

Mechanical Ventilation ◽

Eustachian Tube ◽

Middle Ear ◽

Tracheostomy Tube ◽

Oral Feeding ◽

Eustachian Tube Dysfunction ◽

Impaired Consciousness ◽

Endoscopic Gastrostomy ◽

Tube Dysfunction ◽

Cognitively Intact

AbstractObjective:This study aimed to investigate the prevalence of and risk factors for Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation via tracheostomy tube.Methods:A total of 40 patients on chronic ventilation were included in a prospective cohort study. Middle-ear status was determined by tympanometry. Tympanograms were categorised as types A, B or C; types B and C were defined as middle-ear pathology.Results:In all, 57 ears of 40 patients were examined. Disease was found in at least 1 ear in 26 out of 40 patients. Middle-ear pathology was found in 25 out of 34 patients who were tube fed (via nasogastric tube or percutaneous endoscopic gastrostomy) vs 1 patient out of the 6 fed orally (p = 0.014), and in 23 out of 31 with conscious or cognitive impairment vs 3 out of 9 cognitively intact patients (p = 0.044).Conclusion:Middle-ear pathology is common in patients on chronic mechanical ventilation via tracheostomy tube. The highest prevalence was in those with impaired consciousness or cognition, and oral feeding appeared protective.

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Eustachian Tube Dysfunction and Wideband Absorbance Measurements at Tympanometric Peak Pressure and 0 daPa

Journal of the American Academy of Audiology ◽

10.3766/jaaa.18002 ◽

2019 ◽

Vol 30 (09) ◽

pp. 781-791 ◽

Cited By ~ 2

Author(s):

Sreedevi Aithal ◽

Venkatesh Aithal ◽

Joseph Kei ◽

Shane Anderson ◽

Simon Liebenberg

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Repeated Measures ◽

Peak Pressure ◽

Cross Sectional Study ◽

Eustachian Tube Dysfunction ◽

Control Group ◽

Sectional Study ◽

Cross Sectional ◽

Tube Dysfunction

AbstractAlthough wideband absorbance (WBA) provides important information about middle ear function, there is limited research on the use of WBA to evaluate eustachian tube dysfunction (ETD). To date, WBA obtained under pressurized condition has not been used to evaluate ETD.The objective of the study was to compare WBA at 0 daPa and tympanometric peak pressure (TPP) conditions in healthy ears and ears with ETD.A cross-sectional study design was used.A total of 102 healthy ears from 79 participants (mean age = 10.0 yr) and 43 ears from 32 patients with ETD (mean age = 16.0 yr) were included in this cross-sectional study. WBA was measured at 0 daPa (WBA0) and TPP WBA at TPP (WBATPP).WBA results were analyzed using descriptive statistics and t-tests with the Bonferroni correction. An analysis of variance with repeated measures was applied to the data.WBA0 was significantly lower in the ETD group than in the control group. The WBA0 of the control group demonstrated a broad peak between 1.25 and 4 kHz, whereas the WBA0 of the ETD group had a peak between 2.5 and 4 kHz. WBATPP of the ETD group approached values close to that of the control group. In the control group, WBATPP was only 0.06 to 0.09 higher than WBA0, whereas in the ETD group, WBATPP was 0.29 to 0.42 higher than WBA0 between 0.6 and 1.5 kHz. A differential pattern of WBA at TPP relative to 0 daPa was observed between ears with ETD and ears with otitis media with effusion (OME) and negative middle ear pressure (NMEP).Hence, a comparison of WBA0 and WBATPP can provide potentially useful diagnostic information, and hence can be used as an adjunct tool to evaluate ETD. This is important especially in young children or some adults who are unable to perform maneuvers such as Toynbee or Valsalva during ETD assessment. Further research is needed to verify the results using test performance measures to determine whether WBA0 and WBATPP can objectively determine the presence of ETD or OME with NMEP.

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Nasal and Otologic Effects of Experimental Influenza a Virus Infection

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410300111 ◽

1994 ◽

Vol 103 (1) ◽

pp. 59-69 ◽

Cited By ~ 76

Author(s):

William J. Doyle ◽

Craig A. Buchman ◽

David P. Skoner ◽

James T. Seroky ◽

Frederick Hayden ◽

...

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Influenza A ◽

Serum Antibody ◽

Eustachian Tube Dysfunction ◽

Upper Respiratory Tract ◽

Tube Dysfunction ◽

Antibody Titers ◽

Experimental Influenza

Past studies showed that experimental rhinovirus colds in adults resulted in eustachian tube dysfunction and abnormal middle ear pressures. In the present study, the symptoms and pathophysiologic findings accompanying experimental influenza viral infection were documented. A total of 33 healthy adult volunteers were intranasally challenged with an influenza A/Kawasaki/86 (H1N1) virus and cloistered over a 9-day postchallenge period to monitor for evidence of infection, signs and symptoms of illness, and the extent and frequency of pathophysiologic responses of the nose, eustachian tube, and middle ear. Results showed a protective effect of high (≥16) prechallenge specific hemagglutination-inhibition antibody titer on the rate of infection and the magnitude and extent of provoked symptoms and pathophysiologic findings. Infected subjects with low (<16) prechallenge serum antibody titers (n = 21) developed significant respiratory illness. These subjects also had objectively measurable increases in nasal secretion production, and decreased nasal patency and mucociliary clearance rates. More than 80% of the infected subjects developed eustachian tube dysfunction, and approximately 80% had middle ear underpressures of less than −100 mm H2O on study days 4 and 5. Five of 21 infected subjects with low prechallenge antibody titers had otoscopic evidence of otitis media with effusion. These results support a causal role for viral upper respiratory tract infection in the pathogenesis of otitis media, possibly mediated by the early development of eustachian tube dysfunction and abnormal middle ear pressure.

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Chronic obstructive Eustachian tube dysfunction: CT assessment with Valsalva maneuver and ETS-7 score

PLoS ONE ◽

10.1371/journal.pone.0247708 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247708

Author(s):

Diletta Angeletti ◽

Annalisa Pace ◽

Giannicola Iannella ◽

Valeria Rossetti ◽

Andrea Colizza ◽

...

Keyword(s):

Eustachian Tube ◽

Middle Ear ◽

Valsalva Maneuver ◽

Eustachian Tube Dysfunction ◽

Diagnostic Tools ◽

Chronic Obstructive ◽

Temporal Bone Ct ◽

Before And After ◽

Tube Dysfunction ◽

Strong Suspicion

Chronic obstructive Eustachian tube dysfunction (ETD) is a common disorder of the middle ear. In recent years, two main diagnostic tools have become available: Eustachian tube score (ETS-7) and computed tomography (CT) combined with Valsalva maneuver. The aim of this study is to evaluate the outcomes of ETS-7 and CT in a group of patients affected by middle ear atelectasis with a strong suspicion of ETD. Three males and nine females, affected by middle ear atelectasis with retraction of the TM were enrolled. Each patient underwent to Eustachian tube dysfunction evaluation adopting the ETS-7 score and a temporal bone CT with Valsalva maneuver. The ears analyzed at steady state were divided into 2 groups: ETS<7 group and ETS≥ 7 group. The same division was applied for the ears analyzed after the Valsalva maneuver: ETS<7 group and ETS≥ 7 group. ETs were categorized as “well defined” (WD) and “not defined” (ND). The results of the analysis of the ETS-7 score in all 24 ears showed that 42% presented ETS ≥7, while 58% had ETS <7, indicating a diagnosis of ETD. In the ETS<7 group after Valsalva, ET was visualized in 33% of patients. In the ETS≥7 group it was WD in 29% after the Valsalva manoeuver. In both groups the comparison between the visualization of the ET before and after the Valsalva manoeuver did not present a statistical difference. No correlation emerged between ET evaluation with CT scan during Valsalva maneuver and ETS-7 score. It confirms that there is not a gold standard for the study of ET dysfunction.

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