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PubMed1995

[Transitory evoked otoacoustic emissions in children with impaired middle ear ventilation].

Transient evoked otoacoustic emission (TEOAE) has proven to be a useful clinical screening test for auditory dysfunction. Problems concerning the evaluation are mainly due to irregularities of the physiological middle ear functions. In this study different degrees of middle ear alterations were quantified by means of tympanometry, otoscopy and pure-tone audiometry and then related to the results of TEOAE registration which were classified by the coefficient of the cross correlation and the frequency response spectrum. Data were obtained from 82 ears of 41 children between the age of 3 and 7 years. When children displayed a tympanogram with no observable peak, a successful registration of TEOAE was possible in only 10.5% (n = 19) of the cases. Such results are related to serous or mucoid effusions which probably prevent a transmission of the emission from the cochlea to the meatus. In analysing the related between conductive losses in pure-tone audiometry and TEOAE it was demonstrated that no TEOAE was could be recorded in ears with a conductive loss above 20 dB HL. This study emphasizes the need to reexamine children who do not show positive emissions connected with middle ear imbalances. Only by retesting these children is it possible to determine whether or not cochlear lesions or middle ear problems prevent a positive TEOAE registration.

Acoustic Impedance Tests↗
PubMed1990

Vitreous carbon: a new material for middle ear ventilation tubes.

Synthetic allotropic carbons have been used for nearly 20 years as biomedical implants. Vitreous carbons in particular appear to possess very favourable biocompatibility characteristics. The middle ear compatibility of Sigradur has been tested in the mastoid bulla of gerbils. The period of implantation varied from 1 to 13 months. Light and electron-microscopic examination revealed good middle ear tolerance of the material, especially when the surface had not been modelled. Our animal experiments suggest that this material could be suitable for ventilation tubes, but was less ideal for ossicular replacement prostheses, particularly because of the specific surface properties. Consequently, we have used such carbon ventilation tubes in 38 patients. The results obtained using this material were excellent thanks to the favourable biocompatibility, advantageous surface properties, and low weight.

Animals↗
PubMed1975

Tympano-nasopharyngeal shunt operation. A new method of middle ear ventilation.

The tympano-nasopharyngeal shunt operation is recommended as a "substitute" Eustachian tube. An experimental study regarding the efficacy of tympano-nasopharyngeal shunt operation was conducted in two dogs. Finally, four patients with complete tubal stenosis were operated on by this new method within a period of one year, with no postoperative complications. The hearing improved and patients were able to inflate their middle ears. The method is claimed to have the following advantages: permanent ventilation of the middle ear with preservation of an intact drum; the middle-ear pressure can be increased by Valsalva or Politzer manoeuvres; moderate technical difficulties; no risk of postoperative complications; and suitable in children as well as adults. The disadvantages seem to be: drainage not ensured; minor risk of ascending infection.

Adenoidectomy↗
PubMed2003

[Early postoperative middle-ear ventilation -- risk for the transplant or guarantee for aeration of the tympanic cavity?].

BACKGROUND: Sufficient ventilation of the tympanic cavity is a decisive factor for the success of the therapy and the prognosis after tympanoplastic surgery. With the postoperative use of the Valsalva- and Politzer-maneuver the patient is able to influence the aeration of the tympanic cavity in a positive way by autoinsufflation. However this implicates the risk of a dislocation of the transplant, which is possibly caused by high middle-ear pressure-peaks during the maneuvers mentioned. METHODS: The actual increase of pressure in the tympanic cavity respectively auditory canal during the Valsalva- and Politzer-maneuver is examined in 22 patients with chronic-mesotympanic Otitis media and additionally by using an experiment with a model of a reconstructed middle-ear. The risk of a transplant-dislocation after tympanoplasty type I is estimated. RESULTS: The increase of pressure in the middle ear respectively auditory canal -- and with that the possibility of a dislocation of the transplant -- is lower after Politzer- compared with Valsalva-maneuver. If the transplant is secured through silicon sheets and packings in the auditory canal, the probability of "blowing away" the newly created cover of the tympanon will be very small. CONCLUSIONS: Because of the benefits for the aeration of the tympanic cavity, an early post-operative insufflation of the middle-ear -- using the Politzer- and/or "cautious" Valsalva-maneuver -- is recommended.

Air Pressure↗
PubMed2001

[Duration of middle ear ventilation after laser myringotomy with the CO2 laser otoscope Otoscan].

BACKGROUND: The most important principle in treating secretory otitis media (SOM) is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this via a self-healing perforation whose diameter essentially determines the duration of transtympanic ventilation. PATIENTS, METHODS: In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a homogeneous patient collective comprising 81 children (159 ears) suffering from SOM. The tympanic intervention was combined with an adenoidectomy or a CO2 laser tonsillotomy and therefore performed under general insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12-15 W and a pulse duration of 180 ms. RESULTS: None of the children showed postoperative impairment of inner ear function. Otomicroscopic and videoendoscopic monitoring documented the healing process. The mean closure time was found to be 16.35 days (8-34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later the laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes (1.6%) examined showed atrophic scar formation, one (0.8%) a perforation with a diameter of 0.5 mm. In 19 ears (14.7%) there was a recurrence of SOM within the observation period. CONCLUSIONS: Laser myringotomy competes with ventilation tube insertion in the treatment of SOM. It may be an useful alternative in the surgical management of secretory otitis media.

Child↗
PubMed1983

"How I do it"--otology and neurotology. A specific issue and its solution. Advantages of the T-tube for short and long-term middle ear ventilation.

The T-tube has several advantages that should be considered when selecting a ventilation tube. First, it remains in place much longer than the average tube; thus allowing the physician, rather than chance, to determine when the tube should be removed. Second, it can be removed painlessly without an anesthetic when indicated. Third, it does not have the problem of a high post-removal perforation rate such as seen with other long term tubes. Fourth, it can be easily modified to suit the needs of the patient and the physician.

Humans↗
PubMedDate not supplied

Prolonged middle ear ventilation: the right tube in the right place.

Premature extrusion of ventilating tubes continues to plague both doctor and patient. Migrating epithelium on the lateral surface of the drum has been identified as the principal cause of tube migration and extrusion. This information dictates insertion of a tube in an area where the migrating forces tend to keep the tube in place instead of encouraging rejection. When optimally placed, tubes specifically designed for long-term ventilation will function four times longer than randomly placed conventional tubes. The long-term ventilating tube in use since 1965 has been further refined. A notch and tab on the tube mate with a new inserter/suction device, and this combination permits precise placement through a small incision without tilting and twisting during insertion. Suction may be applied as desired to clear the lumen as the insertion tool is withdrawn.

Adult↗
PubMedDate not supplied

Tympanic membrane changes resulting from different methods of transmyringeal middle ear ventilation.

This experimental study was designed to evaluate the morphologic changes of the tympanic membrane in the rat after different methods of transmyringeal ventilation. Artificial ventilation was obtained in two principal ways, either by making tympanic membrane perforations with delayed healing or by inserting a tympanostomy tube. Perforations occupying the upper rear quadrant of the tympanic membrane were made by diathermy or by a carbon dioxide laser with healing times of 12 to 15 days and 18 to 21 days, respectively. Compared with the healing times of perforations made by lancet (9 to 11 days), the healing pattern was considerably delayed. The structural changes of the healed tympanic membrane were minimal, but the connective tissue remained thickened for several months. Repeated insertion of tympanostomy tubes caused a remarkable thickening (30-fold) of the tubulated quadrants. The thickened tympanic membranes were characterized by a hyperplastic, dense connective tissue containing sclerotic plaques. Similar changes, though less pronounced, were also seen after reiterated myringotomies without tube insertion.

Animals↗
PubMed1997

Results of middle ear ventilation with 'Mangat' T-tubes.

Tympanostomy tube placement has been shown to be an effective treatment for recurrent acute otitis media and chronic otitis media with effusion. The Senior author, (K.S. Mangat), considered stiffness and the longer inner limbs of the Goode (Xomed) or Treace (Treace Medical) T-tubes as important factors in the high incidence of complications, and used smaller soft silicone. Mangat-tube (Xomed) with shorter inner limbs. A prospective study was undertaken over a five year period (July 1987-July 1992) which was a continuation of a previous retrospective study of Goode and Treace T-tubes (Mangat, K.S., Morrison, G.A.J., and Ganiwalla, T.M. (1993) Int. J. Pediatr. Otorhinolaryngol. 25, 119-125). 322 Mangat tubes (M-tubes) were inserted in 191 patients with persistent otitis media with effusion. The peak ages for insertion were between 4 and 6 years. Spontaneous extrusion occurred in 240 ears (66.5%; 154 patients) at a mean time of 29.3 months. Of these, there were 60 perforations at three months follow-up (18.6%) which fell to 31 perforations after six months (9.6%). Surgical extraction of the M-tube was necessary in 82 ears (22.7%; 50 patients) following persistent otorrhoea or resolution of the condition. Otorrhoea, requiring treatment, was noted in 36 ears (11%). No association was found between the occurrence of infection and the incidence of perforation persisting after a year. There was a higher incidence of persistent perforation in those requiring surgical extraction. The overall persistent perforation rate of only 9.6% would appear to be less than that experienced with Goode or Treace T-tubes.

Adolescent↗
PubMedDate not supplied

Normal and abnormal middle ear ventilation.

Studies in infants and children have suggested a functional rather than mechanical obstruction of the Eustachian tube as a predisposing factor in middle ear effusions (MEE). To simulate this condition in the laboratory, an animal model was prepared using juvenile Rhesus monkeys. The tensor veli palatini muscle was transected or expunged posterior to the hamulus of the medial pterygoid lamina. Transection of the muscle resulted in negative middle ear pressure without effusion, whereas when the muscle was expunged, the animals developed a brief episode of negative middle ear pressure followed by a persistent MEE that was sterile for bacteria. An acute bacterial MEE developed following instillation of Streptococcus pneumoniae into the nasopharynx of animals that had had a previous unilateral transection of the muscle. The condition of the middle ear was documented by impedance measurements and presence of the effusion was verified by myringotomy. Animals were periodically examined and tested for Eustachian tube ventilatory function over a period of one year. Before surgical alteration of the tensor muscle. Eustachian tube function tests demonstrated normal ventilatory function, whereas, functional Eustachian tube obstruction patterns similar to studies in children who had MEE were found during the postoperative period. Only after the development of a reliable animal model can current and future methods of management of MEE be tested under controlled laboratory conditions. These data suggest that the Rhesus monkey appears to be an excellent model for the study of normal as well as abnormal tubal function.

Animals↗
PubMed1975

Physiological tympanostomy. A new technique of middle ear ventilation.

Physiological tympanostomy is advanced as a 'substitute' eustachian tube because it opens regularly only on swallowing, as does the 'natural' eustachian tube. The efficacy of the physiological tympanostomy operation was first proved in experimental animals (two dogs). Subsequently, six patients with eustachian insufficiency were successfully managed by this new surgical technique within period of one year, with no post-operative complications. The hearing improved and the middle ears remained air-filled. The method seems to have the following merits: permanent ventilation of the tympanum with preservation of an intact drum (from the functional point of view); no tympanophonia or autophonia; simple technique, short operative period (five minutes); no risk of postoperative complications; and no danger of ascending infection of the middle ear from the ear canal. The demerits appear to be: drainage not ensured; no facility to increase the middle ear pressure by the Valsalva manoeuvre or, Politzerization.

Adult↗