Use of Middle Ear Immittance Testing in the Evaluation of Patulous Eustachian Tube

2011 ◽  
Vol 22 (04) ◽  
pp. 201-207 ◽  
Author(s):  
Andrew P. McGrath ◽  
Elias M. Michaelides
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Standardized Protocol ◽  
Evaluation Protocol ◽  
Data Collection And Analysis ◽  
Number Of Patients ◽  
Uncommon Condition ◽  
Age Range ◽  
Audiologic Evaluation ◽  
Patulous Eustachian Tube

Background: Patulous Eustachian tube is the uncommon condition of a persistently open Eustachian tube, which causes the disturbing symptoms of autophony and respiratory-synchronous tinnitus. We review this condition and propose a specific evaluation protocol that can be performed quickly and easily using standard audiologic test equipment. We have used this protocol in the evaluation of a number of patients and will discuss our findings. Purpose: To establish a standardized protocol for the audiologic evaluation of patulous Eustachian tube using a standard clinical tympanometer and to establish norms with respect to tympanic membrane movement during breathing tasks. Research Design: Quantitative analysis of test results obtained during clinical evaluation of patients referred for suspected patulous Eustachian tube during 2008 and 2009. Study Sample: The cohort was 35 individuals including 25 patients referred for suspected patulous Eustachian tube and 10 control (normal) patients. Of the total group, 25 individuals were female, 10 were male, and the overall age range was 8 yr to 82 yr. Data Collection and Analysis: Patients underwent audiologic and otologic testing including quantitative measurement of middle ear compliance during breathing and nasal endoscopy. Two tympanometers were used to assess middle ear compliance: the Grason-Stadler Instruments Model 33 and Tympstar. Endoscopy was performed using either a Storz Endoskope Xenon Nova 175 or a Pentax EPM 1000. Results of middle ear immittance tests performed during breathing tasks were compared with results of endoscopy as well as the impressions of the examining physician. Magnitude of middle ear compliance was examined for mean and standard deviation, and the control/normal group results were compared with those of individuals complaining of symptoms suggestive of patulous Eustachian tube. Results: We found that slightly greater than 75% of individual ears with patulous Eustachian tube exhibited middle ear compliance greater than 0.07 ml during breathing tasks. All ears with patulous Eustachian tube exhibited a respiratory-synchronous compliance pattern during breathing tasks. Of individual ears without patulous Eustachian tube, 97% exhibited middle ear compliance during breathing of less than 0.07 ml with no respiratory-synchronous pattern. Conclusions: Measurement of middle ear compliance during breathing appears to be a sensitive and specific tool in the examination of patulous Eustachian tube, particularly when both the magnitude of compliance and the pattern of compliance are considered.

scholarly journals Salvage Eustachian Tube Cartilage Chip Insertion After Multiple Transnasal Shim Operations in Intractable Patulous Eustachian Tube

2021 ◽  
pp. 014556132199500
Author(s):  
Wei-Ting Lee ◽  
Heng-Jui Hsu
Keyword(s):  
Surgical Technique ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Repeat Surgery ◽  
Ear Infection ◽  
Middle Ear Infection ◽  
Tube Lumen ◽  
Management Method ◽  
Patulous Eustachian Tube

This article presents 2 cases of extremely intractable patulous Eustachian tube following multiple transnasal shim insertion. These cases highlight the disadvantages of repeat transnasal shim operations, including enlargement of the Eustachian tube lumen, frequent dislocation, repeat surgery, recurrent middle ear infection, and shim misswallowing. The patients in these cases were successfully treated with Eustachian tube cartilage chip insertion through a postauricular approach. We describe the surgical technique and advantages of this promising management method.

Seasonal variation of patulous Eustachian tube diagnoses using climatic and national health insurance data

2021 ◽  
pp. 1-7
Author(s):  
S Lee ◽  
S-W Choi ◽  
J Kim ◽  
H M Lee ◽  
S-J Oh ◽  
...  
Keyword(s):  
Relative Risk ◽  
Eustachian Tube ◽  
Climatic Factors ◽  
Data Sets ◽  
National Data ◽  
Health Insurance Data ◽  
Number Of Patients ◽  
Autumn And Winter ◽  
Insurance Data ◽  
Patulous Eustachian Tube

Abstract Objectives This study aimed to analyse if there were any associations between patulous Eustachian tube occurrence and climatic factors and seasonality. Methods The correlation between the monthly average number of patients diagnosed with patulous Eustachian tube and climatic factors in Seoul, Korea, from January 2010 to December 2016, was statistically analysed using national data sets. Results The relative risk for patulous Eustachian tube occurrence according to season was significantly higher in summer and autumn, and lower in winter than in spring (relative risk (95 per cent confidence interval): 1.334 (1.267–1.404), 1.219 (1.157–1.285) and 0.889 (0.840–0.941) for summer, autumn and winter, respectively). Temperature, atmospheric pressure and relative humidity had a moderate positive (r = 0.648), negative (r = –0.601) and positive (r = 0.492) correlation with the number of patulous Eustachian tube cases, respectively. Conclusion The number of patulous Eustachian tube cases was highest in summer and increased in proportion to changes in temperature and humidity, which could be due to physiological changes caused by climatic factors or diet trends.

Theoretic Analysis of Middle Ear Gas Composition under Conditions of Nonphysiologic Ventilation

1992 ◽  
Vol 101 (5) ◽  
pp. 445-451 ◽  
Author(s):  
Ervin J. Ostfeld ◽  
Alexander Silberberg
Keyword(s):  
Steady State ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Gas Flow ◽  
High Rate ◽  
Gas Flows ◽  
Gas Composition ◽  
Flow Through ◽  
Pressure Changes ◽  
Patulous Eustachian Tube

As gas flows in and out of the nasopharynx, the pressure in that region fluctuates. It drops below or rises above atmospheric pressure, which is itself not constant but is subject to changes in altitude and weather. Such pressure changes in the nasopharynx produce a pumping of gas into and out of the middle ear. The net amount of middle ear gas transferred from or to the nasopharynx will, component for component, in steady state exactly equal the amount of middle ear gas transferred to or from the microcirculation by means of diffusional absorption by (or release from) the mucosa. In the case of a permanently patulous eustachian tube, a single parameter, characteristic of the rate of ventilation through the open eustachian tube, is found to determine the gas composition in the middle ear, whereas in the case of a middle ear ventilated by tympanostomy, two rate-of-ventilation parameters, one for gas flow through the ventilation tube and one for flow through a periodically open eustachian tube, determine the steady state gas composition. A high rate of ventilation favors absorption of oxygen and venting of carbon dioxide from the middle ear in both cases.

scholarly journals Demographic profile of subjects undergoing sphenoidotomy for sphenoid sinusitis, in a tertiary care centre of Punjab- analysis of 75 subjects

2020 ◽  
Vol 7 (12) ◽  
pp. 4962
Author(s):  
Manish Munjal ◽  
Suneet Sethi ◽  
Anurag Chowdhary ◽  
Shubham Munjal ◽  
Ananya Sood ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Ocular Involvement ◽  
Nasal Discharge ◽  
Age Group ◽  
Demographic Profile ◽  
Sphenoid Sinusitis ◽  
Number Of Patients ◽  
Age Range

Background: The demographic profile of patients with Sphenoiditis undergoing surgical intervention, in the state of Punjab was studied. The emphasis was on the age, gender and clinical presentation in this prospective study.Methods: There were 75 patients of  sphenoethmoidal recess pathology with sphenoditis, who were selected from the Rhinology clinics of Otorhinolaryngology and head Neck services of  Dayanand Medical College and Hospital  Ludhiana , in a period one and a half years (November 2002 to October 2004). All patients were taken up for Functional endoscopic sinus surgery of the sphenoid  sinus surgery with sphenoidotomy.Results: The age range of subjects with sphenoiditis was between 12 years to 70 years. The mean age was 38.13 years. The maximum number of patients were in 19-30 years age group and the minimum in 31-40 years age group. Males outnumbered the females by a ratio of 1.7:1. The most common was posterior nasal drip (69.33% cases) behind the Eustachian tube and the least common complaint was diplopia (5.33% cases. Ocular involvement was observed in 32%. The right eye was more frequently involved (17.33%) as compared to the left (12%).Conclusions: Patients with Sphenoid sinusitis were seen in the broad age range from 19 to 30 years with a male predominance. Posterior nasal discharge behind the Eustachian tube, rather than the typical occipital ache was the primary complaint .Right sided eye involvement with ptosis and lateral rectus palsy were commonly noted. 

Paper patching of the tympanic membrane as a symptomatic treatment for patulous eustachian tube syndrome

2014 ◽  
Vol 128 (3) ◽  
pp. 228-235 ◽  
Author(s):  
M Boedts
Keyword(s):  
Tympanic Membrane ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Symptomatic Relief ◽  
Effective Means ◽  
Symptomatic Treatment ◽  
Subjective Improvement ◽  
Patulous Eustachian Tube

AbstractBackground:Application of one or several paper patches on the tympanic membrane can improve autophony and other symptoms in some patients with a patulous eustachian tube.Method:The charts of 21 patients treated for patulous eustachian tube syndrome between 2006 and 2011 were studied for subjective improvement of symptoms following the application of paper patches.Results:Paper patching of the tympanic membrane provided symptomatic relief in 76.2 per cent of patients; relief was permanent in 50 per cent of these patients.Conclusion:Paper patching of the tympanic membrane is a simple and effective means of temporarily or permanently alleviating patulous eustachian tube syndrome symptoms. It is postulated that the patches decrease the admittance of low- to mid-frequency acoustic input at the tympanic membrane by increasing the stiffness of the tympanic membrane, thereby counteracting the middle-ear cushion effect caused by the open eustachian tube.

Goblet Cell Population in the Normal Middle Ear and Eustachian Tube of Children and Adults

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 44-50 ◽  
Author(s):  
Mirko Tos ◽  
K. Bak-Pedersen
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Round Window ◽  
Newborn Infants ◽  
Lateral Wall ◽  
Goblet Cells ◽  
Oval Window ◽  
Mastoid Process ◽  
Temporal Bones ◽  
Age Range

On 54 temporal bones from entirely normal prematures and newborn infants, children, and adults, 30,000 to 90,000 counts of goblet cells were done in different parts of the Eustachian tube and middle ear. In the Eustachian tube, normal prematures showed a very low density of goblet cells in all localities, increasing in the pharyngeal parts gradually through childhood and reaching in the normal adult a very high density in the pharyngeal orifice. There are no differences in density between the medial and lateral wall, but in some parts a decrease of density towards the tubal roof. In the middle ear the density is low in normal prematures, increasing slightly in infants, and decreasing again during the age range 7–14 years and in adults. Goblet cells are present in all middle-ear localities, but in markedly decreasing density in this sequence: hypotympanum anteriorly, posteriorly, promontory anteriorly, in the middle, epitympanum, niche of oval window, antrum, niche of round window, mastoid process, incus, and promontory posteriorly.

Evaluation of Eustachian tube function with ventilation scintigraphy by using 133Xe gas

1999 ◽  
Vol 113 (6) ◽  
pp. 509-511 ◽  
Author(s):  
R. Murat Karaşen ◽  
Erhan Varoǧlu ◽  
Mustafa Yildirim ◽  
Kerim Eryilmaz ◽  
Yavuz Sütbeyaz ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Region Of Interest ◽  
Eustachian Tube Function ◽  
Number Of Patients ◽  
Ventilation Scintigraphy ◽  
Normal Tube ◽  
Percentage Retention ◽  
Tube Dysfunction ◽  
Tube Function

AbstractThe aim of this study was to evaluate Eustachian tube function by ventilation scintigraphy. In 13 patients with normal tube function and 16 with one-sided tube dysfunction, 50 MBq 133Xe was applied into the nasopharyngeal space through a tube inserted into the nasal cavity. Immediately after the insufflation, the patients were asked to perform three Valsalva manoeuvres.The visualization of the middle ear was possible in 10 of the 13 patients (77 per cent) with normal tube function. Decreased uptake of the middle-ear region in the side of dysfunction was demonstrated in 11 of the 16 patients (68.7 per cent) with one-sided tube dysfunction. Quantitative evaluation by region of interest technique revealed that by using percentage retention of activity and uptake rates, there were significant differences between the sides of dysfunction and sides of normal tube function (p<0.05) and also between sides of dysfunction and both sides of controls (p<0.05). There was no significant differences between normal sides of patients and both sides of controls (p>0.05).As a conclusion, this method is non-invasive, easy-to perform and has a low radiation burden in the evaluation of Eustachian tube function. Although the number of patients is limited, the test seems to be applicable with a success rate of about 74 per cent.

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