Tympanometric evaluation using an otoadmittance meter and X-Y plotter was performed on 129 ears of 70 children with history of recurrent acute otitis media, or evidence otoscopically of persistent middle ear effusion, or both. Myringotomy, performed immediately following the tympanometric procedure, confirmed the presence or absence of effusion. Following myringotomy, tympanometric patterns, as shown by susceptance and conductance tracings at 220 and 660 Hz, were identified and middle ear pressures and otoadmittance peak values were determined. These findings were compared and criteria were developed which best determined the presence or absence of effusion. The results revealed the following: 1) High negative middle ear pressure is not necessarily a reliable indicator of middle ear effusion. 2) Tympanometry can be used reliably as an indicator of effusion. A combination of pattern classification and susceptance criteria enabled correct prediction of effusion in 93% of these children. One pattern at B660 was found to be pathognomonic of effusion. 3) In general, otoadmittance at 660 Hz appears to be a better indicator of effusion than 220 Hz.

Acute Disease↗

PubMedDate not supplied

Eustachian tube ventilatory function in relation to cleft palate.

The ventilatory function of the Eustachian tube was assessed in a group of infants and children with cleft palate, some of whom had received palatal repair. Those whose palates had been repaired were better able, in general, to equilibrate applied positive middle ear pressures than were those with open clefts. In many of the patients whose palates had been repaired, the results of Eustachian tube function studies were similar to those in normal subjects. Differences in Eustachian tube ventilatory function are assumed to be related to differences in tubal compliance. Excessive compliance probably results in, or exaggerates, functional Eustachian tube obstruction. Improvement in tubal function following palate repair is probably related to factors resulting in greater tubal stiffness.

Adolescent↗

PubMedDate not supplied

Concepts on the pathogenesis of middle ear effusions.

Several concepts related to the pathogenesis of middle ear effusions are postulated. The mechanisms proposed are based on an understanding of fluid mechanics. A flask with a long, narrow neck is presented as a model of the Eustachian tube-middle ear-mastoid system. Fluid flow into and out of the flask is dependent upon the pressure gradient, compliance of the narrow neck and whether or not the bulbous portion is intact. It is suggested that locking of the tube may be dependent upon the speed of the application of the negative pressure and the compliance. Eustachian tube opening appears to be related not only to active muscle forces but may also be dependent upon the presence of a pressure gradient which passively assists tubal function. It is proposed that middle ear effusions result from reflux, aspiration or insufflation of nasopharyngeal secretions (acute otitis media), or from persistent functional or mechanical Eustachian tube obstruction (secretory otitis media) or both.

Ear, Middle↗

PubMedDate not supplied

Adenoidectomy in relation to otitis media.

Past studies of the efficacy of adenoidectomy in the management of children with otitis media have been inconclusive due to significant limitations in experimental design. At the Children's Hospital of Pittsburgh, the effect of adenoidectomy on the outcome of otitis media is currently being studied in a prospective manner. An attempt is being made to document and to control those factors cited as lacking in the previous studies. This report describes the techniques for assessment of nasal and Eustachian tube function and for the completeness of adenoidectomy.

Adenoidectomy↗

PubMedDate not supplied

Tympanometric patterns found in middle ear effusions.

In 120 ears of 67 children with a history of recurrent acute otitis media or otoscopic evidence of persistent middle ear effusion, or both, tympanograms were obtained using an otoadmittance meter and an electro-acoustic impedance bridge. Myringotomy was performed immediately following the tympanometric evaluation confirming the presence or absence of middle ear effusion. The comparison of myringotomy findings with a tympanometric pattern classification revealed 85.8% overall correct association with the presence or absence of a middle ear effusion for both instruments. In 83.3% of the cases, there was agreement in the classification of the tympanogram between the otoadmittance meter and the electro-acoustic bridge.

Adolescent↗

PubMedDate not supplied

Eustachian tube function in an American Indian population.

A comparatively high prevalence of acute and chronic otitis media (OM) has been reported for the native American Indian population. The present study reports data on the function of the eustachian tube (ET) in 25 White Mountain Apache Indians ranging in age from 3 to 36 years. All study subjects had a history of OM and reported to the reservation clinic with tympanic membrane perforations and a dry middle ear (ME). The results of inflation-deflation tests on these subjects indicated that the Indians had lower forced opening pressures than had been measured in a group of Caucasians with perforations secondary to chronic OM. Of the 23 subjects studied, 67% equilibrated applied positive ME pressures and 38% equilibrate negative pressures by swallowing. During forced response testing, the passive resistance of the ET was found to be lower and the active resistance equivalent to that of a group of Caucasians with traumatic perforations and otherwise negative otologic histories. While the ET was predilated in these subjects by constant airflow, active swallowing further dilated the tube in 67% of the subjects, constricted the tube in 25%, and had no effect in 8%. This study indicated that the ET of the American Indian was functionally different from that of Caucasians previously studied and was characterized by comparatively abnormal, low passive tubal resistance which may be considered to facilitate ventilatory function and to impair protective function. The difference may account for the high prevalence of OM with perforation and the low incidence of cholesteatoma in this population.

Adolescent↗

PubMedDate not supplied

Identification of otitis media with effusion in children.

In an effort to establish the diagnostic value of otoscopy, tympanometry, and the middle ear (ME) muscle reflex in the identification of otitis media with effusion (OME), the diagnostic findings by these three methods were compared with the findings at myringotomy in 333 children (500 ears). The study showed that even experienced clinicians had some difficulty in identifying those ears with effusion (sensitivity) and had even greater difficulty in making a diagnosis of those ears without an effusion (specificity). However, tympanometry, employing patterns that have been validated with myringotomy findings, was found to be more accurate. On the other hand, assessment of the ME muscle reflex as a diagnostic method was unacceptable due to an extremely low specificity (52%). An algorithm derived from the combination of the three methods had highest sensitivity (97%) and specificity (90%).

Acoustic Impedance Tests↗

PubMedDate not supplied

Effect of decongestant with or without antihistamine on eustachian tube function.

In an attempt to determine the effect of a decongestant with or without an antihistamine on the ventilatory function of the eustachian tube (ET), two separate studies were conducted in 50 children who had had chronic or recurrent otitis media with effusion (OME) and in whom tympanostomy tubes had been inserted previously. The first was a double-blind study that compared the effect of an oral decongestant, pseudoephedrine hydrochloride, with that of a placebo in 22 children who developed an upper respiratory infection (URI) during an observation period. Certain measures of ET function were significantly elevated above baseline values during the URI, which was attributed to intrinsic mechanical obstruction of the ET. It was found that the oral decongestants tended to alter these parameters of ET function in the direction of the baseline (preURI) values. Even though the effect was statistically significant, the favorable changes in measurements of tubal function were only partial and were more prominent on the second day of the trial after the subjects had received four doses of the decongestant. However, the administration of nasal spray of 1% ephedrine appeared to have no apparent effect on ET function in these children. The second study was a double-blind crossover design. In this study of 28 children who did not have a URI, the effect of a decongestant-antihistamine combination (pseudoephedrine hydrochloride and chlorpheniramine maleate) was compared with that of a placebo. When the subjects were given the decongestant-antihistamine medication, there were favorable changes in certain ET function measures which were not observed when they received the placebo. Again, the response differences between the two groups were statistically significant. Even though these two studies indicated that an oral decongestant appeared to affect favorably the ET function of children who had a URI, and that the combination of an oral decongestant and antihistamine had a similar effect on tubal function in children without a URI, an evaluation of the efficacy of these commonly employed medications must await the results of controlled clinical trials in children with OME.

Adolescent↗

PubMedDate not supplied

Effect of certain head and neck tumors and their management on the ventilatory function of the eustachian tube.

A prospective study was carried out which tested three hypotheses: 1) certain tumors of the head and neck that originate in sites other than the nasopharynx may cause middle ear effusion; 2) middle ear effusion is a predictable sequela of radical maxillectomy as well as total or partial resection of the soft palate; and 3) middle ear effusions that follow surgery to remove head and neck lesions are due to disturbances in palatal function, specifically to tensor veli palatini muscle dysfunction. Our results indicate that one fourth of all subjects had some evidence of middle ear abnormality prior to entering into treatment although they were asymptomatic. The treatment process influenced the function of the middle ear, as 79% of the subjects experienced middle ear-eustachian tube dysfunction following treatment, and 23% were found to have developed a perforation of the tympanic membrane or required myringotomy and tube insertion to relieve middle ear effusion. The results of these studies indicate that surgery that is adequate to remove cancer of the maxilla, tonsil, or palate in most cases interferes with the function of the tensor veli palatini muscle, resulting in functional eustachian tube obstruction. The need for attention to and the treatment of middle ear effusion in such patients is emphasized in light of other sensory deficits in this patient population.

Adult↗