Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Middle Ear Ventilation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Nonsurgical management of otitis media with effusion.

Otitis media with effusion can be successfully treated without the use of middle ear ventilation tubes. Middle ear inflation will, if performed properly, empty most ears as effectively as direct suction through a myringotomy incision. Over 12,000 patients with middle ear effusion have responded to conservative treatment which includes medical management aided by middle ear inflations using a modification of the classic politzerization technique. The technique of controlled middle ear inflation is described and the proper medical management discussed. The avoidance of oral decongestants is stressed as is the proper diagnosis and treatment of the etiological factors causing the formation of the fluid.

Child↗
PubMed1995

Long-term ventilation of the middle ear using a tympanotomy technique.

The technique of long-term middle ear ventilation using a tympanotomy technique is presented. This has proved successful in the management of persistent middle ear effusion despite numerous previous short- and intermediate-term tympanic membrane ventilation tubes. The technique is particularly appropriate in the presence of severe tympanosclerosis as a result of previous tympanostomy tubes, posterior tympanic membrane collapse and adhesion, and atelectasis.

Adolescent↗
PubMed1997

Ventilation scintigraphy of the middle ear.

UNLABELLED: In this study, an attempt was made to administer radioactive gas into the tympanic cavity to measure initial gas trappings as well as clearance from the middle ear to evaluate eustachian tube function. METHODS: Twenty-eight patients were administered 50 MBq 133Xe gas. Three different methods for gas application were tested: (a) direct injection through a tympanostomy tube in two patients, (b) administration through a nasopharyngeal catheter combined with Valsalva maneuvers in six subjects without middle ear dysfunction and (c) insufflation into the pharyngeal space through a nose olive performed in 12 patients with normal eustachian tube function and in eight patients with one-sided tube dysfunction. RESULTS: All three approaches were successful in visualizing middle ear ventilation, demonstrating tracer trapping within the tympanic cavities in 20 of 28 patients. Semiquantitative evaluation by region of interest techniques revealed a left-to-right uptake ratio of 48.4%-51.6% in 13 patients without tube dysfunction. Five patients with one-sided tube dysfunction showed a significantly lower median uptake of 31.6% (p = 0.01). The clearance half-lives ranged from 9 to 283 min in normal subjects and 37-64 min in patients with one-sided tube malfunction, demonstrating no statistically significant difference between the two groups and a trend towards increased washout in patients with tympanic dysfunction. CONCLUSION: Middle ear ventilation scintigraphy with 133Xe through a nose olive is an easy-to-perform test to evaluate eustachian tube function and has a success rate of about 70%, thus, reflecting the complex physiological mechanisms involved.

Adult↗
PubMed1993

[Gas ventilation through middle ear mucosa].

The possible effects of gas ventilation via the middle ear mucosa on middle ear pressure changes with N2O inhalation were studied. Sixty-seven ears without otologic problems were selected from among cases undergoing ENT surgery under general anesthesia. Anesthesia was induced by isoflurane or sevoflurane, and inhalation with a gas mixture of 21/min O2 and 31/min N2O was started under controlled respiration via endotracheal tube. Middle ear pressure was measured each minute with tympanometry just before and during N2O inhalation. Changes in pressure were plotted against time on an X-Y plotter, and the rate of middle ear pressure change and pressure change in 10 minutes were calculated. The following results were obtained; 1. In all cases, the middle ear pressure rose with N2O inhalation. However, the same concentration of N2O created different middle ear pressure changes in different individuals varying from 1.6 mmH2O to 107.8 mmH2O per minute. 2. The rate of middle ear pressure elevation tended to be greater in younger subjects, especially in children aged 4 to 7. 3. There was a negative correlation between the middle ear pressure change and pneumatization of the middle ear. 4. Sex, pulmonary function, and the N2O expiratory flow concentration did not contribute to the variability in the rate of the middle ear pressure elevation.

Acoustic Impedance Tests↗
PubMed1990

Levator veli palatini muscle and eustachian tube function.

Thirty previously unoperated patients with submucous cleft palate, occult submucous cleft palate, and unilateral congenital paralysis of the levator veli palatini muscle were examined. All patients were subjected to a comprehensive otoscopic, endoscopic, audiologic, and tympanometric evaluation. A correlation was made between levator veli palatini muscle anomalies, eustachian tube orifice anomalies, and middle ear ventilation and disorders. Normal middle ear ventilation was found in 23 patients. Negative middle ear pressure that consequently normalized following treatment of coexisting sinusitis was found in 3 patients. Only in 4 patients was chronic middle ear disease found. In one of them, middle ear effusion disappeared following successful treatment of sinusitis. Our conclusion is that the levator veli palatini muscle has no significant function in the opening mechanism of the eustachian tube and must be considered as a velopharyngeal valve muscle only.

Adolescent↗
PubMed1976

[Experiences with polyethylene ventilation tubes in children with recurrent middle ear inflammation (author's transl)].

Middle-ear ventilation tubes (of the Sheehy modification) were placed in 401 ears of 209 children under 16 years of age as treatment for recurrent middle-ear infection. The same procedure was later required in 26% of the cases studied because of further recurrence of middle-ear infection. In four per cent of all patients studied, the ventilating tube failed to cure middle ear disease in spite of controlled concomitant antibacterial therapy. In these cases, an early extrusion of the tube was commonly found. Among all patients, the tube was spontaneously extruded in 76 per cent of the ears, whereas the intubation time was longer than half a year in 53 per cent of the cases. No complications from insertion of the ventilation tubes was seen in the present series of patients. The tympanic membrane was found to be normal in 71 per cent of all cases when follow-up examination was obtained three months after completion in intubation. However, a permanent tympanic membrane perforation was found in five ears (1% of patients). The present study has confirmed the usefulness of middle-ear ventilation tubes, particularly in patients with recurrent middle-ear infections.

Adolescent↗
PubMed2006

Conductive hearing loss in patients with active acromegaly.

OBJECTIVE: There have been rare conflicting results reported concerning possible higher frequency of hearing loss in acromegalic patients. Our goal was to determine whether there is higher frequency of conductive hearing loss in acromegalics and what may cause it if there is any. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Thirty previously untreated patients with acromegaly were compared with 20 age- and sex-matched healthy control subjects. INTERVENTIONS: In all subjects: Otomicroscopy, tuning fork tests, audiometry tympanometry, cochleostapedial reflex, otoacoustic emissions. In acromegalics: endocrinologic assessment, MRI and if necessary, epipharyngoscopy. MAIN OUTCOME MEASURES: We searched for: 1) Signs of ossicle fixation: absence of stapedial reflex in the presence of normal tympanogram, conductive hearing loss, and absence of or grossly disturbed OAE; 2) Disturbances of middle ear ventilation: excessive negative pressure (tympanogram type C), or middle ear effusion (tympanogram type B). RESULTS: The only statistically significant difference between untreated acromegalics and healthy subjects was the presence of middle ear ventilation problem: 7/30 acromegalics (23%) in comparison to none out of 20 healthy controls (0%), p = 0.033. The acromegalics with middle ear ventilation problem were significantly older, had longer duration of the disease, and lower mean growth hormone (GH) levels in comparison with acromegalics without this problem (51.6 +/- 1.7 vs. 44.4 +/- 2.5 years, 11.6 +/- 2.4 vs. 7.7 +/- 0.4 years, 21.68 +/- 4.89 vs. 49.98 +/- 12.54 microg/L respectively). CONCLUSION: Patients with active acromegaly have more frequent middle ear ventilation problem than normal population, especially those with longer duration of the disease. Possible causes are discussed.

Acoustic Impedance Tests↗
PubMed1994

Immunohistochemical quantitation of collagen types I, II, IV and V in the ventilated and non-ventilated rabbit middle ear with otitis media with effusion.

Morphometric quantitation of the area fractions of collagen types I, II, IV and V was determined in the normal rabbit middle ear mucosa and in relation to otitis media with effusion (OME) using a three-layered peroxidase-antiperoxidase technique. The effects of substituting normal low-oxygen middle ear gas (non-ventilated) with atmospheric air (ventilated) were studied in both healthy ears and ears with OME. Based upon previous histological examinations in rabbits, only ears with OME for more than 8 weeks were included to ensure the presence of chronic inflammation (COME). Atmospheric air was introduced into the middle ears by insertion of ventilation tubes or by an enlarged myringotomy. Collagen type I was predominant in all groups studied. The area fractions of collagen types I, II and IV were increased significantly in COME, with collagen type II elevated in particular. Ventilation of the normal ears resulted in a significantly increased area fraction of cells, while the area fractions and distributions of the collagen types were unaffected. None of the ventilated ears in COME improved or healed spontaneously. The total fraction of collagen in COME was not changed significantly by the introduction of atmospheric air. However, the individual distribution of the collagen types was altered, with significantly larger area fractions of types II and V found in ventilated ears with COME. Possible explanations for the differences found are discussed, including the role of oxygen-derived free radicals.

Animals↗
PubMed1998

Middle ear laser office ventilation (LOV) with a CO2 laser flashscanner.

BACKGROUND: Laser assisted ventilation of the middle ear with a defocused laser beam has been performed on adults in an office setting without anesthesia. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of a highly controlled, char-free CO2 flashscanner technology for the ventilation of the middle ear in young children, at this stage under general anesthesia, and later without anesthesia. METHODS: A CO2 flashscanning laser, in conjunction with a micromanipulator, was used on 21 SOM patients ages 3-7 years old, with followup at 2 months. Operating time is approximately 5 minutes. RESULTS: Postoperative results show average patency of 2-3 weeks without adverse effects. Of the treated patients, 53% did not require a second treatment, whereas 47% still suffered from otitis media and needed a second treatment. CONCLUSION: The CO2 flashscanner laser technology is effective and safe for middle ear ventilation and provides excellent control of the perforation diameter. It is already being performed in an office setting with sedation on a limited basis with very promising preliminary results. Based on the current study and on 70 additional cases with longer interval followup, we anticipate the office technique to become widely used in the future.

Ambulatory Surgical Procedures↗
PubMed1997

Dependence of middle ear gas composition on pulmonary ventilation.

The middle ear (ME) steady state gas composition resembles that of mixed venous blood. We changed arterial and venous blood gases by artificially ventilating anesthetized guinea pigs and measured simultaneous ME gas changes during spontaneous breathing, hyperventilation, and hypoventilation. During hyperventilation, PaCO2 and PvCO2 (a = arterial, v = venous) decreased from 46.0 and 53.0 mm Hg to 17.9 and 37.5 mm Hg, respectively, while PaO2 and PvO2 (85.6 and 38.2 mm Hg) did not change. This was accompanied by an ME PCO2 decrease from 70.4 to 58.8 mm Hg and a PO2 decrease from 36.8 to 25.4 mm Hg. During hypoventilation, PaCO2 and PvCO2 increased to 56.8 and 66.4 mm Hg, while PvO2 decreased to 21.8 mm Hg. The ME PCO2 increased simultaneously to 88.8 mm Hg and the ME PO2 decreased to 25.4 mm Hg. The ME PO2 decrease during hyperventilation may be explained by a 33% decrease in ME mucosa perfusion, calculated from the ME ventilation-perfusion ratio. This study shows that ME gas composition follows fluctuations of blood gas levels and thus may affect total ME pressure.

Animals↗
PubMed2003

Effects of non-invasive ventilation on middle ear function in healthy volunteers.

OBJECTIVES: To evaluate the effects of non-invasive ventilation (NIV) with facial mask or helmet on middle ear (ME). DESIGN. Prospective, randomised study. SETTING: University hospital. PARTICIPANTS: Ten healthy subjects randomly allocated in two groups of five subjects each. INTERVENTIONS: NIV for 1 h, with helmet (group H) or facial mask (group M). Flow-triggered pressure support was 10 cmH(2)O, PEEP 5 cmH(2)O, FiO(2) 0.21. MEASUREMENTS AND RESULTS: Impedenzometry was performed before NIV and 5 min after NIV ended; it was repeated 60 min later. In group H the acoustic compliance increased after NIV from 2.0+/-.6 ml to 2.3+/-.6 ml ( P<.01), suggesting that the tympanic membrane became less stiff; 1 h later the compliance returned to basal values (2.0+/-.7 ml); in group M the compliance was unaffected (from 2.0+/-.5 ml to 2.0+/-.4 ml; 1.9+/-.4 ml 1 h later). The acoustic reflex, i.e., the contraction of the stapedial muscle in response to an auditory stimulus, involving the acoustic and facial nerves, was also evaluated during impedenzometry at 250 Hz, 500 Hz, 1,000 Hz, and 4,000 Hz; no significant change of the threshold was observed. CONCLUSIONS: The tympanic membrane is tighten by the tensor tympani and a reversible loosening suggests muscle fatigue in response to the application of intermittent positive pressure applied to the external ear during NIV with helmet. The loss of tensor tympani protective action could theoretically predispose the middle and inner ear to mechanical damage during NIV with helmet, suggesting the use of protective devices (ear plugs) in selective cases requiring long-term, high-pressure treatment.

Adult↗
PubMed2001

Optimizing effectiveness of laser tympanic membrane fenestration in chronic otitis media with effusion. Clinical and technical considerations.

OBJECTIVE: To describe the patient, disease and clinical characteristics that optimize the effectiveness of laser tympanic membrane fenestration (LTMF) to treat chronic otitis media with effusion (OME). SETTING: Four pediatric otolaryngology tertiary referral centers. IRB approved; participation by informed consent. METHODS: An observational clinical effectiveness trial was conducted in 164 ears (94 children), who had chronic OME. All patients were candidates for insertion of pressure equalization tubes (PETs) but agreed to undergo LTMF instead. Clinical and audiologic follow-up are reported at 90 days after LTMF. OUTCOME MEASURES: Clinical effectiveness was defined as an effusion free middle ear at otoscopy with A or C1 tympanogram and normal hearing. RESULTS: At 90 days, 66% of the 95 evaluable ears were effusion free, all with normal hearing. Children younger than 4 years (P<0.04), who had shorter durations of effusion (P<0.009), and who experienced longer duration of fenestration patency (FP) (P<0.009) correlated to improved outcomes. CONCLUSIONS: The use of LTMF to create 2--3 weeks of middle ear ventilation in patients with chronic OME (middle ear effusion (MEE) for 3 months or greater) is effective in 66% of 95 (58%) of ears evaluable at 90 days follow-up. This study provides basic information needed to optimize the use of LTMF today and enhance research efforts in the future.

Child↗
PubMed1984

Experimental background for the use of tympanostomy tubes.

Already within 24 h, splitting of the soft palate in rats caused production of effusion in the attic space. During the next couple of days the effusion material filled the meso- and hypotympanon. The production of a serous fluid in the attic space appeared concomitant with an elevated histamine content in the middle ear cavity, irrespective of whether the ears were ventilated or not. In the artificially ventilated middle ears no effusion appeared in the meso- and hypotympanon and the hypotympanal mucosal lining remained normal. The serous effusion filling the middle ear cavities with the intact tympanic membranes was replaced at about 7 days by a purulent effusion material containing mainly Gram-negative enteric rods. Thus it seems that a serous otitis media and a purulent otitis media occur in a continuum. The change to a purulent infection could be prevented by artificial ventilation, but as soon as the myringotomies were healed or the tympanostomy tubes got clogged a flocculent, pus-like effusion also appeared in these middle ear cavities.

Animals↗
PubMed2004

[Otological findings in adults with isolated cleft palate or cleft lip, jaw, and palate].

BACKGROUND: Children with cleft palate often develop middle ear ventilation disorders due to chronic Eustachian tube dysfunction. This may lead to hearing loss. The insertion of ventilation tubes is a widely accepted measure to avoid sequelae of middle ear ventilation disorders and hearing loss. On the other hand, long-term therapy with ventilation tubes may inflict iatrogenic complications. The objective of the study was the evaluation of otoscopic and audiometric long-term findings in adult cleft patients who had been treated with ventilation tubes since childhood when chronic otitis media with effusion had been observed. PATIENTS AND METHODS: Ninety-two cleft palate patients had been followed up otoscopically and audiometrically for years. The average age was 19.3 years (minimum: 14, maximum: 39 years) at the time the last status was taken. RESULTS: Otoscopy revealed a perforation of the tympanic membrane in 3.8% of the 184 ears. 12% of the patients developed cholesteatoma, however three quarters of these occurred after age 11. 86.4% of the 92 patients had normal hearing in pure tone audiometry. CONCLUSION: Compared with adult cleft patients who did not receive ventilation tubes, our patients had a similar low incidence of eardrum perforations but a higher incidence of cholesteatomas while hearing loss occurred less often. Whether the higher incidence of cholesteatomas is caused iatrogenically or due to a longer follow-up period remains unclear. Whether the use of long-lasting ventilation tubes affects the incidence of cholesteatomas must be proved in further studies.

Adolescent↗
PubMed2001

Effectiveness of adenoidectomy and laser tympanic membrane fenestration.

OBJECTIVE: Adenoidectomy alone or with tonsillectomy (A+/-T) is an effective surgical intervention in the management of otitis media in children, especially when it is performed in conjunction with insertion of pressure equalization tubes (PETs). Otorrhea and persistent tympanic membrane (TM) perforation are frequent complications. This study evaluates the effectiveness of intermediate duration middle ear ventilation using laser tympanic membrane fenestration (LTMF) without tube insertion and as an adjunct to adenoidectomy in resolving middle ear disease within the first 90 days after surgery. STUDY DESIGN: This pilot study was a multicenter, prospective clinical cohort trial. Institutional review board approval and informed consent were obtained. The study involved four tertiary care pediatric otolaryngology departments. Fifty children (96 ears) were treated with LTMF in conjunction with A+/-T from June 1, 1998, through March 30, 1999. Ages ranged from 9 months to 12 years. Patients undergoing A+/-T who would have been recommended for PET insertion instead underwent middle ear ventilation with LTMF using the Oto-LAM device (ESC/Sharplan, Yokneam, Israel). Patients were seen at 30, 60, and 90 days postoperatively. Resolution of otitis media with effusion was determined by clinical examination, which included pneumatic otoscopy, audiometry, and tympanometry. RESULTS: Of the treated ears, 88%, 86%, and 83% had clinical resolution of middle ear disease at 30, 60, and 90 days, respectively. Preoperatively, 45% (n = 85) of ears had normal hearing; 92% (n = 49) had normal hearing at 90 days. Eighty-nine percent (n = 92) had type C2 or B tympanograms preoperatively, and 12% (n = 60) had type C2 or B at 90 days. CONCLUSION: Laser tympanic membrane fenestration in conjunction with adenoidectomy was effective in restoring normal middle ear function at 90 days post-treatment in greater than 80% of children who otherwise may have had placement of PETs.

Adenoids↗
PubMedDate not supplied

Middle ear pressure during brief pathological conditions of the nose and throat.

Middle ear ventilation was investigated by repeated tympanometry in different groups of patients with impaired air current in the upper airways. Among patients with total blocking of the nose by bilateral anterior packing, 46% had a negative pressure of -100 mm H2O or less, which quickly returned to normal after removal of the packing. Unilateral anterior packing produced no significant changes in middle ear ventilation. Unilateral posterior packing produced changes in 50% of ears, tonsillectomy in 60% of ears, amounting to a negative pressure of -100 mm H2O or less. Patients with infectious mononucleosis showed the poorest middle ear ventilation, 45% having pressure between -100 and -199, 45% between -200 and -350 mm H2O. Normalization of the pressure was very slow, but occurred in all cases after 2-4 weeks. The different pathogenetic possibilities, viz. direct occlusion of the tubal orifice, inflammatory mucosal reaction, insufficient swallowing, insufficient air current through the rhinopharynx, are discussed.

Acoustic Impedance Tests↗
PubMed1998

[The CO2 laser otoscope. A new application device for paracentesis].

The CO2 laser myringotomy is a current low-pain procedure for middle-ear ventilation for secretory otitis media (SOM) that can be performed under topical anesthesia, even in children. The duration of middle-ear ventilation is essentially determined by the size of the perforation created. Perforations with a diameter greater than 2 mm ventilate the tympanic cavity for approximately 3 weeks, thus avoiding tympanic ventilation tubes. To date, the CO2 laser beam can only be reliably applied to the tymapanic membrane via a micromanipulator system coupled to an ear microscope. The CO2 laser otoscope is a new application system that markedly reduces the technical complexity of surgery and improves the mobility and availability of the system. The incorporation of a small inexpensive CO2 laser in the otoscope represents a significant development in SOM therapy.

Animals↗
PubMedDate not supplied

Study of the ventilation of middle ear using radioactive xenon.

The greatest contribution of nuclear medicine has been to make possible dynamic measurements of regional function. It is conceivable that if this technology could be successfully used to measure the ventilation and clearance of the middle ear, answers to some of the most crucial problems in otology may be found. The objectives of this paper are three-fold: 1) A descriptive account of radiotracers and radiodetectors with emphasis on Xenon133. 2) The development of scintillographic techniques for the dynamic study of the ventilation of the ear and sinuses. 3) The methods that are being explored for the quantification of these functions.

Ear, Middle↗