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Fricano EE, Gremba AP, Teixeira MS, Swarts JD, Alper CM. Using Geometric Morphometric Analysis of Magnetic Resonance Imaging to Assess the Anatomy of the Eustachian Tube in Children with and without Otitis Media. Bioengineering (Basel) 2023; 10:1115. [PMID: 37892845 PMCID: PMC10604907 DOI: 10.3390/bioengineering10101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Otitis media (OM) is among the most common of childhood illnesses. It has long been hypothesized that children under age two are predisposed to OM due to differences in the anatomy of the Eustachian tube (ET), including the angle of the ET. OM in later childhood is less common but does occur, begging the question, are there shape differences in the ET that persist underlying later occurrences of OM? To answer this question, a novel method, which applied geometric and morphometric shape analysis to landmarks obtained from MRI data, was used. MRI scans were performed on 16 children (5 control, 3 cOME, and 8 rAOM) between 2011 and 2015. Sixteen landmarks representing the shape of the ET, cranial base, and palate were analyzed. The results of a Procrustes ANOVA indicate that the shape of the ET varies significantly (p < 0.01) between the OM and control groups. The shape differences between the OM group and the control are a medial and low attachment site of the tensor veli palatini (TVP) muscle, a posterior and high torus tubarius, and an anteriorly projected palate. These results support previous findings that a relatively horizontal ET is associated with a predisposition for OM. This study used a novel approach to examine anatomical differences in children with and without OM. First, the data set is unique in that it includes MRI scans of children with a confirmed OM diagnosis. Second, the use of MRI scans in craniofacial anatomy OM research is novel and allows for the collection of soft tissue landmarks and the visualization of soft tissue structures. Third, geometric morphometric shape analysis is a statistical method that captures shape differences, offering a more universal picture of nuanced changes within the entire set of landmarks, in contrast to more traditional linear and angular measurements used in prior OM studies examining craniofacial anatomy.
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Affiliation(s)
- Ellen E. Fricano
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Allison P. Gremba
- Doctor of Physical Therapy Program, School of Natural and Health Sciences, Seton Hill University, Greensburg, PA 15601, USA
| | - Miriam S. Teixeira
- Department of Graduate Medical Education, Arnot Ogden Medical Center, Elmira, NY 14905, USA
| | - J. Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Cuneyt M. Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
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Liu S, Ni X, Zhang J. Assessment of the Eustachian tube: a review. Eur Arch Otorhinolaryngol 2023; 280:3915-3920. [PMID: 37246976 DOI: 10.1007/s00405-023-08026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Dysfunction of the Eustachian tube (ET) can lead to negative pressure within the middle ear, which, in turn, causes various pathological changes. Multiple testing methods for ET function have been devised, each with its own advantages and disadvantages. Knowing the characteristics of each ET function test and the unique characteristics of ET dysfunction (ETD) in children are prerequisites for choosing the optimal assessment method. For a comprehensive diagnosis, assessment should also include the localisation of any sites of obstruction. This review aims to summarise the methods of evaluating ET function and locating sites of ET lesions. METHODS Articles evaluating ET function, localising lesions in the ET, and ETD in children were collected from the PubMed database. We selected only relevant English publications. RESULTS ETD in children has different characteristics to those in adults. The appropriate tests for assessing ET function depend on the specific conditions of the individual patient. Valsalva computed tomography can provide information on the soft and bony anatomy of the ET to facilitate identification of lesion sites. CONCLUSION An accurate diagnosis should be based on a combined analysis of objective and subjective results, with interpretation made in conjunction with clinical history and physical examination. A comprehensive assessment should include lesion localisation. When assessing ETD in children, it is important to take into account the characteristics of this population.
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Affiliation(s)
- Shanshan Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing, China.
| | - Jie Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing, China.
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Albawardi KA, Alsanad FA, Aldosari HS, Alhelal SA, Alasmari MM, Alsadi MA, Aldohayan A. The Prevalence of Hearing Symptoms Associated With Patulous Eustachian Tube Dysfunction Following Bariatric Surgery at King Khalid University Hospital, Saudi Arabia. Cureus 2023; 15:e43255. [PMID: 37692735 PMCID: PMC10491997 DOI: 10.7759/cureus.43255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background A patulous Eustachian tube (PET) is defined as a persistent tubal opening, which affects 0.3-6.6% of the population, with a female preponderance. PET is caused by the loss of subcutaneous adipose tissue enclosing the cartilaginous portion of the Eustachian tube (Ostmann's pad) as a result of acute, rapid, and substantial loss of weight which occurs during bariatric surgery. The most common complaint of PET is autophony, in which patients hear their own voices or breaths, with additional symptoms including crackling sounds, tinnitus, and aural congestion. In this study, we aimed to determine the prevalence of symptoms associated with PET dysfunction subsequent to bariatric surgery at King Khalid University Hospital (KKUH). Methodology A cross-sectional study was conducted at KKUH, Saudi Arabia. The presence of symptoms consistent with the diagnosis of PET dysfunction was assessed through in-person and telephonic interviews of bariatric surgery patients using a standardized questionnaire. Results A total of 450 patients were evaluated. The preoperative body mass index (BMI) of evaluated patients ranged from 28 to 117 kg/m2 (mean = 46.07 kg/m2), with no significant difference between symptomatic and asymptomatic groups (p = 0.303). The postoperative BMI ranged from 16 to 100 kg/m2 (mean = 29.37 kg/m2), with no significant difference between symptomatic and asymptomatic groups (p = 0.263). Hypertension was the most prevalent comorbid condition (12.2%), followed by diabetes (9.3%). In total, 91 (20.22%) patients exhibited symptoms (aural fullness and autophony) compatible with patent auditory tube dysfunction. Conclusions Overall, 20.22% of the bariatric surgery patients in our study sample displayed symptoms consistent with patulous auditory tubal dysfunction. The preoperative and postoperative BMI of symptomatic and asymptomatic patients did not differ significantly. To improve patient outcomes and satisfaction following bariatric surgery hearing symptoms associated with PET need to be included in postoperative follow-ups after bariatric surgery.
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Affiliation(s)
| | | | | | | | | | - Mada A Alsadi
- Otolaryngology - Head and Neck Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah Aldohayan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, SAU
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Teixeira MS, Swarts JD, Lim AYN, Alper CM. Tubomanometry in measurement of velopharyngeal closure: A pilot study. Laryngoscope Investig Otolaryngol 2023; 8:554-560. [PMID: 37090858 PMCID: PMC10116987 DOI: 10.1002/lio2.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Objective To investigate the differences in velum closure pattern in people with and without a history of middle ear disease using intranasal pressure curves recorded with the tubomanometer, a Eustachian tube (ET) testing device. Study Design Case control study. Setting Tertiary referral center. Subjects and Methods Tubomanometry nasopharyngeal pressure curves from 20 controls (Group 1) and 20 people with history of otitis media (OM) and possible ongoing ET dysfunction (ETD) (Group 2 or OM/ETD group) were compared. The variables included in the analysis were: (a) ratio of signal amplitude relative to the delivered nasal pressure (C2/delivered pressure x 10); (b) time (s) to achieve maximal signal amplitude (C2-C1); (c) duration of velum closure (s) and (d) plateau decay during the isometric contraction of the velum (C3-C2) and (e) swallow duration (s) (C4-C1). Statistical analysis was conducted using mixed models for the normalized values of individual characteristics. Results Age, race and sex distribution in each group was as follows: 24 ± 8 years, 15 whites and 12 females in Group 1; 20 ± 10 years, 19 whites and 15 females in Group 2. Group 2 demonstrated a greater velopharyngeal pressure decay (p = .13), longer swallow duration (p = .10), and longer duration of velum closure (p = .14). Conclusion This is the first study using tubomanometry to investigate differences in velopharyngeal closure between controls and individuals with OM/ETD. Although not statistically significant, our results showed that those with OM/ETD demonstrated a longer swallow and velum closure duration, and a higher degree of leakage during velum contraction compared to controls.
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Affiliation(s)
- Miriam S. Teixeira
- Graduate Medical Education Research Division Arnot Ogden Medical Center Elmira New York USA
| | - John Douglas Swarts
- Department of Otolaryngology University of Pittsburgh, School of Medicine Pittsburgh Pennsylvania USA
| | - Audrey Y. N. Lim
- Department of Medicine University of Pittsburgh, School of Medicine Pittsburgh Pennsylvania USA
| | - Cuneyt M. Alper
- Department of Otolaryngology University of Pittsburgh, School of Medicine Pittsburgh Pennsylvania USA
- Division of Pediatric Otolaryngology Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania USA
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Abstract
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.
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Affiliation(s)
- Matthew E Smith
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
| | - Manohar L Bance
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
| | - James R Tysome
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
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Ikeda R, Kikuchi T, Kawamura Y, Miyaaki H, Kawase T, Katori Y, Kobayashi T. Plug size selection protocol for the treatment of intractable patulous Eustachian tube with Kobayashi Plug. Acta Otolaryngol 2019; 139:849-853. [PMID: 31430219 DOI: 10.1080/00016489.2019.1651939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: There have been no useful criteria for initial plug size selection protocol for the treatment of intractable patulous Eustachian tube (PET). Aims/objectives: To establish a method for appropriate plug size selection using tubal function test and subjective symptom severity in PET patients who were treated by Kobayashi Plug insertion. Material and methods: A retrospective survey of medical records identified 39 ears of 35 patients with PET who received insertion of the Kobayashi Plug and whose PET symptoms were thereafter controlled for at least 6 months after surgery. Method: The evaluation scale of PET handicap inventory-10 (PHI-10) was used to indicate PET subjective symptom severity. Tubal function tests (sonotubometry and tubo-tympano-aerodynamic-graphy: TTAG) were performed. Results: There was no correlation between the preoperative PHI 10 score and plug size (p = .157). There was a significant correlation between the preoperative sound attenuation from nostril to EAC measured by sonotubometry and plug size (p < .001). There was no correlation between the preoperative pressure transmission ratio estimated by TTAG and plug size (p = .271). Conclusions and Significance: Sonotubometry which evaluates sound attenuation from nostril to EAC can be a useful tool for selecting plug size.
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Affiliation(s)
- Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
- Otolaryngology, Sen-En Rifu Otologic Surgery Center, Rifu, Japan
| | - Toshiaki Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Yoshinobu Kawamura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
- Otolaryngology, Sen-En Rifu Otologic Surgery Center, Rifu, Japan
| | - Hiromitsu Miyaaki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
- Otolaryngology, Sen-En Rifu Otologic Surgery Center, Rifu, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Toshimitsu Kobayashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
- Otolaryngology, Sen-En Rifu Otologic Surgery Center, Rifu, Japan
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Alper CM, Teixeira MS, Richert BC, Douglas Swarts J. Presentation and eustachian tube function test results in children evaluated at a specialty clinic. Laryngoscope 2018; 129:1218-1228. [PMID: 30474114 DOI: 10.1002/lary.27545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET-specific or sinus balloons around the world and off-label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children. STUDY DESIGN Retrospective cross-sectional study. METHODS This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable. RESULTS Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%). CONCLUSIONS ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1218-1228, 2019.
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Affiliation(s)
- Cuneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Beverly C Richert
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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