Relationship between the prevalence of tympanic membrane perforation after intratympanic steroid administration and the results of Eustachian tube function tests

On 100 pathological ears with tympanic membrane perforation, eustachian tube function was measured by using sonotubometry and the negative pressure equalization test in an attempt to compare these two methods. The pressure equalization test did not appear to be a reliable tool for preoperative clinical determination of tube function because sonotubometry showed tubal opening in 85 % (myringoplasty group) and in 49 % (radical surgery group) of pathological ears, which were not able to equalize negative middle ear pressure at all during swallowing. The negative pressure equalization test is considered to be unphysiological and may produce a locking phenomenon of the tube. Even a small negative pressure can act like a valve, producing an obstruction that muscle activity of the tube is no longer able to overcome particularly when mucosal changes are present in the tubal orifice. Sonotubometry is a physiological test and as such gives a reliable picture of the opening of the tube during swallowing. Data on tympanic aeration postoperatively will be reported later.

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Effect of Surgical Alterations of the Tensor Veli Palatini Muscle onc Eustachian Tube Function

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894800890s313 ◽

1980 ◽

Vol 89 (3_suppl) ◽

pp. 47-54 ◽

Cited By ~ 48

Author(s):

Erdem I. Cantekin ◽

David C. Phillips ◽

Charles D. Bluestone ◽

William J. Doyle ◽

Kyle K. Kimes

Keyword(s):

Eustachian Tube ◽

Otitis Media With Effusion ◽

Forced Response ◽

Eustachian Tube Function ◽

Complete Excision ◽

Function Tests ◽

Short Period ◽

Tube Function ◽

Tensor Veli Palatini Muscle ◽

One Year

Previous studies in humans have indicated that functional obstruction of the eustachian tube (ET) is an important factor in the pathogenesis of otitis media with effusion (OME). This type of obstruction appears to be related to the structural properties of the tube, or to an inefficient active tubal opening mechanism, or both. In this study, functional ET obstruction was created in 22 rhesus monkeys ( Macaca mulatta) by surgically altering the tensor veli palatini (TVP) muscle using three different procedures: 1) complete excision of the muscle; 2) transection of the superficial muscle bundle; or 3) transposition of the muscle tendon medial to the hamular process. Prior to surgery, weekly tympanometry, pneumatic otoscopy, and otomicroscopic examinations were performed for a period of at least six months to document middle ear (ME) status. A minimum of four ET function tests were performed on each animal using the inflation-deflation and forced-response tests. Following surgery, these tests and examinations were continued for periods of up to one year. Postoperatively, the animals in which the TVP had been excised developed a sterile ME effusion which proved to be a chronic condition which persisted throughout the follow-up period. Eustachian tube function tests showed a complete absence of any active tubal dilation by swallowing. Animals that had the muscle transected developed abnormal ME pressures, or effusions, or both, which returned to normal in some ears, but which were recurrent or chronic in others. Eustachian tube function tests in these animals showed an initial loss of active tubal function which gradually improved, but not to normal levels, presumably as a result of healing of the muscle. In cases in which the muscle was transposed the ME pathology and ET dysfunction were similar after the surgery, but improved within a short period of time. These data suggest that alteration of the TVP muscle can create functional obstruction of the ET. The severity of ET obstruction depends upon the surgical procedure undertaken. The results of postoperative ET function tests were similar to those recorded from children with recurrent and chronic OME.

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Eustachian Tube Function Tests and their Diagnostic Potential in Normal and Diseased Ears

Acta Oto-Laryngologica ◽

10.3109/00016489309126169 ◽

1993 ◽

Vol 113 (sup500) ◽

pp. 10-13 ◽

Cited By ~ 7

Author(s):

Tadami Kumazawa ◽

Tadashi Iwano ◽

Koichi Ushiro ◽

Takuya Kinoshita ◽

Eimoto Hamada ◽

...

Keyword(s):

Eustachian Tube ◽

Eustachian Tube Function ◽

Function Tests ◽

Diagnostic Potential ◽

Tube Function

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Eustachian tube function assessed with tympanometry a new testing procedure in ears with intact tympanic membrane

Acta Oto-Laryngologica ◽

10.3109/00016487009131509 ◽

1970 ◽

Vol 69 (sup263) ◽

pp. 14-14 ◽

Cited By ~ 1

Author(s):

J. Holmquist

Keyword(s):

Tympanic Membrane ◽

Eustachian Tube ◽

Testing Procedure ◽

Eustachian Tube Function ◽

Tube Function ◽

Intact Tympanic Membrane

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Epitympanic Diaphragm: Endoscopic Functional Tympanoplasty

Annals of Otology and Neurotology ◽

10.1055/s-0037-1608754 ◽

2018 ◽

Vol 01 (01) ◽

pp. 023-028

Author(s):

Sreerama Boddepalli ◽

Rajesh Boddepalli

Keyword(s):

Gas Exchange ◽

Tympanic Membrane ◽

Eustachian Tube ◽

Middle Ear ◽

Normal Mucosa ◽

Tympanic Membrane Perforation ◽

Middle Ear Mucosa ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Middle Ear Cleft

Abstract Background Simple closure of tympanic membrane perforation is not a successful myringoplasty. It has to obey a lot of functional aspects of the middle ear cleft. Certain factors play a role in failure cases. The endoscopic functional myringoplasty or tympanoplasty is a clear visualization of all the parts of the middle ear; examination and removal of the disease from the hidden parts of the middle ear, examination of inter-attico-tympanic diaphragm; and removal of blocks, if any, in isthmus, to reestablish the gas exchange pathways and finally preserve the middle ear mucosa at maximum to further restore the ventilation. Methods Endoscopic tympanoplasty was performed in 100 patients with large tympanic membrane perforations and patent eustachian tube, using 4-mm “0” and “45” degree endoscopes by proper visualization of the tympanic diaphragm and isthmus in every patient and clearing its blockage if present. Results Among the 100 patients, 78 had epitympanic diaphragm blockage at the level of isthmus, 5 patients were found with closed tensor tympani folds, both vertical and horizontal without any ventilatory routes in them. Although in all the patients the eustachian tube was patent, we found majority of them had a dysventilation at the level of the epitympanic diaphragm. Thus, by performing endoscopic ventilatory pathway clearance and tympanoplasty, we achieved 94% positive results. Conclusion Epitympanic diaphragm is a functional barrier between upper and lower compartments of the middle ear cleft, which play important role in the ventilation and partial pressure regulation, blockage of its isthmus may lead to tympanic membrane retractions and perforations. With the aid of endoscopes of various degrees, removing any pathological blocks, recreating proper ventilation, reestablishing gas exchange mechanism, and maximum preservation of normal mucosa for the gas exchange are the aims of an endoscopic functional tympanoplasty procedure.

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Eustachian Tube Function and Retraction of the Tympanic Membrane

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894800890s318 ◽

1980 ◽

Vol 89 (3_suppl) ◽

pp. 65-66 ◽

Cited By ~ 1

Author(s):

Jörgen Holmquist ◽

Ulf Renvall ◽

Pål Svendsen

Keyword(s):

Tympanic Membrane ◽

Eustachian Tube ◽

Middle Ear ◽

Air Pressure ◽

Eustachian Tube Function ◽

Present Material ◽

Pressure Equalization ◽

Air Volume ◽

Middle Ear Cholesteatoma ◽

Tube Function

The medial displacement of the tympanic membrane or the retracted tympanic membrane is a common clinical finding. Also, retractions are looked upon as the precursor of middle ear cholesteatoma. In current otologic literature there seems to be some dispute whether the retractions of the tympanic membrane are caused by negative intratympanic air pressure or by shrinkage of middle ear adhesions pulling the tympanic membrane or part of it medially. In this study only ears with posterior/superior retractions of the tympanic membrane were investigated. Tympanometry revealed that only 33% of the ears did have middle ear pressure within ± 100 mm H2O. After insertion of a polyethylene tube through the tympanic membrane, the eustachian tube function was tested using the air pressure equalization technique. None of the ears could change the negative air pressure upon swallowing. Planometric measurements on the x-ray of the mastoid air cell system of the present material deviate from those of a normal material, indicating a significantly smaller air volume in the present material. It may be concluded that dysfunction of the eustachian tube and a small air volume of the mastoid are characteristic features of an ear with posterior/superior retraction of the tympanic membrane.

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