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ABSTRACT: Impaired opening and closing functions of the Eustachian tube are considered to be pathogenic factors in secretory otitis media (SOM). As the clinical course of SOM is variable, the variability of tubal function is of interest. We aimed to explore the short- and long-term variability of tubal opening and closing functions in SOM. The study comprised 42 ears in 21 children (13 males and 8 females) with tympanostomy tubes due to SOM. The middle ear pressure was recorded during repeated passive forced openings, equalization of + 100 daPa and - 100 daPa by swallowing, Valsalva inflation and forceful sniffing. Test sessions were performed twice (separated by 30 min) on each of 2 days, with a mean interval of 3.7 months in between. In the forced opening test there was a considerable intra-individual variability over time. Expressed as SD of the mean, the variability of the forced opening and closing pressures in individual ears was on average 15% and 23%, respectively, between sessions and 20% and 30% respectively, between test days. In the equalization, Valsalva and sniff tests the rates of responses that changed from positive to negative between sessions and test days ranged from 12% to 33%. Female gender and retraction pockets were related to poorer opening function in the forced opening test. Ears with serous effusion (in contrast to mucoid) showed a similar trend and also a lower occurrence of positive equalization, Valsalva and sniff tests. It was concluded that Eustachian tube opening and closing functions are highly variable in ears with SOM. Consequently, single tubal function tests have low value when used as a prognostic tool in individual ears.
Acta Oto-Laryngologica 10/2000; 120(6):716-23. · 1.08 Impact Factor
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ABSTRACT: To explore the short-term and longterm variability of tubal opening and closing in ears with advanced retractions and in healthy ears.
Twenty ears with retraction type middle ear disease (R-MED) and 20 normal ears underwent direct recording of the middle ear pressure during repeated forced openings, equalization of +100 daPa and -100 daPa by swallowing, Valsalva inflation, and forceful sniffing. Tests were performed twice (separated by 30 min) on each of 2 days separated by 3 to 4 months.
There was considerable intraindividual variability of the forced opening pressure and the closing pressure in both groups, within as well as between sessions and test days. Although the variability was 1.5 to 2 times higher in ears with retraction than in the normal group, mean Po and Pc did not differ between the groups. Compared with normal ears, ears with retraction changed more frequently from a positive to negative test response, or vice versa, when re-tested after 30 minutes. Rates of positive response in the equalization and Valsalva tests were significantly lower in diseased ears compared with normal ears.
Eustachian tube opening and closing functions vary more in ears with retraction disease than in normal ears, which is consistent with the variable clinical course of R-MED and implies that single tubal function tests have little prognostic value on the individual level.
The Laryngoscope 09/2000; 110(8):1389-95. · 1.75 Impact Factor
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ABSTRACT: Despite the variable clinical course of diseases related to Eustachian tube function, the variability of tubal function has been less focused than outcomes of single tests. This study aimed to compare the passive and active tubal function and its variability in children with secretory otitis media (SOM) at tube insertion and at follow-up.
Thirty-eight ears in 19 children aged 4-10 years (mean 7.0 years) with long-standing SOM were examined 4-6 h after tube insertion, at 4 months and at 9 months. The pressure in the middle ear and the nasopharynx were recorded while performing (1) forced opening test, (2) equalization of +100 and -100 daPa, (3) Valsalva test, and (4) sniff test. The procedure was repeated after 30 min. Relationships were analyzed by uni- and multi-variate analysis of variance.
From tube insertion to 4 months, the mean forced opening pressure increased from 282+/-128 to 355+/-153 daPa (P<0.01), and the mean closing pressure from 91+/-51 to 126+/-82 daPa (P<0.01). There was no further change at 9 months. Female gender, serous effusion (in contrast to mucoid), and more than three previous episodes of acute otitis media were related to higher opening and closing pressures. At tube insertion, 60% and 16% equalized +100 and -100 daPa, respectively, and 28% succeeded in performing Valsalva inflation. The sniff test was positive in 32%, indicating a closing failure. These rates did not change significantly over time. For individual ears, outcomes of all tests varied considerably when retested after 30 min; P(o) changed by +/-12% and P(c) by +/-26%, and 9-29% of the ears changed from a positive to negative response, or vice versa, in the equalization, Valsalva, and sniff tests.
The unexpected finding of weaker closing forces at the day of tube insertion and increased tubal resistance at follow-up might be ascribed to changes in the muco-adhesive forces related to the disease and tube treatment. The pronounced intra-individual variability of test outcomes indicates that tubal function is dynamic and variable in ears prone to SOM, which emphasizes that results of single tubal function tests have very low prognostic value.
International Journal of Pediatric Otorhinolaryngology 04/2000; 52(2):131-41. · 1.17 Impact Factor
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ABSTRACT: Transient sound disturbances are common but neglected symptoms in retraction type middle ear disease (R-MED). The aim of this study was to explore and describe their character, their individual consequences, and their role in the development of tympanic membrane retractions.
Fifty-three subjects with manifest retractions and experiences of disturbing sound and ear sensations were interviewed. A qualitative method was used for analysis of the transcribed interviews.
Two different patterns emerged from the interviews. 1. Too weak sound was the least common and most tolerable disturbance. It occurred in 45% and was eliminated by Valsalva's inflation. 2. Sudden and transient sensations of too loud and piercing sound, and intermittent autophony frequently caused intense and intolerable discomfort, which might in turn cause loss of control of speech and conversation. These types occurred in 74% and 60%, respectively, and were eliminated by evacuating the middle ear, for example by sniffing. Subjects who described too loud sound or intermittent autophony commonly preferred a retracted tympanic membrane position. This may explain why pressure equalization by swallowing, and inflation by Valsalva's manoeuvre often elicited discomfort.
Transient experiences of too loud sound or intermittent autophony may indicate a shift of sound preference towards the sound experienced at negative middle ear pressure, and an unreliable tubal function in the sense that it fails to stay closed to protect the ear from sounds and pressure variations in the nasopharynx. Such experiences of altered sound may trigger evacuation of the middle ear, which eliminates the sound disturbance. It is crucial to identify, interpret, and explain the disturbances correctly in the therapy and prevention of retractions, since habitual evacuation exposes the tympanic membrane to strong negative pressure loads and a subsequent risk of developing retraction.
International Journal of Pediatric Otorhinolaryngology 12/1999; 51(1):11-21. · 1.17 Impact Factor
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Lakartidningen 01/1998; 94(49):4633-8.
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ABSTRACT: Different tympanometric procedures were compared regarding their reliability and systematic differences in middle ear pressure estimation in healthy adults. In a second part of the study the accuracy of measurement was judged by correlating tympanometric readings, obtained by using the different procedures, with known pressure levels applied after cannulating the mastoid air cell system. There were no significant differences in reliability between the different tympanometric procedures tested (p greater than 0.05). However, forward-backward tracing tympanometry and 'zero sweep rate' tympanometry gave smaller errors in the middle ear pressure estimates than the conventional decreasing pressure sweeps. Forward-backward tracing tympanometry at high sweep rate is recommended both for pressure measurements during physiological studies and in clinical practice.
Scandinavian Audiology 02/1990; 19(3):183-6.
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ABSTRACT: The eustachian tube is an essential part of the pressure regulating system of the middle ear. The physiologic function of the tube is to equalize the middle ear pressure with that of the atmosphere, and at the same time make the middle ear independent of the nasopharyngeal environment with its loud sounds, extensive respiratory pressure changes, and potentially harmful bacterial flora. Thus, the protective closing action is essential in the normal physiology of the eustachian tube, and lack of protection is central in tubal malfunction. We have come to consider eustachian tube closing failure and the subsequent induction of negative middle ear pressure as an important causative factor in the development of chronic ear disease, for example, persistent middle ear effusion and manifest retraction of the tympanic membrane. Here, the patient's behavior may be of more importance than the simple tubal mechanics. In the presence of tubal closing failure, if the patient sniffs habitually, the middle ear cavity will be evacuated repeatedly. This constitutes a repetitive barotrauma which may have secondary effects. As a result of the negative pressure the tympanic membrane retracts, and increased transudation and secretion of fluid may give rise to effusion. Tubal closing failure also implies reduced protection against ascending infection with increased susceptibility to acute otitis media. Repeated sniff-induced barotrauma and repeated purulent infection may together be responsible for the development of manifest structural lesions seen in chronic ear disease. Is it possible to determine the function of the eustachian tube? This question is crucial since it is difficult or impossible to give normative values for tubal function tests. The variability of tubal responses with time has been found to be considerable. Thus, the result of a test represents only one specific moment in time, having little prognostic value. Tubal function is a continuous and composite variable that cannot be "determined" according to a static scheme. Our knowledge of eustachian tube physiology is still fragmentary, and continued study is necessary in order to learn more. Presently, tubal function tests have little value from the clinical viewpoint. When a tympanoplastic procedure is considered, the need for surgery should be determined by the clinical judgment based on the otomicroscopic findings and the hearing. In the case of a central perforation of the eardrum the prognosis for hearing is good, irrespective of results obtained in tubal function tests.(ABSTRACT TRUNCATED AT 400 WORDS)
Otolaryngologic Clinics of North America 12/1984; 17(4):659-71. · 1.65 Impact Factor
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ABSTRACT: Previous research on eustachian tube function has been devoted mainly to the study of the tubal opening ability and pressure equalization. This article summarizes a series of experimental studies focusing on the closing ability of the tube. Results support the belief that the purpose of the tube should be seen primarily as protecting the middle ear from the extensive pressure variations that physiologically take place in the nasopharynx. A number of studies of diseased ears have shown that tubal malfunction was characterized mainly by a reduced ability to withstand negative pressure in the nasopharynx. Sniffing can evacuate the middle ear, causing high negative intratympanic pressure. It seems likely that this mechanism is involved in the development of middle ear effusion and manifest retraction-type middle ear disease.
Otolaryngology Head and Neck Surgery 07/1984; 92(3):312-8. · 1.72 Impact Factor
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ABSTRACT: One important role of the Eustachian tube is to protect the middle ear from the extensive physiological pressure variations that take place in the nasopharynx, for example on sniffing. In a previous investigation in 50 children with persistent middle ear effusion a surprisingly high percentage of ears were evacuated by sniffing. The present study was undertaken in a second series of children, and results were found to be reproducible. In total 156 ears in 100 children have been investigated. In 63% of ears (73% of subjects) evacuation of the middle ear took place on sniffing. Results show that Eustachian tube malfunction in these subjects is characterized by a reduced protective function; a condition denoted "Eustachian tube closing failure".
International Journal of Pediatric Otorhinolaryngology 06/1984; 7(2):97-106. · 1.17 Impact Factor
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ABSTRACT: Previous studies in patients with middle ear disease have shown that high negative pressure is frequently induced actively in the middle ear cavity by sniffing. The present study concerns 84 ears in 42 patients with cleft palate and middle ear disease. Sniff-induced evacuation of the middle ear was studied by direct pressure recording or tympanometry. Sixty-one percent of diseased ears showed tubal closing failure; 18% had constantly or intermittently wide-open tubes. In most cases, negative intratympanic pressure was not equalized on swallowing. It is suggested that eustachian tube malfunction in patients with cleft palate is constituted by the combination of closing failure with evacuation of the middle ear on sniffing, and by a secondary opening failure with inability to equalize the sniff-induced negative intratympanic pressure.
Archives of otolaryngology (Chicago, Ill.: 1960) 02/1984; 110(1):10-4.
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ABSTRACT: In our previous studies on eustachian tube function in children with middle ear effusion, we found that many ears were evacuated by the act of sniffing. When subjects were tested repeatedly, however, responses to sniffing were very variable. In order to study the spontaneous variability, a total of 51 subjects (81 ears) were retested. The results of the retest were very similar to those of the first test when all the ears were considered as a group. However, in individual ears pronounced variability was seen. In the sniff test, responses changed qualitatively in 30% of the ears, and in 27% of the ears there was a change in the ability to equalize pressure by swallowing. Thus, the results of the group were highly reproducible, while at the same time individual results were highly variable with time.
Archives of Oto-Rhino-Laryngology 02/1984; 240(2):145-52.
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ABSTRACT: Our traditional concepts relating to the development of middle ear disease are based on the assumption that obstruction of the Eustachian tube with reduced ventilation of the middle ear space leads to the development of high negative pressure in the middle ear and, ultimately, to the development of middle ear disease. This hypothesis, which focuses on Eustachian tube opening failure, has not been verified satisfactorily. Results of recent studies indicate that another approach to the problem can lead to a better understanding of the Eustachian tube pathophysiology leading to the development of ear disease. Direct measurements of middle ear pressure in patients with manifest ear disease have revealed that high negative intratympanic pressure is generated by the voluntary act of sniffing. This type of Eustachian tube malfunction is thus characterized by Eustachian tube closing failure. The repetitive barotrauma induced by sniffing or reverse Valsalva maneuvers seems to be a basic predisposing factor in the development of recurrent middle ear effusion and chronic middle ear disease, including adhesive otitis and cholesteatoma.
The Journal of otolaryngology 07/1983; 12(3):187-93. · 0.50 Impact Factor
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Lakartidningen 02/1983; 80(4):224-7.
