The rat eustachian tube:Anatomical, histological, and radiological features

Purpose: This study investigated the anatomical and histological characteristics of the rat Eustachian tube(E-tube)and the feasibility of Eustachian tubography in a rat model.Materials and methods: Fifteen male Wistar rats were used in this study, and the bilateral E-tubes of each rat were examined. Ten E-tubes were used for anatomical studies, another ten for histological analysis, and the other ten for Eustachian tubography. Five rats were euthanized and decapitated, and ten E-tubes were dissected to describe the anatomy of the E-tube. Ten E-tube specimens obtained from five other rats were sectioned to investigate Etube histology. Eustachian tubography was performed on the bilateral E-tubes of the other five rats using the trans-tympanic approach.Results: The rat E-tubes consisted of bony and membranous parts. Cartilage and bone tissue covered only the bony part. The E-tubes’ mean diameter and overall length were 2.97 mm and 4.96 mm, respectively. The tympanic orifices’ mean diameter was 1.21 mm. The epithelium of E-tubes was mainly composed of pseudostratified ciliated and goblet cells. Eustachian tubography was successfully performed on both sides of the E-tube for each rat.The technical success rate was 100%, the average running time was 4.9 min, and no procedure-related complications occurred. On tubography images, the E-tube, tympanic cavity, and nasopharynx could be identified because of the visualization of bony landmarks.Conclusion: In this study, we described the anatomical and histological features of rat E-tubes. With the aid of these findings, E-tube angiography was successfully performed using a transtympanic approach. These results will facilitate further investigation of E-tube dysfunction.

THE EFFECT OF EXOGENOUS SURFACTANT ON THE EUSTACHIAN TUBE FUNCTION IN THE GERBIL MODEL OF SECRETORY OTITIS MEDIA

Objective To investigate the effect of exogenous surfactant on Eustachian tube opening function. Methods This reasarch measures for the Eustachian tube opening pressure by injection of surface active substance into middle ear space, studying the effect of surfactant on Eustachian tube opening function. Results It has been showed that the injection of killed streptococcus pneumoneac bacteria by the transtympanic route, successfully developed a secretory otitis media model. Eustachian tube opening pressure in ears with SOM was significantly greater than those without effusion ( P <0.01). Irrigation the middle ear space with surfactant resulted in a dramatic decrease in eustachian tube passive opening pressure in both normal and patients ( P <0.01). Conclusion The results indicate that flushing with exogenous surfactant by the transtympanic rote reduce of eustachian tube surface tension, and it benefits the Eustachian tube opening.

Eustachian tube teratoma: A case report

BACKGROUND Mature teratoma composed of all three basic germ cell layers of the head and neck is a rare disease.Teratomas involving the temporal bone are particularly scarce.CASE SUMMARY A 48-year-old male patient with a history of chronic otitis of the left ear from infancy,for which he had been operated on twice,was referred to our hospital for chronic otitis,cholesteatoma and a middle ear mass.Computed tomography(CT)scan and magnetic resonance imaging(MRI)revealed a eustachian tube teratoma,in which the anterior lower part and posterior upper part were connected by a thin membranaceous tissue.The mass was removed completely under general anesthesia by mastoidectomy.As of last follow-up(2 years post-surgery),the disease had not relapsed.CONCLUSION Pre-operative CT and MRI are necessary for eustachian tube teratoma.Complete surgical resection provided excellent prognosis.

Eustachian tube involvement in a patient with relapsing polychondritis detected by magnetic resonance imaging:A case report

BACKGROUND Relapsing polychondritis(RP)is a rare inflammatory disease involving the systemic cartilage,such as the auricle,trachea,and bronchiole,among others.A patient with RP shows variable symptoms based on the involved cartilage.CASE SUMMARY A 72-year-old Japanese woman with a history of redness of the bilateral auricles for 3 d was referred to a clinician.The clinician prescribed antibiotics to the patient;however,the symptoms worsened;thus,she was referred to our hospital.Head and neck magnetic resonance imaging(MRI)showed edematous auricle with remarkable contrast,fluid collection in the bilateral mastoid cells,suggesting otitis media.The eustachian tube(ET)on the right side was also edematous with contrast enhancement.The patient was suspected of RP according to the diagnostic criteria.A biopsy of the auricular cartilage was performed by an otorhinolaryngologist,confirming pathological proof of RP.Treatments with steroids were immediately administered thereafter.CONCLUSION We highlight a rare case of RP with radiologically confirmed involvement of ET in the MRI.

Balloon dilation of Eustachian tube combined with tympanostomy tube insertion and middle ear pressure equalization therapy for recurrent secretory otitis media

Objective: To report outcomes of balloon dilation Eustachian tuboplasty combined with tympanostomy tube insertion and middle ear pressure equalization therapy in treatment of recurrent secretory otitis media. Methods: Fifty one patients with recurrent secretory otitis media (62 ears) underwent balloon dilation of Eustachian tube and tympanic tube insertion under general anesthesia, followed by long term middle ear pressure equalization therapies. The Eustachian tube score (ETS) and Eustachian tube function questionnaire (ETDQ-7) were used for pre- and postoperative (up to 12 months) evaluation of Eustachian tube functions. Results: The mean ETS score was 2.34 ± 0.97 preoperatively, and 6.17 ± 1.54, 7.23 ± 1.62, 8.24 ± 1.97, and 7.63 ± 1.86 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). The ETDQ-7 score was 4.82 ± 1.07 preoperatively, and 2.20 ± 0.54, 2.32 ± 0.68, 2.53 ± 0.79, and 2.67 ± 0.76 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). Conclusion: Balloon dilation of Eustachian tube combined with tympanostomy and catheterization resulted in significant improvement of subjective symptoms and objective evaluation of Eustachian tube functions in most patients with recurrent secretory otitis media, as indicated by the ETS and ETDQ-7 scores, demonstrating high levels of efficacy and patient satisfaction.

Tympanometry, a Prognostic Indicator of Myringoplasty with Assessment of Eustachian Tube Function

Objective: To determine Eustachian tube function in tubotympanic type of chronic ear disease and to correlate Eustachian tube function with pathological change in middle ear mucosa. Materials and Methods: A prospective study of the cases of tubotympanic type of chronic suppurative otitis media was undertaken. Patients were subjected to clinical examination followed by audiometry tests and impedence audiometry to determine eustachian tube functions. Patients were then subjected to myringoplasty and eustachian tube function were then reassessed post operatively. Results: In our study, out of 30 cases who underwent myringoplasty, 21 cases had successful surgical outcome and 9 cases were failed. Out of 24 cases of good Eustachian tube function, 21 cases had successful surgical outcome intends of taking up graft, absence of otorrhea and improvement in hearing. In remaining 3 cases, there was recurrence of otorrhea with central perforation. All the 6 cases with poor Eustachian tube function had surgical failure. Conclusion: The prognosis of the middle ear reconstructive surgery has direct correlation with Eustachian tube functions and Eustachian tube function tests should be a routine investigation in all the cases planned for surgical reconstruction of the middle ear.

Patulous Eustachian tube (PET), a practical overview

Symptoms of patulous Eustachian tube(ET),particularly autophony,can overlap with other conditions,and can arise from a variety of causes.We review the pathophysiology of“speech hyper-resonance syndromes”,and possible mechanisms,including resonances in the tympanic membrane,Eustachian tube and nasopharynx.Treatment can be directed at the eardrum or the ET depending on site of pathology.We review typical presentations,examination findings,and useful clinical tests to distinguish PET from other disorders,and our philosophy of management.

Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review

Objectives:Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments.This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sources:A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language.References of included studies were checked.Methods:A systematic review was undertaken.Outcomes assessed were:primary outcomes-subjective improvement in symptoms(ETDQ-7),audiometric improvement of hearing,improvement of negative middle ear pressure noticed in tympanometry,objective improvement of tympanic membrane retraction.Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e.Valsalva manoeuvre,improved quality of life,passive tubal opening,tubomanometry,swallowing test,reduction in mucosal inflammation of Eustachian tube orifice in the nose,complications from the procedure,the need for further procedures.Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.Results:Three studies were included.All included studies were small-scale case series(13-38 par-ticipants).Studies were conducted outside the UK.Subjective and objective improvement of Eustachian tube function was reported in all studies.But all included studies were at high risk of bias and subject to multiple limitations.No major complications were reported in either study.Conclusions:Based on current evidence,it is not possible to recommend the clinical use of either of these two interventions i.e.Laser or Microdebrider Eustachian tuboplasty.Lack of controlled studies was identified as a gap in the evidence.Future research should be directed toward designing randomised controlled trials.These trials should use strict standard methodology and reporting criteria.Future trials should make use of consensus statement document about Eustachian tube dysfunction definition,diagnostic methods,and outcome assessment criteria to design clinical trials.

The status of Eustachian tube balloon dilations in Nordic countries

There is no unanimous consensus for indications of eustachian tube balloon dilation(ETBD).Nordic countries have relatively similar hospital organizations and treatment guidelines.Therefore,it was logical to organize a consensus meeting of ETBD.The symposium:Nordic Experiences on Eustachian Tube Balloon Dilation,in Copenhagen,30-31 March,2017.The panellists from Denmark,Finland,Norway and Sweden and the attendees of the meeting agreed a consensus on the following issues:Candidates,Definition of Eustachian Tube Dysfunction,Diagnostic Work up,Differential Diagnosis,Contraindications,ETBD Procedure,Complications,Follow-up,and Outcomes.The article also presents the status for ETBD in each of these countries.Thereafter the consensus statement has been discussed in the national societies and meetings for ear surgeons in each of these countries.It can be assumed that surgeons in the hospitals of these Nordic countries generally follow the recommendations from the consensus meeting.

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Objective:To evaluate the significance of Eustachian tube(ET)angles and ET pretympanic diameter on high resolution computed tomography(HRCT)Temporal bone in patients with chronic otitis media(COM).Methods:A retrospective study was carried out at Tertiary care centre.Group A included 92 ears with COM(38 patients with bilateral COM and 16 with unilateral COM);and Group B included 108 normal ears(54 patients with bilateral normal ears).Reid plane-ET angle,Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone,and compared in the two groups.Patients with chronic otitis media(Group A)were subdivided into Group A1(Blocked ET)and Group A2(Patent ET).The parameters were evaluated and compared in the subgroups too.Results:The mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41
2.57 and 148.12
3.43 respectively;whereas in Group B it was 27.56
3.62 and 145.14
4.34 respectively.Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients.ET pretympanic diameter was(5.37
2.10)mm in Group A and(6.47
2.40)mm in Group B.It was significantly less in patients with COM.A significant correlation was found between the ET patency and the two ET parameters(Reid plane-ET angle and pretympanic diameter).Conclusions:Eustachian tube angles in adults may play a significant role in the etiology of chronic otitis media.Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

Advances in Eustachian tube function testing

Obstructive and patulous Eustachian tube dysfunction provide a significant diagnostic and management challenge.The development of new treatments such as balloon Eustachian tuboplasty has generated renewed interest in measuring Eustachian tube function,as a method of selecting appropriate patients for intervention,and measuring their treatment outcomes.This review summarises recent findings relating to Eustachian tube function assessment.Increasingly it is recognised that patient reported outcome measures based on symptoms are highly non-specific and non-diagnostic,and clinical assessment alone may not permit the selection of individuals with abnormal Eustachian tube opening.Tests of Eustachian tube opening therefore may represent a practical and objective addition to patient assessment in clinic,allowing the identification of individuals with abnormal(patulous or obstructive)Eustachian tube function.A diagnostic pathway is described on this basis.More work is required to validate the described Eustachian tube function tests,and there remain individuals,such as those with dysfunction limited to pressure challenges,in whom function tests have yet to fully characterise the disorder.

Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique

Endoscopic technique in patients undergoing chronic ear surgery allows visualization of protympanic(proximal)segment of the Eustachian tube(ET).The proximal cartilaginous ET is a common site of anatomical Obstruction in chronic otitis media and it is this proximal end of ET that is being observed,instrumented and dilated with transtympanic methods.The aim of this article is to discuss our approach to the assessment of the Eustachian tube using opening pressure measurement,endoscopic assessment of the protympanic segment of ET and Valsalva CT.And also to discuss detailed technique of transtympanic Eustachian tube dilatation.

Surgical treatment of hairy polyp in the Eustachian tube

Hairy polyps are congenital masses of head and neck.They usually arise from the oropharynx or nasopharynx,and hairy polyp of the Eustachian tube （ET）is extremely rare.We describe a new case of hairy polyp,which originated from the right ET and was completely excised by a postauricular approach.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

In-office balloon dilation of the Eustachian tube under local anesthesia: A retrospective review

Objective:To study the effectiveness and feasibility of in office balloon dilation of the Eustachian tube(BDET)utilizing a novel anesthetic protocol.Study design:retrospective review.Methods:Retrospective chart review looking at the tolerability and effectiveness of standalone BDET in an office setting utilizing a novel topical anesthesia protocol in 33 patients with Eustachian tube dysfunction as defined by an ETDQ-7 score greater than 2.2 and type B or C tympanograms for greater than 3 months despite maximal medical management,including at least 4 weeks of nasal steroids.Results:BDET in the office was well tolerated with 94%(31/33)of patients completing the procedure as planned.No adverse effects or complications were reported;however,the planned dilation time was cut short in one case due to significant discomfort and aborted prior to dilation in another due significant coughing.Tympanograms normalized at six weeks in 87.1%(27/31)of patients who underwent dilation.Conclusion:This study demonstrates that performing BDET in an office setting utilizing a local anesthesia protocol is feasible and effective when the unique barometric considerations of BDET are addressed.

奥美拉唑在分泌性中耳炎合并咽喉反流患者中的治疗价值

目的:探讨奥美拉唑在分泌性中耳炎(SOM)合并咽喉反流(LPR)患者中的治疗价值。方法:选取单侧或双侧SOM合并LPR患者82例,根据治疗方案不同将患者分为治疗组(35例)和对照组(47例)。所有患者均给予鼓膜穿刺术、配合使用鼻部激素、口服黏液促排剂和抗组胺药物1个月。治疗组同时给予患者抗反流宣教及足疗程奥美拉唑抗反流干预。随访3个月,比较两组患者治疗前后气骨导差、七项咽鼓管功能障碍症状评分量表(ETDQ-7)评分及临床疗效。结果:两组治疗后第1~3个月气骨导差较治疗前降低(均P<0.05)。治疗组治疗后第1~3个月气骨导差低于对照组(均P<0.05)。两组患者治疗后第1~3个月ETDQ-7评分较治疗前降低(均P<0.05)。治疗组治疗后第1~3个月ETDQ-7评分较对照组降低(均P<0.05)。治疗后第2、3个月,治疗组总有效率高于对照组(均P<0.05)。结论:对于SOM合并LPR患者,奥美拉唑能改善咽鼓管功能,提高听力水平及SOM治疗效果。

Acute Otitis Media in Children Aged 0-5 Years, Epidemiological Aspects and Management in the Paediatrics Department of the Hospital National Ignace Deen (Conakry)

Introduction: Acute otitis media is an acute inflammation of the mucosa of the middle ear cavities. It is often secondary to nasopharyngitis, which favors the passage of infection through the Eustachian tube to the middle ear. The aim of our study was to improve the management of AOM in the Paediatric Department of the Hospital National Ignace Deen (Conakry). Patients and Methods: This was a prospective descriptive study lasting 6 months from 01 July to 31 December 2011;the study covered 525 cases out of a total of 6276 children, i.e. a frequency of 8.36%. Results: The most affected age group was 6 to 11 months. Males predominated (69.71%). 82.29% had a history of recurrent rhinopharyngitis. The most frequent reason for consultation was incessant crying (66.29%). Rhinopharyngitis and malaria were the most commonly associated pathologies (87.62% and 39.62% respectively). 72.19% of our patients were admitted with congestive AOM and received medical treatment. We recorded one case of otomastoiditis which was treated surgically. Conclusion: AOM is more common in children aged between 6 and 24 months. Good collaboration between paediatricians and ENT specialists is essential to reduce the morbidity of AOM.

Expression and Clinical Significance of Various Cytokines in Otitis Media

The expression and clinical significance of relevant cytokines in otitis media (OM) are discussed, and the alterations to the pathological state of the otitis media mucosa are further understood through the study of cytokine transduction pathways. More and more studies have shown that relevant cell proliferation and inflammation progression pathways play a role in the development of otitis media, such as the Jun amino-terminal protein kinase (JNK) mitogen-activated protein kinase (MAPK) signaling pathway, the NF-κB signaling pathway, and the PI3K/AKT/PTEN pathway, which are involved in the proliferation of the middle ear mucosa during otitis media, which affects the mucosal cilia, motor function, Eustachian tube function, and the mucosal ciliary function. These studies provide new ideas for the treatment of otitis media and further explore the feasibility of immunotherapy in the future treatment of otitis media. In this paper, we present a review of the latest research progress on the expression of various cytokines in otitis media.

咽鼓管功能对行Ⅰ型鼓室成形术的慢性中耳炎患者短期听力影响分析

目的 通过对耳内镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎患者的临床资料分析,探讨咽鼓管功能对其听力影响。方法 收集诊断为慢性化脓性中耳炎患者42例,结合声导抗正负压平衡试验和咽鼓管功能障碍评分量表(ETDQ-7)将分为咽鼓管功能障碍患者作为研究组(25例),将咽鼓管功能正常患者作为对照组(17例),对比分析两组患者手术前后听力的变化。结果 研究组术前与术后气导平均听阈、骨导平均听阈均高于对照组,差异具有统计学意义(P <0.05);研究组术后气导平均听阈和骨导平均听阈的改善值均高于对照组,差异无统计学意义(P> 0.05);研究组术后4 k Hz气导听阈改善值低于对照组,差异无统计学意义(P> 0.05);研究组术后8 k Hz气导听阈改善值低于对照组,差异有统计学意义(P <0.05)。结论 良好的咽鼓管功能不会增加Ⅰ型鼓室成形术对慢性化脓性中耳炎患者平均听力的改善程度,但有利于患者术后高频听力的恢复。

Ⅰ型鼓室成形术疗效与咽鼓管功能的相关性分析

目的探讨慢性化脓性中耳炎(CSOM)Ⅰ型鼓室成形术的疗效与咽鼓管功能的关系。方法对100例诊断为CSOM的患者行Ⅰ型鼓室成形术,根据术前咽鼓管功能测试结果分为咽鼓管功能正常组(对照组)和咽鼓管功能障碍组(观察组)。术后随访6个月,记录并分析患者的听力结果和鼓膜愈合情况。结果对照组鼓膜愈合率为91.70%(44/48),观察组为78.80%(41/52),2组差异有统计学意义(P<0.05)。对照组和观察组术后的纯音听阈(PTA)和气骨导差(ABG)均低于术前(P值均<0.05);2组患者在术前及术后6个月的PTA和ABG差异均有统计学意义(P值均<0.05),术前与术后的PTA差值和ABG差值的差异无统计学意义(P值均>0.05)。结论咽鼓管功能状态对CSOMⅠ型鼓室成形术后患者的听力恢复无显著影响,但会影响术后的鼓膜愈合率。因此,在鼓室成形术前评估咽鼓管功能是很有必要的,有助于初步预测患者术后的恢复情况。