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Otology
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Jameel Muzaffar, Chloe Swords, Adnan Darr, Karan Jolly, Manohar Bance, Sanjiv Bhimrao
Background: Eustachian tube (ET) problems are common, sometimes difficult to diagnose and often difficult to improveThe ET has three main functions: (i) pressure equalisation and ventilation of the middle ear, (ii) mucociliary clearance of middle ear secretions and (iii) protection of the middle ear from sounds, pathogens and secretions from the nasopharynxMay be acute (<3 months) or chronic (>3 months)The three main subtypes of ETD are (i) dilatory ETD (typically functional obstruction, muscular failure or anatomical obstruction), (ii) baro-challenge induced ETD and (iii) patulous ETDPatulous eustachian tube (PET) describes a widely open ET causing increased air transfer into ME typical symptoms are: Autophony, aerophony, aural fullness
Acute Otitis Media and Otitis Media With Effusion in Adults
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
OME may also arise due to acquired dysfunction of the Eustachian tube, most notably, radiotherapy to the head and neck has a strong dose-related relationship with OME. Equally, in patients with prolonged sedation (and consequent lack of swallow), there is a very high incidence of OME. This is also seen in patients with ciliary dysfunction such as smokers and patients with primary ciliary dyskinesia. Barotrauma and hyperbaric oxygen therapy may also cause ETD and consequent OME, but this typically resolves spontaneously. OME has also been associated with sniffing to suppress patulous eustachian tube symptoms.
Eustachian Tube Dysfunction
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
A patulous Eustachian tube (PET) (tuba aperta, hyperpatent ET) may lead to an enormous reduction in quality of life. Symptoms of PET include autophony, breath synchronous tinnitus, pressure sensation in the ear, and hearing loss. In combination with so-called ‘sniffing’, it may rarely lead to the development of cholesteatoma.41 Due to the diffuse symptoms, the correct diagnosis of this disease and especially the distinction from obstructive ETD can be challenging. The movement of the tympanic membrane in synchrony with respirations is not always present but is diagnostic when seen. PET disorders may occur in two types: the PET type, in which the lumen remains anatomically open, even at rest. The other type, the semi-patulous Eustachian tube, is a less severe form. In the latter the tube lumen is anatomically closed at rest but, due to low tubal resistance to airflow, it may open during exercise. It may then become patent due to a decrease in peritubal extracellular fluid volume attributable to disease, exercise, weight loss (leading to reduction of Ostmann’s fat pad which lies inferomedial to the ET) or concurrent medical treatment for another condition.
Silicone plug insertion for treatment of refractory patulous eustachian tube after irradiation
Published in Acta Oto-Laryngologica Case Reports, 2020
Patulous Eustachian tube (PET) is a disease caused by pathological increase of the tubal patency, and is characterized by its aural symptoms such as voice- and breathing-autophony and aural fullness, which change with posture. These symptoms may greatly worsen quality-of-life (QOL) in some cases. One-third to a half of these patients are idiopathic, however, it is well-known that nasopharyngeal scarring after radiation therapy or adenoidectomy leads to PET [1]. In most PET cases, the increase in patency is subtle and reversible, so symptoms can be controlled using conservative treatments. But in cases with massive and irreversible change in the tubal tissues, conservative treatments are usually ineffective. There have been a variety of surgical trials for refractory PET [2]. Among them, tubal plugging with a Kobayashi plug is safe and less-invasive with excellent outcomes [3]. In this study, the plugging surgery was performed for PET after radiotherapy for nasopharyngeal carcinoma (NPC).
Plug size selection protocol for the treatment of intractable patulous Eustachian tube with Kobayashi Plug
Published in Acta Oto-Laryngologica, 2019
Ryoukichi Ikeda, Toshiaki Kikuchi, Yoshinobu Kawamura, Hiromitsu Miyaaki, Tetsuaki Kawase, Yukio Katori, Toshimitsu Kobayashi
The Eustachian tube (ET) is the connection between the middle ear cavity and the nasopharyngeal space. ET functions include regulating pressure between the middle ear and the surrounding condition, clearance of middle ear secretions, and protecting the ear from reflux of nasopharyngeal contents. Patulous Eustachian tube (PET) is a condition in which the ET is abnormally open. PET patients report symptoms such as aural fullness and autophony of voice or breathing sounds due to a persistent opening of the ET [1]. Several management strategies, including conservative therapy and surgical procedures, have been used for its treatment [2]. Most cases of PET can be controlled by explaining the disease mechanism to the patient, providing reassurance and performing conservative therapy. In contrast, patients with severe PET require more invasive treatments to control their symptoms [2].
The expression of thymic stromal lymphopoietin in patients and animal models with eosinophilic otitis media
Published in Acta Oto-Laryngologica, 2018
Tomoya Miura, Atsushi Matsubara, Naomi Kudo, Ryutaro Hara, Junko Takahata, Akira Sasaki
Research of middle ear allergy using animal models was conducted about three decades ago. At that time, the eustachian tube was reported to act as a ‘gatekeeper,’ limiting the entry of most substances into the tympanic cavity, although type-I allergic reactions in the middle ear were reported [17]. However, Iino et al. identified more cases of patulous eustachian tube, which allows the entry of antigenic substances into the tympanic cavity, in patients with EOM compared with the controls [18]. Indeed, a recent report described the presence of antigen-specific IgE for house dust mite, fungi, and staphylococcus enterotoxins in the MEE [19]. Morphologically, the epithelium cilia is present in the eustachian tube and around the tympanic ostium, similar to airway epithelium, but the tympanic epithelium loses the cilia and takes a different form farther away from the eustachian tube. In the present study, TSLP immunoreactivity was found in the epithelium around the eustachian tube, indicating that EOM is a kind of airway allergy and supporting the concept of ‘one airway, one disease’.