Trans-tympanic Cartilage Chip Insertion for Intractable Patulous Eustachian Tube

BACKGROUND AND OBJECTIVES: Patulous Eustachian tube (PET) causes troublesome autophony. We treated PET using tragal cartilage chip insertion to fill in the concavity within the tubal valve and evaluated the feasibility of this method. SUBJECTS AND METHODS: This study used a prospective design. Eleven patients with PET disorder were included. Tragal cartilage chip insertion via a transcanal approach into the Eustachian tube (ET) was performed in 14 ears of those patients. They were followed-up for at least 12 months after surgery and were evaluated by symptom questionnaire scores. RESULTS: The average follow-up was 16.4 months. Thirteen of fourteen ears received immediate complete relief of autophony symptoms. Autophony symptoms at the last follow-up were as follows: four ears (28.6%) had complete relief; five ears (35.7%) showed satisfactory improvement; four ears (28.6%) showed significant but unsatisfactory improvement; and one ear (7.1%) was unchanged. The PET symptom questionnaire in the affected ears showed a significant reduction in autophony (p=0.047) and improvement in breathing sound conduction (p=0.047). There were no complications such as otitis media or occlusion symptom. CONCLUSIONS: Transtympanic cartilage chip insertion into the ET provides a safe and accessible surgical option for the treatment of PET.

Temporomandibular Joint Disorders as a Cause of Aural Fullness

OBJECTIVES: Temporomandibular joint disorders (TMD) are often associated with aural manifestations. However, it is not clear whether aural fullness could be induced by TMD. The purpose was to investigate the TMD and effectiveness of TMD treatments in patients with mainly or exclusively aural fullness complaint. METHODS: One hundred and twelve patients, who had aural fullness as the main or sole complaint, presented to the Otolaryngology Department, PLA Army General Hospital, Beijing, China, between January 2010 and January 2015. Patients’ medical history indicated that they had previously been diagnosed and treated for otitis media or sensorineural hearing loss but without positive results. Patients were subjected to pure tone audiometry and acoustic immittance screening using GSI-61 clinical audiometer and GSI TympStar middle ear analyzer respectively. Patients were examined by questionnaire, X-ray and/or computed tomography scan of temporomandibular joint. TMD was categorized according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were then treated for TMD. RESULTS: All the patients showed normal eardrum and type A tympanogram. The patients of 60.7% (68/112) were classified as group I TMD disorders (muscle disorders), 34.8% (39/112) were group II (disc displacements), and 4.5% (5/112) were group III (arthralgia, osteoarthritis, and osteoarthrosis). Aural fullness was completely resolved or significantly improved in 67 and 34 patients respectively following treatments aimed at improving TMD, with a combined effectiveness of 90.2% (101/112). TMD treatments are especially effective (94.1%) in group I TMD. CONCLUSION: TMD as a potential cause of aural fullness should be considered in otolaryngology practice.

<b>Five Cases of Patent Eustachian Tube Treated </b><b>with Kigikenchuto for Asthenic Disease </b> / 日本東洋医学雑誌

The patent eustachian tubes (PET) of five patients with a chief complaint of aural fullness were successfully treated with kigikenchuto. A Kampo extract preparation of ogikenchuto and tokikenchuto (daily dose of 9 and 7.5 g, respectively) was applied as a representative prescription for kigikenchuto. The five patients had also been diagnosed with definitive PET on otological examination. Case 1 was a 73-year-old male suffering from aural fullness and autophonia after a common cold. These ear symptoms improved on lying down and resting. He had a history of admission for cerebral hemorrhage with hypertension and weight loss. Bilateral stiffness of the abdominal rectus muscle and an intolerable tickling sensation were noted. After taking kigikenchuto for two weeks, his symptoms improved. An additional study of four patients treated with kigikenchuto, including Case 2, a 75-year-old female, Case 3, a 33-year-old female, Case 4, a 78-year-old female, and Case 5, a 21-year-old male, showed effective cures. Kigikenchuto is a <i>qi</i>-blood supplementing derivative of shokenchuto, a minor center-reinforcing Kampo medicine for asthenic disease. Based on these results, we suggested that kigikenchuto serves as a useful formulation to treat PET. Life guidance to promote health is also essential for cure.

Clinical Manifestations of Aural Fullness

PURPOSE: Even though aural fullness is ubiquitous among patients presenting to otolaryngology clinics, the association between aural fullness and disease development has not yet been clearly determined. MATERIALS AND METHODS: Our study was performed on outpatients from June 2006 to February 2010 whose major complaint was "ear fullness", "aural fullness", or "ear pressure". We assessed their demographic and clinical characteristics, including sex, associated diseases, symptoms, otoscopic findings, audiology test results, and final diagnoses. RESULTS: Among 432 patients, 165 (38.2%) were males and 267 (61.8%) were females, with mean ages of 42+/-19 years and 47+/-17 years, respectively. Tinnitus, hearing disturbance, autophony (p<0.01) as well as nasal obstruction and sore throat (p<0.05) showed a statistically significant correlation with aural fullness. Among patients who complained of hearing fullness, tests and measures such as impedance audiometry, speech reception threshold, and pure tone audiometry generated statistically significant results (p<0.05). Ear fullness was most frequently diagnosed as Eustachian tube dysfunction (28.9%), followed by otitis media with effusion (13.4%) and chronic otitis media (7.2%). However, 13.4% of patients could not be definitively diagnosed. CONCLUSION: Among patients complaining of ear fullness, Eustachian tube dysfunction, otitis media with effusion, chronic otitis media were most commonly observed. Performance of otoscopy, nasal endoscopy, the Valsalva maneuver, and additional audiological tests is necessary to exclude other diseases.

Aural Fullness / 대한이비인후과학회지

Aural fullness is common in patients that visit otolaryngology clinics. It is necessary to examine their detailed medical history, have a physical examination and include additional appropriate studies in order to make an accurate diagnosis for patients who complain about aural fullness. Physicians should have extensive knowledge about diseases which can cause aural fullness. In this paper, the author will introduce an appropriate approach to aural fullness and review typical diseases associated with aural fullness.

Analysis of evoked otoacoustic emission in normal pure tone hearing thresholds patients with aural fullness / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze normal pure tone hearing thresholds patients with aural fullness using evoked otoacoustic emission in order to detect the early cochlear impairment. Method: Forty-three normal pure tone hearing thresholds patients(72 ears,aural fullness group)with aural fullness were served as subjects and 30 normal volunteers(60 ears,control group)as controls. Transiently evoked otoacoustic emission (TEOAE) and distortion product evoked otoacoustic emission (DPOAE) were tested with Capella otoacoustic emission machine.The DPOAE detection rate and amplitudes at all frequencies,the passing rate and wave signal noise ratio (SNR), wave reproducibility,band SNR and band reproducibility of TEOAE were recorded and analyzed.Result:①Only on the frequency points of 0. 50 kHz and 0. 75 kHz,the detection rate of DPOAE in aural fullness group was lower than that in control group(P＜0. 05). There was no significant difference in the rate among other frequency points(P＞0. 05). ②The passing rate of TEOAE was 100% in control group and 90.28% in aural fullness group.There were statistical differences between two groups(X~2=6. 16, P＜0. 05).③Compared with the control group,the DPOAE amplitudes at all frequencies,the wave signal noise ratio(SNR), wave reproducibility,band SNR and band reproducibility of TEOAE in patients with aural fullness were significantly decreased.There were statistical differences(P＜0.05 or P＜0.01). Conclusion:Some patients of normal hearing thresholds with aural fullness have had early harm of outer hair cell in cochlear.TEOAE and DPOAE may be used to detect these lesions early before the hearing impairment occurred.

Effect of Intratympanic Chemical Labyrinthectomy with Streptomycin on Auditory Symptoms / 대한평형의학회지

BACKGROUND AND OBJECTIVES Intratympanic treatment with aminoglycosides for Meniere's disease has been used, trying to eliminate vertigo complaints, while preserving hearing. This study was undertaken to evaluate the therapeutic outcomes for auditory symptoms in Meniere's disease patients after intratympanic application with single low-dose streptomycin powder. MATERIALS AND METHODS Ninty-eight patients diagnosed with definite Meniere's disease who underwent chemical labyrinthectomy with streptomycin at Yonsei University Medical Center from March 1997 to June 2006 were enrolled. Low dose streptomycin powder (10 mg) was applied into the round window niche directly. Changes of hearing threshold, tinnitus and aural fullness were evaluated postoperatively according to Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease of American Academy of Otolaryngology?Head and Neck Surgery. RESULTS Hearing threshold was not changed significantly after the procedure (from 65.5+/-19.1 to 69.3+/-20.0 p>0.05) and was improved in 7% of the patients. Hearing deterioration after the procedure was detected only in 17%. Tinnitus and aural fullness was improved in 51% and 25% respectively. CONCLUSION Single application of streptomycin powder filling round window niche showed minimal deterioration of hearing threshold. It is the useful method to improve or prevent the progress of auditory symptoms in patients with Meniere's disease