Remissão total do zumbido pediátrico: relato dos resultados de uma abordagem não medicamentosa da disfunção tubária / Total remission of pediatric tinnitus: reporting the results of a non-drug approach to tubal dysfunction / Remisión total del acufeno pediátrico: informe de los resultados de un enfoque no farmacológico a la disfunción tubárica

Introdução: Zumbido é um sintoma crescente na população pediátrica e sua multifatoriedade etiológica demanda amplas investigações para utilizar-se adequadas intervenções. Objetivos: relatar os efeitos de uma abordagem não medicamentosa em um caso de remissão total do zumbido pediátrico oriundo da disfunção tubária. Método: Este artigo apresenta um indivíduo com sete anos, do sexo feminino e com queixa de zumbido crônico associado a disfunção tubária, considerado escasso na literatura. Além disso, este estudo descreve as avaliações médicas (neurológica e otorrinolaringológica), a avaliação audiológica e psicoacústica do zumbido, o processo diagnóstico e a intervenção fonoaudiológica realizada. Utilizou-se uma abordagem não medicamentosa que contemplou exercícios miofuncionais orofaciais, Manobra de Valsalva e limpeza nasal. Resultados: Após um mês de intervenção, com a prática diária dos exercícios, o indivíduo estudado referiu ausência da percepção do sintoma e das demais queixas auditivas. Este resultado também foi constatado nas avaliações audiológicas. Conclusão: A abordagem não medicamentosa da disfunção tubária demonstrou bons resultados frente ao manejo do zumbido crônico, para o presente caso. (AU)

Introduction: Tinnitus is a growing symptom in the pediatric population and its etiological multifactorial demands extensive investigations to use appropriate interventions. Objective: report the effects of a non-medicated approach of a case of total remission of pediatric tinnitus from tube dysfunction. Methods: This article presents a seven-year-old female patient with a complaint of chronic tinnitus associated with tubal dysfunction, considered rare in the literature. Besides that, this study describes the medical evaluations (neurological and otorhinolaryngological), the audiological and psychoacoustic evaluations of the tinnitus, the diagnostic process and the speech-language intervention performed. It was used a non-medication approach that included orofacial myofunctional exercises, Valsalva maneuver and nasal cleaning. Results: After a month of intervention, with the daily practice of exercises, the studied subject reported the absence of perception of the symptom and other auditory complaints. This result was also verified in the audiological evaluations. Conclusion: The non-medication approach to tubal dysfunction has shown good results in relation to the management of chronic tinnitus for the present case. (AU)

Introducción: Acufeno es un síntoma creciente en la población pediátrica y su multifatoriedad etiológica demanda amplias investigaciones para utilizar adecuadas intervenciones. Objetivos: Informar los efectos de un enfoque no farmacológico de un caso de remisión total del acufeno pediátrico oriundo de la disfunción tubárica. Metodos: Este artículo presenta un sujeto con siete años, del sexo femenino y con queja de acufeno crónico asociado a disfunción tubárica, considerado escaso en la literatura. Además, este estudio describe las evaluaciones médicas (neurológica y otorrinolaringológica), la evaluación audiológica y psicoacústica del zumbido, el proceso diagnóstico y la intervención fonoaudiológica realizada. Se utilizó un abordaje no medicamentoso que contempló ejercicios miofuncionales orofaciales, Maniobra de Valsalva y limpieza nasal. Resultados: Después de un mes de intervención, con la práctica diaria de los ejercicios, el sujeto estudiado refirió ausencia de la percepción del síntoma y de las demás quejas auditivas. Este resultado también se constató en las evaluaciones audiológicas. Conclusión: El abordaje no medicamentoso de la disfunción tubárica demostró buenos resultados frente al manejo del acufeno crónico, para el presente caso. (AU)

"Step-up"surgical treatment strategy for patulous Eustachian tube / 临床耳鼻咽喉头颈外科杂志

Patients with patulous Eustachian tubes(PET) usually suffer from annoying symptoms, such as tinnitus, autophony and aural fullness, due to the excessive opening of the Eustachian tube. There is no uniform standard of treatment, and conservative therapy combined with"Stepup"surgical intervention strategy is the main treatment. In this article, we reviewed various surgical treatments of patulous Eustachian tube in recent years, including key points of surgical operation, effectiveness, safety and complications. Full communication and evaluation are needed to establish appropriate patients' expectations preoperatively. A "Stepup" treatment strategy will be carried out, including conservative treatment, tympanic membrane surgery, Eustachian tube pharyngeal orifice constriction surgery, Eustachian tube tympanic orifice plug surgery and Eustachian tube muscle surgery, which aims to maintain normal Eustachian tube function and good middle ear ventilation.

Numerical simulation modeling of middle ear-eustachian tube ventilation based on Chinese digital visual human body / 中华耳鼻咽喉头颈外科杂志

Objective: To establish a three-dimensional model of middle ear-eustachian tube based on Chinese digital visual human dataset, and the deformation and pressure changes of the middle ear-eustachian tube system after eustachian tube opening are simulated by computer numerical simulation. Methods: The first female Chinese Digital Visual Human data was adopted. The images were imported by Amira image processing software, and the images were segmented by Geomagic software to form a three-dimensional model of middle ear-eustachian tube system, including eustachian tube, tympanum, tympanic membrane, auditory ossicles, and mastoid air cells system. The 3D model was imported into Hypermesh software for meshing and analysis. The structural mechanics calculation was carried out by Abaqus, and gas flow was simulated by Xflow. The tissue deformation and middle ear pressure changes during eustachian tube opening were numerically simulated by fluid-solid coupling algorithm. Several pressure monitoring points including tympanum, mastoid, tympanic isthmus, and external auditory canal were set up in the model, and the pressure changes of each monitoring point were recorded and compared. Results: In this study, a three-dimensional model of middle ear-eustachian tube and a numerical simulation model of middle ear ventilation were established, including eustachian tube, tympanum, mastoid air cells, tympanic membrane, and auditory ossicles. The dynamic changes of the model after ventilation could be divided into five stages according to the pressure. In addition, the pressure changes of tympanum and tympanic isthmus were basically synchronous, and the pressure changes of mastoid air cells system were later than that of tympanum and tympanic isthmus, which verified the pressure buffering effect of mastoid. The extracted pressure curve of the external auditory canal was basically consistent with that of tympanometry in terms of value and trend, which verified the effectiveness of the model. Conclusions: The numerical simulation model of middle ear-eustachian tube ventilation established in this paper can simulate the tissue deformation and middle ear pressure changes after eustachian tube opening, and its accuracy and effectiveness are also verified. This not only lays a foundation for further research, but also provides a new research method for the study of middle ear ventilation.

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy / Disfunção da trompa de Eustáquio em pacientes com apneia do sono e melhoria proporcionada pela terapia com pressão positiva contínua nas vias aéreas

Abstract Introduction Upper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome. Objective To investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions. Methods Forty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared. Results Right middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002). Conclusion Mild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.

Resumo Introdução A resistência das vias aéreas superiores pode se acompanhar de disfunção da trompa de Eustáquio e alterar a pressão na orelha média em pacientes com síndrome da apneia obstrutiva do sono Objetivo Investigar os efeitos do tratamento da síndrome da apneia obstrutiva do sono com pressão positiva contínua nas vias aéreas nas funções da trompa de Eustáquio. Método Foram incluídos 42 pacientes com síndrome da apneia obstrutiva do sono leve, 45 pacientes com síndrome da apneia obstrutiva do sono moderada, 47 pacientes com síndrome da apneia obstrutiva do sono grave submetidos à terapia de pressão positiva contínua nas vias aéreas, 32 pacientes com síndrome da apneia obstrutiva do sono grave sem terapia de pressão positiva contínua nas vias aéreas e 88 indivíduos sem apneia do sono (controle). Os parâmetros timpanométricos dos grupos foram comparados. Resultados As pressões na orelha média direita nos grupos com síndrome da apneia obstrutiva do sono leve e moderada não diferiram significantemente das do grupo controle (p = 0,93 e p = 0,55), assim como nas pressões da orelha média esquerda (p = 0,94 e p = 0,86). A pressão na orelha média direita foi significantemente maior nos grupos com síndrome da apneia obstrutiva do sono grave do que no grupo controle, assim como a pressão na orelha média esquerda (p < 0,001). A pressão negativa na orelha média foi significantemente menor nos pacientes com síndrome da apneia obstrutiva do sono grave submetidos à terapia com pressão positiva contínua nas vias aéreas em comparação com aqueles que não receberam tratamento (p < 0,001). As frequências dos timpanogramas do tipo B e C da orelha direita foram significantemente maiores em pacientes com síndrome da apneia obstrutiva do sonograve que não receberam terapia com pressão positiva contínua nas vias aéreas (12,4%) do que nos controles (0%) (p = 0,02). As frequências dos timpanogramas do tipo B ou C na orelha esquerda foram significantemente maiores em pacientes com síndrome da apneia obstrutiva do sonograve que não receberam terapia com pressão positiva contínua nas vias aéreas (21,9%) do que nos controles (0%) (p = 0,002). Conclusão Síndrome da apneia obstrutiva do sono leve e moderada não afetou a pressão da orelha média, mas a síndrome da apneia obstrutiva do sono grave pode aumentar a pressão negativa da orelha média. Em pacientes com síndrome da apneia obstrutiva do sono grave, a terapia em longo prazo com pressão positiva contínua nas vias aéreas pode normalizar a pressão da orelha média.

Clinical and imaging features of middle ear hairy polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To collect the clinical cases of middle ear hairy polyp, and to summarize the imaging features. Methods: We retrospectively analyzed the clinical data of four cases middle ear hairy polyp confirmed by surgical and pathologic between January 2007 and January 2020 at the Affiliated Eye & ENT Hospital of Fudan University. There were three females, one male, with two left ears and two right ears, aged from 1 to 59 years. The CT and MRI imaging of the patients, and the corresponding clinical manifestations were analyzed. Results: Hairy polyps originated from tympanum in one case, originated from Eustachian tube in two cases, exhibiting recurrent otorrhea without evident inducement. The other case, hairy polyps originated from the Eustachian tube pharyngeal orifice and protruded into the nasopharyngeal cavity, with pharynx discomfort and aural fullness, endoscope showed offwhite polypoid mass with a little hair. All the four cases presented polypoid soft tissue masses on CT and MRI imaging, containing soft tissue wall and a large amount of adipose tissue, with soft tissue in the center of the mass which liked the core, and enhanced. MRI showed stratified arrangement of fat and soft tissue in the wall of the mass. Four cases all had surgical treatment, postoperative pathology examination presented that hair follicles, mature sebaceous glands and other skin appendages were found under squamous epithelium. A large amount of adipose tissue, part of muscle tissue, cartilage tissue, and some fibro-collagenous tissue were proliferated in the mass, accompanied by collagen degeneration. Conclusion: The middle ear hairy polyps has imaging characteristics, the polypoid soft tissue mass usually looks smooth and contains a large amount of adipose tissue, with a soft tissue in the center, and can be suggestively diagnosed by CT and MRI.

THE function and morphology study of eustachian tube based on sonotubometry and multi-slice spiral CT in normal subjects / 中华耳鼻咽喉头颈外科杂志

Objective: In order to assess ET more comprehensively, sonotubometry (STM)combined with CT images were applied to investigate the opening features of eustachian tube (ET) in normal subjects. STM was also used as a monitor training ET opening maneuver and optimizing CT scan parameters. Methods: Following ET opening training monitored by STM, STM data of ET opening duration and maximum sound pressure from 13 healthy volunteers (10 males and 3 females, 22 to 26 years old) were acquired using maneuvers of swallowing and Valsalva in standing and supine positions. Two trials of CT scan, setting A (slice thickness 6.0 mm, manually simulated to 0.6 mm, reconstruction thickness 0.6 mm) for normal and Valsalva scans and setting B(slice thickness 0.4 mm,reconstruction thickness 0.4 mm)for Valsalva scan, were conducted in each subject. The bone area and cartilage area of ET were measured respectively in reconstructed CT images. Statistical software SPSS 19.0 was employed in data analysis. Results: The duration of ET opening and maximum sound pressure by Valsalva were longer and stronger than those by swallowing in both positions. For Valsalva maneuver, standing position resulted in longer ET opening duration compared to supine position (P<0.05). Under setting A, ET cartilage area was measured larger by Valsalva scan than by normal scan (P<0.05). By Valsalva scan, setting A captured larger ET cartilage area compared to setting B (P<0.05). CT setting B resulted in longer scan time in comparison to setting A (P<0.05). Conclusions: Techniques of STM in supine position plus CT scan under setting A can be combined by Valsalva passive ET opening. Not only the invisible ET lumen through routine CT scan can be illustrated, but also relevant ET open-close process is shown, therefore, this study provides the technique for ET research of function and structure.

Resultados de la dilatación de la trompa de Eustaquio en adultos con disfunción tubárica crónica / Results of Eustaquian tube dilation in adults with chronic tubal disfunction

Introducción: la dilatación endoscópica con balón ha mostrado ser una herramienta terapéutica y efectiva para el tratamiento de la disfunción de la trompa de Eustaquio. Al momento se desconocen los resultados en la población colombiana. Objetivos: determinar la mejoría clínica de la dilatación de la trompa de Eustaquio en pacientes adultos con disfunción tubárica crónica, en un centro de IV nivel de atención en Bogotá. Diseño: estudio observacional retrospectivo con componente analítico. Métodos: se revisaron los registros clínicos de pacientes intervenidos con la dilatación endoscópica de la trompa de Eustaquio; se describen los cambios objetivos y subjetivos en el posoperatorio. Resultados: se obtuvieron 22 pacientes entre los 18 y 66 años con seguimiento de 6 a 22 meses. Al 84,5 % se les realizó la intervención bilateral y al 15,8 % la unilateral, para un total de 38 oídos intervenidos. El 60 % lograron la normalización del timpanograma. Hubo una mejoría de las presiones del oído medio de -102,5 a -3,5 daPa (p = 0,005). Se alcanzó una mejoría estadísticamente significativa en 6/7 síntomas según la escala de severidad y reducción del gap aéreo-óseo en 7 dB y 4 dB del promedio de tonos puros por vía aérea (PTA) (p = 0,249; p = 0,711). Además, se generó un impacto positivo promedio de +32 en la escala de calidad de vida según el Glasgow Benefit Inventory (GBI). Conclusión: la dilatación de trompa de Eustaquio resulta ser una terapéutica segura y eficaz en población adulta, con mejoras estadísticamente significativas en la severidad de los síntomas y en las presiones del oído medio, lo cual genera un impacto positivo en la escala de calidad de vida según el GBI.

Introduction: Endoscopic balloon dilation has been shown to be a therapeutic and effective tool for the treatment of eustachian tube dysfunction. Now, the results in the Colombian population are unknown. Aim: Describe the clinical improvement of eustachian tube dilation in adult patients with chronic tubal dysfunction, in a 4th level complexity hospital in Bogotá. Design: Retrospective observational study with analytical component. Methods: The clinical records of patients undergoing endoscopic dilatation of the Eustachian tube were reviewed. Objective and subjective changes in the postoperative period are described. Results: 22 patients were obtained between 18 and 66 years and follow-up from 6 to 22 months. 84.5 % underwent bilateral intervention and 15.8 % unilaterally for a total of 38 operated ears. 60 % achieved tympanogram normalization. There was improvement of middle ear pressures from -102.5 to -3.5 daPa (p = 0.005). Statistically significant improvement in 6/7 symptoms according to the severity scale and reduction of air-bone Gap in 7 dB and 4 dB of airway PTA (p = 0.249; p = 0.711). Generating an average positive impact of +32 on the quality-of-life scale according to the Glasgow Benefit Inventory (GBI). Conclusions: Eustachian tube dilation proves to be a safe and effective therapy in an adult population with statistically significant improvements in the severity of symptoms, and in middle ear pressures. Generating a positive impact on the scale of quality of life according to the GBI.

Disfunción del conducto faringotimpánico. El ETDQ-7 como herramienta para el diagnóstico clínico / Pharyngothympanic tube dysfunction. The ETDQ-7 as a tool for clinical diagnosis

RESUMEN En la actualidad se hace referencia en la bibliografía a una gran variedad de métodos para evaluar la disfunción del conducto faringotimpánico (DCFT), la gran mayoría de ellos requiere de instrumental de alta complejidad y personal altamente capacitado. Pese a lo mencionado, ninguno de dichos métodos ha sido validado como herramienta gold standard para el diagnóstico de esta patología. En este contexto, se presenta una herramienta complementaria para el diagnóstico de la DCFT, el Eustachian Tube Dysfunction Questionnaire -7 ítemes (ETDQ-7); cuestionario autoadministrado que considera 7 preguntas en base a una escala de Likert, fue creado para evaluar la sintomatología asociada a la disfunción del conducto con una puntuación que va desde lo más leve (1 punto) a lo más grave (7 puntos) de acuerdo con los síntomas percibidos, y posee un puntaje máximo de 49 puntos, correspondiente a una disfunción severa. La presente revisión tiene como objetivo buscar, organizar, clasificar y describir la información disponible en publicaciones científicas indexadas sobre el ETDQ-7 como herramienta para el diagnóstico clínico complementario de la DCFT. Se incluyeron 11 artículos científicos que hacen referencia al uso del ETDQ-7 en diferentes países. Los resultados recabados sugieren que el ETDQ-7 sería una valiosa herramienta, de alta sensibilidad, especificidad y validez clínica, que permitiría discriminar la presencia de la DCFT. No se encontró evidencia respecto a la aplicación o validación de este cuestionario en nuestro país.

ABSTRACT At present, great variety of methods are described to evaluate the dysfunction of the pharyngotympanic duct (DCFT), the vast majority of them require highly complex instruments and highly trained personnel. Despite this, none of these methods has been validated as the gold standard for the diagnosis of this pathology. In this context, a complementary tool for the diagnosis of the DCFT is presented. The Eustachian Tube Dysfunction Questionnaire-7 items (ETDQ-7), a self-administered questionnaire that includes 7 questions based on a Likert scale, was created to evaluate the symptomatology associated with the dysfunction of the duet. It is scored ranging from the mildest symptomatology (1 point) to the most severe (7 points), according to the perceived symptoms, with a maximum score of 49 points, corresponding to a severe dysfunction. The present review aims to search, organize, classify and describe the available information in scientific indexed journals about the ETDQ-7 as a tool for complementary diagnosis of the DCFT. Eleven scientific articles were included, referred to the use of ETDQ-7 in different countries, describing it as a valid tool which allows to discriminate the presence of a DCFT.

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction / Comparação entre adenoidectomia por curetagem e adenoidectomia por microdebridador assistida por endoscopia, em relação à disfunção tubária

Abstract Introduction Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. Objective The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. Methods This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. Results There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128). Conclusion Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

Resumo Introdução A adenoidectomia pode ser realizada de várias maneiras, inclusive por curetagem e por microdebridador, assistida por endoscopia. Essas duas técnicas têm algumas vantagens e desvantagens. Objetivo O objetivo deste estudo foi investigar os efeitos da técnica de adenoidectomia por curetagem e da adenoidectomia por microdebridador assistida por endoscopia sobre a pressão timpânica em pacientes pediátricos com hipertrofia adenoideana sem otite média com efusão. Método Estudo descritivo prospectivo feito com 65 pacientes que apresentavam membrana timpânica e timpanograma normais, que foram então submetidos à adenoidectomia ou adenotonsilectomia por hipertrofia adenoamigdaliana. Os pacientes foram divididos aleatoriamente em dois grupos: grupo adenoidectomia por curetagem e grupo adenoidectomia por microdebridador assistida por endoscópio. Todos os pacientes fizeram timpanometria e os valores das pressões do tímpano pré-operatórios e pós-operatórios no 1º e 7º dias foram comparados intragrupos e entre os grupos. Resultados Foram incluídos 32 pacientes no grupo adenoidectomia por curetagem e 33 pacientes no grupo adenoidectomia com microdebridador. Diferenças estatisticamente significantes foram observadas na mediana da diferença entre a pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para ambas as orelhas, direita e esquerda, na adenoidectomia por curetagem (p < 0,001, p < 0,001). Essa diferença ocorreu no 1º dia do pós-operatório e o valor retornou ao normal no 7º dia. Não houve diferença significante na mediana entre pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para as orelhas direita e esquerda no grupo de adenoidectomia com microdebridador (p = 0,376, p = 0,128). Conclusão A disfunção tubária no pós-operatório é observada menos frequentemente com a técnica de adenoidectomia por microdebridador assistida por endoscopia quando comparada com a técnica convencional.

Prevalence of hearing symptoms related to patulous eustachian tube after bariatric surgery / Prevalência de sintomas auditivos relacionados à tuba auditiva patente em pós-operatório de cirurgia bariátrica

ABSTRACT Background: Rapid and severe weight loss can result in the reduction of the ear tube lining fat tissue and it becomes patent, leading to symptoms such as autophony, aural fullness and tinnitus. Patients after bariatric surgery have, in theory, a predisposition to the development of such alteration. Aim: To evaluate the presence of patent tuba-related complaints in patients undergoing bariatric surgery, correlating with weight and body mass index (BMI) values, as well as demographic data. Methods: Cross-sectional study composed of the evaluation of patients undergoing bariatric surgery through a standardized questionnaire about the presence of symptoms compatible with ear tube patency. Results: Eighty patients were evaluated, 77 female and three males. The main comorbidity was systemic arterial hypertension (37.5%). Fifteen (18.75%) presented symptoms compatible with patent auditory/Eustachian tube - aural fullness and autophony - postoperatively. In symptomatic individuals the initial weight was 112 kg on average and the preoperative BMI was 45 kg/m², while in asymptomatic individuals the weight was 117 kg and BMI 47 kg/m². There was statistical significance in the comparison between individuals with and without symptoms in the variables of initial weight (p=0.00000), current weight (p=0.00029), preoperative BMI (p=0.00219) and postoperative BMI (p=0.00148). Conclusion: The presence of symptoms compatible with patent auditory/Eustachian tube was 18.75% of the patients submitted to bariatric surgery in the evaluated sample. Both preoperative weight and BMI were lower in symptomatic patients when compared with the asymptomatic group.

RESUMO Racional: A perda ponderal rápida e intensa pode resultar na redução do tecido gorduroso de revestimento da tuba auditiva e ela se tornar patente, gerando sintomas como autofonia, plenitude aural e zumbido. Pacientes após operação bariátrica possuem, em teoria, predisposição para o desenvolvimento de tal alteração. Objetivo: Avaliar a presença de queixas relacionadas à tuba patente em pacientes submetidos à cirurgia bariátrica, correlacionando com os valores de peso, índice de massa corpórea e de dados demográficos. Método: Estudo transversal composto pela avaliação de pacientes submetidos à cirurgia bariátrica através de questionário padronizado, sobre a presença de sintomas compatíveis com patência de tuba auditiva. Resultados: Foram avaliados 80 pacientes, 77 mulheres e três homens. A principal comorbidade foi hipertensão arterial sistêmica (37,5%). Quinze (18,75%) apresentaram sintomas compatíveis com tuba auditiva patente - plenitude aural e autofonia - no pós-operatório. Nos sintomáticos o peso inicial era em média 112 kg e o IMC pré-operatório de 45 kg/m²; já nos assintomáticos o peso era de 117 kg e o IMC de 47 kg/m². Houve significância estatística na comparação entre indivíduos com e sem sintomas nas variáveis de peso inicial (p=0,00000), peso atual (p=0,00029), IMC pré-operatório (p=0,00219) e IMC pós-operatório (p=0,00148). Conclusão: A presença de sintomas compatíveis com tuba auditiva patente foi de 18,75% dos pacientes submetidos à cirurgia bariátrica na amostra avaliada. Tanto o peso pré-operatório, quanto o IMC foram menores nos pacientes sintomáticos, quando comparados com o grupo assintomático.

Translation, validation and cultural adaptation of "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) to Brazilian Portuguese (BR) / Tradução, validação e adaptação cultural do questionário "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) para o português brasileiro (BR)

Abstract Introduction: Chronic Eustachian tube dysfunction can cause several symptoms and middle ear conditions that can impact patient quality of life. It is estimated to be relatively frequent, affecting approximately 5% of adults. The diagnostic tools for this condition are still inadequate. In 2012, McCoul et al. published a questionnaire for the evaluation of Eustachian tube dysfunction named ETDQ-7. They established its replicability and validity. The cutoff point for the diagnosis of chronic Eustachian tube dysfunction was equal to or greater than 14.5, with 100% sensitivity and 100% specificity. Objective: To translate, adapt and validate the ETDQ-7 questionnaire to Brazilian Portuguese. Methods: We translated the questionnaire into Brazilian Portuguese and applied it to 50 patients, 20 of whom had chronic Eustachian tube dysfunction, and 30 controls. Results: The results obtained with the North-American questionnaire were confirmed in its Brazilian version. The cut-off point for the diagnosis of chronic Eustachian tube dysfunction was ≥14, also exhibiting high sensitivity and specificity, very similar to that of ETDQ-7. Conclusion: It is recommended that ETDQ-7 be used to complement the clinical history of patients with chronic Eustachian tube dysfunction; it can also be used as an important tool for diagnosis, patient follow-up and treatment management.

Resumo Introdução: A disfunção crônica da tuba auditiva pode causar diversos sintomas e doenças de orelha média e impactar a qualidade de vida dos pacientes. Estima-se que é uma morbidade relativamente frequente, acomete cerca de 5% dos adultos. Os instrumentos diagnósticos para essa afecção ainda são insuficientes. Em 2012 McCoul et al. publicaram um questionário para a avaliação da disfunção da tuba auditiva denominado ETDQ-7. Eles demonstraram sua reprodutibilidade e validade. O ponto de corte para o diagnóstico de disfunção de disfunção crônica da tuba auditiva foi de maior ou igual a 14,5 com 100% de sensibilidade e 100% de especificidade. Objetivo: Traduzir, adaptar e validar o questionário ETDQ-7 para o português brasileiro. Método: Traduzimos o questionário para o português do Brasil e o aplicamos em 50 pacientes, 20 com disfunção crônica da tuba auditiva e 30 controles. Resultados: Os resultados obtidos no questionário americano foram confirmados na versão brasileira. O ponto de corte para o diagnóstico de disfunção crônica da tuba auditiva foi maior ou igual a 14, também com alta sensibilidade e especificidade, muito semelhante ao ETDQ-7. Conclusão: Recomenda-se que o ETDQ-7 seja usado como um complemento na história clínica do paciente com disfunção crônica da tuba auditiva e pode ser usado também como uma importante ferramenta para fins de diagnóstico, seguimento de pacientes e manejos no tratamento.

Comment on: Trans-Tympanic Cartilage Chip Insertion for Intractable Patulous Eustachian Tube

No abstract available.

Management of Acquired Cholesteatoma Associated With Patulous Eustachian Tube and Habitual Sniffing

OBJECTIVES: To investigate the effect of surgical treatment with eustachian tube (ET) catheter insertion in patients with acquired cholesteatoma associated with patulous eustachian tube (PET) and habitual sniffing. METHODS: Nine ears of nine patients (two men and seven women; age, 20 to 65 years; average, 37.9±12.0 years) of acquired cholesteatoma associated with PET and habitual sniffing who underwent cholesteatoma surgery with simultaneous additional ET catheter insertion were examined in this study. Successful treatment was defined as stoppage of sniffing, a relief of a PET handicap inventory-10 (PHI-10), an improvement of autophony grade and no cholesteatoma recurrence. RESULTS: ET catheter insertion was performed in all ears. Follow-up duration ranged from 16 to 37 months (average, 25.4 months). Cases consisted of nine pars flaccida type (100%). All patients obtained relief from aural symptoms and stopped sniffing. Postoperative PHI-10 scores were significantly lower than preoperative scores (P<0.001). During an average follow-up of 25.4 months, no cholesteatoma recurrence has occurred to date. One patient developed otitis media with effusion (OME) post-catheterization; OME resolved spontaneously without treatment. Four patients had a consecutive ET catheter insertion on the other side to resolve PET-related aural symptoms. CONCLUSION: In case of acquired cholesteatoma with PET and habitual sniffing, ET catheter insertion performed simultaneously with cholesteatoma surgery could help reduce aural symptoms and stop sniffing. Moreover, the procedure might help in preventing cholesteatoma recurrence.

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty. SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively. RESULTS: The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008). CONCLUSION: The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7 / Validade e confiabilidade do Eustachian tube dysfunction questionnaire-7 no idioma turco

Abstract Introduction During clinical evaluations, in order to interpret patients' complaints caused by Eustachian tube dysfunction and to monitor the success of the treatment, standardized and disease-related scales are necessary. Objective The aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian tube dysfunction questionnaire-7. Methods Forty patients diagnosed with Eustachian tube dysfunction and 40 healthy individuals were enrolled for the study. After language validation of the Eustachian tube dysfunction questionnaire-7 for Turkish, a scale was completed by the both Eustachian tube dysfunction and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test-retest method, item-total score correlation and internal consistency analysis were used in reliability analyses. Results Cronbach's alpha coefficient was 0.714 for the entire questionnaire. The test-retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the Eustachian tube dysfunction group, total and each item scores were found significantly higher than the control group (p < 0.001). Conclusion The Turkish version of Eustachian tube dysfunction questionnaire-7 was found to be highly valid and reliable. This scale is recommended to use for screening of Eustachian tube dysfunction and evaluating treatment outcome.

Resumo Introdução No intuito de interpretar as queixas dos pacientes causadas por disfunções na tuba auditiva durante uma avaliação clínica, e para monitorar o sucesso do tratamento, há necessidade de escalas padronizadas relacionadas à doença. Objetivo Investigar a validade e a confiabilidade da versão turca do Eustachian tube dysfunction questionnaire-7. Método Quarenta pacientes diagnosticados com disfunção da tuba auditiva e 40 indivíduos saudáveis foram incluídos no estudo. Após a validação do Eustachian tube dysfunction questionnaire-7 para o idioma turco, o questionário foi aplicada aos grupos disfunção da tuba auditiva e controle. Duas semanas após a primeira avaliação, 15 pacientes preencheram o questionário novamente sem qualquer tratamento. O método de grupos conhecidos foi utilizado na análise de validade. Os efeitos teto e chão, o método teste-reteste, a correlação se escore de item-total e a análise de consistência interna foram utilizados nas análises de confiabilidade. Resultados O coeficiente alfa de Cronbach foi de 0,714 para todo o questionário. O coeficiente de confiabilidade teste-reteste para a escala total foi determinado como 0,792, indicando correlação entre os dois questionários preenchidos pelo mesmo paciente ao longo do tempo. No grupo disfunções da tuba auditiva, foi observado que os escores total e de cada item foram significativamente maiores do que no grupo controle (p < 0,001). Conclusão A versão no idioma turco do Eustachian tube dysfunction questionnaire-7 foi considerada altamente válida e confiável. Recomenda-se a utilização dessa escala para a triagem de disfunções da tuba auditiva e avaliação do resultado do tratamento.

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.

Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse

Auditory tube diverticula, also known as guttural pouches, are naturally occurring dilations of the auditory tube in horses that communicate with the nasopharynx through a small ostium. Infection and select other conditions can result in inflammation and narrowing of the nasopharyngeal ostium, which prevents drainage of fluid or egress of air and can lead to persistent infection or guttural pouch tympany. Auditory tube diverticulotomy allows continuous egress from the auditory tube diverticula and is a feature of disease treatment in horses, in which medical treatment alone is not successful. Transpharyngeal endoscopic auditory tube diverticulotomy was performed using a diode laser either at a single dorsal pharyngeal recess location or bilaterally caudal to the nasopharyngeal ostium in 10 horse head specimens. Both methods resulted in clear communication between the nasopharynx and auditory tube diverticula. Diverticulotomy performed in the dorsal pharyngeal recess required less laser energy and activation time and had a shorter surgical duration than diverticulotomy performed caudal to the nasopharyngeal ostium. Further study related to the clinical application of both techniques is warranted.

Efficacy of balloon Eustachian tuboplasty combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To evaluate the efficacy of balloon Eustachian tuboplasty (BET) combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction (CDETD).@*METHODS@#A retrospective study was performed in 19 patients with CDETD who underwent BET at the Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine, from October, 2014 to September, 2016. The ages of these patients ranged from 10 to 67 years. All the patients underwent the preoperative assessment of oto-endoscope, tympanometry, pure tone audiometry, fiber nasopharyngeal endoscopy, Eustachian tube pressure measurement (TMM), CT and MRI. These patients had failed to respond to medicine, multiple tympanic membrane puncture and at least 2 times grommet insertion before our study. BET was performed in 5 patients (5 ears), and BET+grommet insertionwas performed in other 14 patients (23 ears). The changes of Eustachian tube function in these patients was assessed using the Eustachian tube score (ETS) and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) preoperatively and 1, 3, 6, 9 and 12 months after surgery, respectively. In addition, subjective symptoms including the difficulty level of valsalva, aural fullness and earache were assessed by visual rating scale (VAS score) preoperatively and at 1, 6, and 12 months after surgery. The mean scores before surgery were compared with that at 1, 3, 6, 9 and 12 months. Postoperative adverse reactions and complications were recorded, such as earache, nosebleeding and so on.@*RESULTS@#Valsalva score and VAS score for aural fullness before surgery were 8.286±0.189 and 8.571±0.221, respectively. Valsalva score and VAS score for aural fullness were 3.714±0.317, 2.393±0.434, respectively, at one month after surgery, which were decreased significantly, as compared with the scores before surgery (<0.05). VAS score at 6 months and 12 months after surgery were statistically significant compared with those before surgery (<0.05). ETS score after surgery was significantly higher than that before surgery (<0.05). ETDQ-7 score after surgery was significantly lower than that before surgery (<0.05). The subjective satisfaction in these patients was 84.2%.@*CONCLUSIONS@#BET is simple and safe, with fewer complications, and effective for the treatment of CDETD combined with grommet insertion.