Concept: Patulous Eustachian tube
The development of minimally invasive procedures such as the balloon dilation Eustachian tuboplasty (BET) is an alternative to the grommet tympanum membrane. BET is applied in the cases where, after elimination of all factors influencing the ET and middle ear functioning, no sufficient improvement is observed. The aim of this study was to present the therapeutic benefits of the BET method in the treatment of ETD caused by disorders in the middle ear ventilation. The BET procedure was offered to four patients (3 men and 1 woman) after subjective, physical, otorhinolaryngological and audiometric examinations including pure tone audiometry, tympanometry and pressure-swallow test. As the method was novel, preinterventional CT angiography of the carotid arteries was performed in all patients. Any complications were noticed during and after the procedure (bleeding or damage of regional mucosa) in any patients. Our clinical studies assessed the feasibility and safety of the BET during a short-term period-only a 6-week observation. Although patients revealed a significant improvement of ET score, longer long-term studies are necessary to determine whether this method will demonstrate lasting benefits and safety in the treatment of chronic Eustachian tube dysfunction. In other investigations, improvement was found to be time dependent.
Sufficient diagnostic tools and effective therapies for chronic obstructive eustachian tube dysfunction are lacking.
Patulous eustachian tube remains a challenging management problem in otolaryngology. The autophony experienced by this patient population can be severe, and as yet no reliable surgical method exists to reduce or eliminate this annoying symptom. Our objective was to develop a novel endoscopic technique to assist these patients.
Eustachian tube dysfunction is a common problem and transnasal endoscopic balloon dilation of the Eustachian tube (ET) is a new surgical technique. The goal of this study is to review the evolution of this novel technique and study the preliminary outcomes.
Eustachian Tube Dysfunction is common, and implicated in persistent middle ear disease. Recent studies suggest the promise of balloon dilatation of the Eustachian tube to modify local anatomy and physiology, restoring normal function.
OBJECTIVE: The Eustachian tube is difficult to evaluate because it is located deep in the head. However, the introduction of 320-row area detector CT has made it possible to evaluate this region. In the present study, movement of the Eustachian tube during sniffing was visualized using area detector CT in patients with patulous Eustachian tube. METHODS: Four patients with patulous Eustachian tube were examined using an area detector CT scanner (Aquilion ONE, Toshiba). This scanner supports 320-row scanning of 0.5-mm slices at up to 0.275 s/rot., eliminating temporal mismatch between various parts of the acquired images and permitting 4-dimensional CT (4DCT) images to be obtained by continuous scanning. The scan conditions were 120 kV, 120 to 150 mA, 0.5 mm × 280 to 320 slices, and 0.35 seconds per rotation × 9 rotations. The patient was seated on a reclining chair tilted to 45 degrees and was instructed to sniff during continuous scanning. Images of the Eustachian tube were generated at 0.1-second intervals. CONCLUSION: At the start of sniffing, the cartilaginous portion of the Eustachian tube closed from the isthmus toward the pharynx. The starting point differed from patient to patient. In patients with patulous Eustachian tube, sniffing (an unconscious habit that helps to relieve ear discomfort) is an important factor in the development of middle ear diseases. We have successfully depicted this event for the first time, demonstrating various patterns of Eustachian tube closure during sniffing in patients with patulous Eustachian tube. This method may be useful for evaluating Eustachian tube dysfunction.
To investigate the evidence for balloon dilatation of the eustachian tube using a transtympanic approach.
A 20-year-old man presented with a history of popping sounds in both ears during deep breathing. Audiometry showed normal hearing. Otoscopy revealed indrawn and severely atrophic eardrums that moved outward on nasal expiration and inward on inspiration, shown in a video.
Baro-challenge-induced Eustachian tube dysfunction (baro-induced ETD) is characterized by failure of the Eustachian tube (ET) to open adequately to permit middle-ear pressure regulation during ambient pressure changes. There are no well-characterized tests for identifying the condition, which makes both patient diagnosis and research into treatment efficacy challenging. This systematic review evaluates ET function tests as potential outcome measures for baro-induced ETD.
Objective: By comparing the clinical characteristics of patulous Eustachian tube with habitual nasal extraction and those of non-Eustachian tube abnormalities, we aimed to investigate the relationship between patulous Eustachian tube and acquired cholesteatoma of middle ear. Methods: A total of 218 patients in Affiliated Hospital of Qingdao University from November 2011 to November 2016 who underwent surgical treatment and with complete data of acquired cholesteatoma of middle ear were enrolled. The patients were divided into two groups: patulous Eustachian tube with habitual nasal extraction and non-Patulous Eustachian tube. Their ages of onset , sides, characteristics of acoustic immitance, clinical manifestations, prognosis and complications were compared. The statistical analysis was carried out with SPSS 19.0 software. Results: Among the 218 cases of acquired cholesteatoma of the middle ear, 22 cases were diagnosed as patulous Eustachian tube with habitual nasal extraction [with average age of (35.7±7.5) years]; 196 cases were diagnosed as non-patulous Eustachian tube [with average age of (47.8±20.1) years]. The average age of the patulous Eustachian tube with habitual nasal extraction was significantly lower than that of the non-patulous Eustachian tube group (t=4.25, P<0.01). Ratio of bilateral middle ear cholesteatoma in patulous Eustachian tube [68.2%(15/22)] was significantly higher than that of the non-patulous Eustachian tube group [18.9%(37/196)] (χ(2)=26.47, P<0.01). Conclusions: Some acquired cholesteatoma patients are associated with the patulous Eustachian tube with habitual nasal extraction. The patients have a lower age, and are susceptible for bilateral middle ear cholesteatoma.