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

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

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

2019 ◽  
pp. 55-61
Author(s):  
Owen J. O’Neill ◽  
Elizabeth Smykowski ◽  
Jo Ann Marker ◽  
Lubiha Perez ◽  
drah Gurash ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Eustachian Tube Dysfunction ◽  
Tube Placement ◽  
Treatment Schedule ◽  
Surgical Interventions ◽  
Hyperbaric Treatment ◽  
Middle Ear Pressure ◽  
Tube Dysfunction

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.

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

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

2017 ◽  
Vol 131 (9) ◽  
pp. 817-822 ◽  
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.

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

2019 ◽  
Vol 30 (09) ◽  
pp. 781-791 ◽  
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.

Nasal and Otologic Effects of Experimental Influenza a Virus Infection

1994 ◽  
Vol 103 (1) ◽  
pp. 59-69 ◽  
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.

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

PLoS ONE ◽  
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.

The Middle Ear Cleft Status in a “Natural” Cohort With Eustachian Tube Dysfunction

2017 ◽  
Vol 38 (8) ◽  
pp. 1133-1139 ◽  
Author(s):  
Udi Cinamon ◽  
Dov Albukrek ◽  
Yahav Oron ◽  
Sharon Ovnat Tamir ◽  
Abraham Goldfarb ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Eustachian Tube Dysfunction ◽  
Tube Dysfunction ◽  
Middle Ear Cleft

The effect of compression rate and slope on the incidence of symptomatic Eustachian tube dysfunction leading to middle ear barotrauma: a Phase I prospective study

2019 ◽  
pp. 95-100
Author(s):  
L. Varughese ◽  
◽  
O.J. O'Neill ◽  
J. Marker ◽  
L. Perez ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Eustachian Tube Dysfunction ◽  
P Value ◽  
Compression Rate ◽  
Hyperbaric Chamber ◽  
Compression Phase ◽  
Class A ◽  
Tube Dysfunction ◽  
Linear Compression

Introduction: Symptomatic Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the most common reported complications during hyperbaric oxygen (HBO2) treatment. There is no standardized rate of compression (ROC) reported to decrease the incidence rates of ETD and MEB during hyperbaric treatments. Few studies actually demonstrate that the ROC decreases the incidence of ETD or MEB. Methods: Our study was designed to determine an optimal hyperbaric chamber compression rate that might reduce the incidence of symptomatic ETD leading to MEB during the compression phase of treatment in a multiplace hyperbaric chamber. Data was collected prospectively over 2,807 elective patient treatments compressed using a U.S. Navy Treatment Table 9 (USN TT9) with a modified ROC. ROC was assigned using two variables, time (10 vs.15 minutes) and slope (linear vs. non-linear compression). Patients were exposed to all four compression schedules in a consecutive daily fashion. We recorded any patient requiring a stop during initial compression due to ear discomfort. Anyone requiring a stop was evaluated post treatment for MEB. Findings were compared to our standard 10-minute linear ROC. Evaluation of the tympanic membrane was accomplished using video otoscopy. Barotrauma when present was classified using both the Teed and O’Neill grading systems. Data was analyzed using basic statistical methods. Results: When comparing four different rates of compression during an elective USN TT9 in a multiplace (Class A) chamber there is a decreased incidence for symptomatic ETD when using a 15-minute linear compression schedule (p-value < 0.05). Conclusion: Using a 15-minute linear compression schedule is associated with less symptomatic ETD and less MEB when performing an elective 45 fsw (USN TT9) hyperbaric treatment in a Class A chamber. Asymptomatic ETD and MEB were not considered in this study.

Uncomplicated Eustachian Tube Dysfunction: The Site of the Nasal Septal Deformity

1982 ◽  
Vol 68 (1) ◽  
pp. 23-29
Author(s):  
W. D. McNicoll
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Nasal Septum ◽  
Ambient Pressure ◽  
Eustachian Tube Dysfunction ◽  
Control Group ◽  
Royal Navy ◽  
Tube Dysfunction ◽  
Function Testing ◽  
Submucous Resection

AbstractEighty-nine recruit volunteers to the Submarine. Diving and Fleet Air Arm branches of the Royal Navy who were suffering from an unsuspected Eustachian tube dysfunction underwent investigation, which included middle ear analysis. Eustachian function testing and PA x-radiography of the skull. Twenty-five aircrew candidates who had positive Valsalva and Toynbee manoeuvres on otoscopy, acted as a control group and underwent the same investigations as the investigative group. All the subjects in the investigative group had either a unilateral or bilateral Eustachian tube dysfunction. This dysfunction was confirmed by exposing the subjects to an increase in ambient pressure not exceeding three metres of water. None of the subjects with Eustachian tube dysfunction were able to equilibrate their middle ear pressures at this depth equivalent.All 89 subjects were found to have a nasal septal deformity situated at the posterior half of the nasal septum at the level of the vomero-ethmoid suture. All the volunteers underwent submucous resection of the nasal septum, care being taken to excise the vomeroethmoid suture and the adjacent vomer and perpendicular plate of ethmoid. Six weeks after operation 85 (95.5%) of subjects were able to equilibrate their middle ear pressures when they were exposed to an increase in ambient pressure of 10 metres of water.

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