4DCT在咽鼓管功能障碍患者咽鼓管功能评估中的应用

目的 通过4DCT(four-dimensional CT)动态评估咽鼓管功能障碍(Eustachian tube dysfuction,ETD)患者Valsava动作时的咽鼓管(Eustachian tube,ET)功能.方法 2018年11月～2019年3月期间就诊于首都医科大学附属北京安贞医院的ETD患者15例,...     

阻塞性咽鼓管功能障碍治疗进展[综述]

阻塞性咽鼓管功能障碍是常见的耳科疾病之一,由于发病机制尚未完全阐明,既往缺乏有效的治疗手段。近年来国内外开展了大量临床研究探索治疗阻塞性咽鼓管功能障碍的新方法。在本综述中,我们将结合自身经验介绍阻塞性咽鼓管功能障碍的药物治疗、吹张治疗、呼吸训练和手术治疗等方面的研究进展,并着重阐述球囊扩张技术的应用。     

First results of Endonasal dilatation of the Eustachian tube (EET) in patients with chronic obstructive tube dysfunction

For years, several surgical and non-surgical therapeutic strategies in Eustachian tube dysfunction have been described. The Endonasal dilatation of the Eustachian tube (EET) utilising a balloon catheter is a feasible option in patients with symptoms of chronic obstructive Eustachian tube dysfunction. However, long-term results in a large series are missing. In a prospective case series, 217 patients (342 cases) with symptoms of chronic Eustachian tube dysfunction underwent uni- or bilateral EET at the ENT Department of the University of Hamburg, Germany, between September 2010 and April 2013. A tube score consisting of the type of tympanogram and the R value of the tubomanometry was used to evaluate pre- and postoperative tube function. All patients underwent follow-up with a post-operative interval of 3–12 months. The mean value of the pre-treatment tube score was 2.23 ± 1.147 and significantly improved to 2.68 ± 1.011 1  year after EET. There was a significant increase in the tube score during follow-up. The co-variables time period, tympanoplasty and pressure range showed a significant impact on the tube score. EET is a minimally invasive and effective treatment of chronic obstructive tube dysfunction. It is a safe procedure without causing significant complications. Nevertheless, long-term results of larger, placebo-controlled multicentre studies are needed to confirm its effectiveness.     

咽鼓管功能障碍研究进展

咽鼓管功能与中耳相关疾病的发生发展及手术密切相关,一直受到广泛重视,咽鼓管功能障碍的诊断、治疗及疗效评估仍存在争议。本文通过对咽鼓管的解剖和生理功能、咽鼓管功能障碍的分类和临床表现进行归纳,旨在对咽鼓管功能障碍与中耳相关疾病的发生发展提出思路,其功能评估方法和治疗尚需要更多大样本、多中心的长期研究来取得突破。     

Aerodynamic pattern of Eustachian tube dysfunction

Detailed aerodynamic patterns for various disorders of the Eustachian tube function were reported. Simultaneous recording of the pressure in the ear canal and the pharyngeal cavity during Valsalva's maneuver and deglutition permitted an objective evaluation of different tubal dysfunctions. The patient with occluded tube showed either disturbance of the air flowing into the tube or outflowing from the tympanum to the pharynx. Depending on the degree of patency, the patulous tube showed either a synchronous change of the tympanal pressure with that of the pharyngeal cavity or an early and sudden drop of the tympanal pressure without deglutition. Through this rather simple aerodynamic technique, evaluation of different tubal dysfunction is possible.     

The usefulness of Valsalva computed tomography as an assessment tool for the Eustachian tube

PurposeTo determine the usefulness of ‘computed tomography (CT) with Valsalva maneuver (VM)’ (Valsalva CT) for localizing lesions of the eustachian tube (ET) and identifying characteristics of ET dysfunction (ETD).Materials and methodsIn this case-control study, 12, 17, and 25 patients with obstructive ETD (OETD), patulous eustachian tube (PET), and conductive hearing loss (control), respectively, underwent Valsalva CT in the supine position. The visualized length to total length ratio of the cartilaginous ET (VTRET) with and without VM were compared in the three groups. In the OETD group, obstructed areas of the ET were identified on multiplanar reconstructed images.ResultsVTRET without VM in the PET group was significantly higher than that in the control and OETD groups (p-values, 0.003 and 0.007, respectively). However, there was no significant difference between the control and OETD groups (p = 0.053). VTRET with VM in the PET group was significantly higher than that in the other two groups (p < 0.001), whereas that in the control group was significantly higher than that in the OETD group (p < 0.001). In the OETD group, the obstructed area was clearly identified, and there were one, one, six, and eight patients in the isthmus; bony portion and isthmus; bony portion, isthmus, and cartilaginous portion; and isthmus and cartilaginous portion subgroups, respectively.ConclusionValsalva CT is particularly valuable as a visualization assessment tool for identifying obstructed areas in the OETD. It may help future research of disease-specific mechanical characteristics of the ET on controlling pressure variables.     

Clinical evaluation of balloon dilation Eustachian tuboplasty in the Eustachian tube dysfunction

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.     

Physiotherapy of Eustachian tube dysfunction in adults--preliminary report

The paper presents preliminary results of Eustachian tube dysfunction treatment with the use of vibroaerosols in adult patients. 21 patients aged 16-73 y.o. (mean age 49 y.o) have been included in the study. The treatment included inhalation of medicines individually selected for the patient, based on the results of the physical examination. The patients have been divided into 2 groups, depending on the type of tympanogram. Group I included patients with type A tympanogram and abnormal Eustachian tube patency test result. Group II comprised of patients with type B or C tympanogram and abnormal Eustachian tube patency test result. After treatment, subjective improvement has been observed in 88.9% of the ears, objective improvement in 61.5% of the ears. In group II, objective improvement observed by the change of tympanogram has been observed in 85% of ears. Lack of correlation between objective and subjective improvement have been observed in 26% of the ears. In 11.1% of the ears no benefit from treatment has been observed. The correlation between subjective and objective improvement has been observed in 74% of ears. It appears that treatment with the use of vibroaerosols is beneficial for patients with Eustachian tube dysfunction.     

Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube

Conclusion. Trans-tympanic insertion of a new silicone plug seems to be useful for controlling the distressing symptoms of patients with a chronic patulous Eustachian tube (PET). Objective. To evaluate the effectiveness of a new silicone plug for blocking the isthmus of a PET in patients whose symptoms were resistant to other therapies for?>?6 months. Material and methods. The silicone plug (total length 23–25 mm; tip diameter 1.0–2.0 mm) was inserted in 44 ears of 37 patients with chronic PET. It was inserted through the tympanic orifice of the ET to obstruct the isthmus of the tube via an incision in the anterosuperior portion of the tympanic membrane. Results. Insertion of the plug was possible in all except two ears, in which it failed because of a narrow tympanic orifice of the ET. In 11 ears of 10 patients, the plug was replaced by a larger one using the same approach to improve efficacy. Of the 42 ears in which the silicone plug was successfully inserted, 30 (71.4%) achieved relief from symptoms of PET without additional treatment. In?>?60% of these cases, the symptoms of PET were well controlled with an aerated middle ear. The follow-up period ranged from 6 to 68 months (mean 38.9 months).     

Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube

CONCLUSION: Trans-tympanic insertion of a new silicone plug seems to be useful for controlling the distressing symptoms of patients with a chronic patulous Eustachian tube (PET). OBJECTIVE: To evaluate the effectiveness of a new silicone plug for blocking the isthmus of a PET in patients whose symptoms were resistant to other therapies for > 6 months. MATERIAL AND METHODS: The silicone plug (total length 23-25 mm; tip diameter 1.0-2.0 mm) was inserted in 44 ears of 37 patients with chronic PET. It was inserted through the tympanic orifice of the ET to obstruct the isthmus of the tube via an incision in the anterosuperior portion of the tympanic membrane. RESULTS: Insertion of the plug was possible in all except two ears, in which it failed because of a narrow tympanic orifice of the ET. In 11 ears of 10 patients, the plug was replaced by a larger one using the same approach to improve efficacy. Of the 42 ears in which the silicone plug was successfully inserted, 30 (71.4%) achieved relief from symptoms of PET without additional treatment. In > 60% of these cases, the symptoms of PET were well controlled with an aerated middle ear. The follow-up period ranged from 6 to 68 months (mean 38.9 months).     

Diagnostic value of computed tomography in Eustachian tube dysfunction

ObjectiveInvestigate radiological findings on temporal bone computed tomography, which are associated with obstructive Eustachian tube dysfunction and determine its diagnostic validity.MethodsThe present study was conducted as a prospective, cross-sectional case series study in a tertiary referral center. Forty patients with clinically diagnosed unilateral Eustachian tube dysfunction and older than 16 years old underwent pre interventional radiological assessment by temporal bone computed tomography while performing a Valsalva-maneuvre to enhance visualization of Eustachian tube lumen. The Eustachian tubes were assessed for intersite morphological differences, presence of mucus in the lumen or middle ear cleft and secretion retention or mucosal swelling in the adjacent sinuses. Image analyses and radiological statements about the side of pathology were delivered blinded to the clinical diagnoses.ResultsThe radiologic detection of mucus/mucosal edema in Eustachian tube or adjacent middle ear cleft structures was associated with the pathological side (t (1, N = 40) = 3.60, p = 0.001 < 0.05). On the contrary, there is no association between radiological findings of sinonasal disease and side of Eustachian tube dysfunction (x² (1, N = 40) = .00, p = 1.00 > 0.05). The diagnostic value of radiologic assessment in Eustachian tube dysfunction has a sensitivity and specificity of 52,5 and 97,5% respectively.ConclusionThe sensitivity of radiologic assessment is rather low, and hence it is inappropriate as a screening tool for Eustachian tube dysfunction in routine clinical practice. In the case of present CT-scans of the temporal bone, the focus should be laid on the detection of mucus in the Eustachian tube or adjacent structures, as a predictor of disease.     

Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7

Introduction

During clinical evaluations, in order to interpret patients’ complaints caused by Eustachian tube dysfunction and to monitor the success of the treatment, standardized and disease-related scales are necessary.