Eustachian tube and middle ear mechanics

Abstract

Even the most sophisticated prostheses for reconstruction of the ossicular chain do not work in the presence of Eustachian tube dysfunction. This review gives an update on the mechanisms of middle ear pressure regulation and middle ear ventilation, as well as methods for measuring the opening and closing function of the Eustachian tube. So far, in most tube function tests pressures are applied far beyond the physiological range in order to open the tube or force it to open. New methods like sonotubometry with perfect sequences (PSEQ) or the application of pressure in the nasopharynx with the Estève technique seem very promising. However, these measurements only provide snapshots of tube function. Presently, new tests are being developed for long-term measurements even in cases with perforated tympanic membranes. Attempts to improve impaired tube function have recently included laser surgery and balloon tuboplasty, yielding positive long-term results requiring verification in larger controlled studies. Eustachian tube dysfunction does not only mean blockage but can also include abnormal patencies of the Eustachian tube, for which new approaches are discussed here. In the case of suspected tube dysfunction, cartilage should be used to avoid early tympanic retraction or recurrent perforation; external ventilation using ventilation tubes should be considered.

Treatment of Middle Ear Ventilation Disorders: Sheep as Animal Model for Stenting the Human Eustachian Tube – A Cadaver Study

“…If its function is disturbed, this can lead to acute and chronic otitis media, cholesteatoma and consecutive hearing impairment [1], [2]. Today, about 0.9% of the British population is suffering from ventilation disorders of the ET [3] and there is still no effective therapy for many patients affected chronically [4].…”

Balloon Dilatation of the Eustachian Tube: Postoperative Validation of Patient Satisfaction

“…A dysfunction of the Eustachian tube, especially an obstruction, results in faulty pressure conditions in the middle ear and pneumatised mastoid process. In addition to complaints, such as an unpleasant sensation of pressure or fullness in the affected ear, tube ventilation dysfunction is often accompanied by chronic middle ear infections, with or without cholesteatoma [1,3,4,5,6,7]. …”

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

“…TMM procedure allows to compare pressure equalization function of normal subjects and those with ETD objectively. A few other techniques like sonotubometry with perfect sequences (PSEQ) were described in order to estimate ETD accurately [9]. PSEQ seems promising but needs validation.…”