[Clinical features of congenitally enlarged bony portion of Eustachian tube].

Objective:To investigate the clinical features of patients with congenitally enlarged bony portions of the Eustachian tube（ET）. Methods:The medical history, physical examination, hearing test, temporal bone high resolution computed tomography（HRCT） of six patients（nine ears） with congenitally enlarged bony portion of the ET were retrospectively analyzed. Results:Four patients were men and two were women. The minimum, maximum, and average ages were 5, 21, and（14.7±6.4） years, respectively. Three malformations were bilateral and three were left-sided. Three ears had conductive hearing loss（average bone and air conduction thresholds were 13.7 dB and 71.3 dB）, three had mixed hearing loss（average bone and air conduction thresholds were 27.7 dB and 83.7 dB）, and one had extremely severe sensorineural hearing loss. The average maximum length and width of the enlarged bony ET on temporal bone HRCT were（22.61±2.94） mm and（6.50±2.33） mm, respectively. The enlargement was combined with an external auditory canal malformation in six ears, narrow tympanic cavity in six, tympanic antrum malformation in five, ossicular chain malformation in seven, cochlear malformation in six, helicotrema malformation in three, vestibule widening in two, semicircular canal malformation in three, vestibular window malformation in six, facial nerve abnormality in five, internal auditory meatus malformation in two, low middle cranial fossa in eight, and severe internal carotid artery malformation in one. Conclusion:Bony ET enlargement is a rare congenital middle ear malformation which could combined with other ear malformations. Patients can have no ET dysfunction but different patterns of hearing loss. The defect is usually found unintentionally during imaging, and the HRCT of temporal bone is significant.

Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation.

PURPOSE: The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA. METHODS: Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data. RESULTS: Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube. CONCLUSION: The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.

[CT features of abnormally whole-course wide eustachian tubes with microtia and atresia].

Objective: To study the clinical and CT features of the abnormal whole-course wide of eustachian tube (AWWET) with microtia and atresia(MA). Methods: The clinical and CT data of 19 patients (20 ears) from January 2017 to December 2021 with AWWET with MA were retrospectively analyzed, including 15 males and 4 females. The age ranged from 5 to 16 years, with an average of 9.5 years. 50 patients with common MA without wide eustachian tube(ET) as a case control group, including 32 males and 18 females.The age ranged from 5 to 16 years, with an average of 9.2 years. 20 patients (40 ears) who had normal ear CT for tinnitus, otalgia as a normal control group, including 12 males and 8 females. The age ranged from 5 to 16 years, with an average of 12.5 years. We measured the dimension and length of the bony portion of the ET, the total length, the angle between the bony portion and the cartilage portion, and the horizontal angle of ET on CT imagings, and compared with 40 normal ears by SPSS 27.0 software. Results: According to the relationship between AWWET and tympanum, patients were divided into the communicated group and the blocked group. A male predominance, left ear predominance, with high incidence of hemifacial microsomia exhibited in both groups. AWWET was presented as a widened lumen on CT. In 11 ears (4 ears in the communicated group, 7 ears in the blocked group), ETs bifurcated, the upper bony tube extended to the sphenoid body, the lower part continued down to cartilaginous ET and opened onto the nasopharynx, with"mastoid-like"pneumatization of the sphenoid body in 6 ears. The middle ear deformity in case group was more serious than MA control group, especially the blocked group. The incidence of otitis media in the communicated group was lower than that in the MA control group, and 4 cases in the blocked group had effusion in the ET. Compaired with normal ear, the bony ET elongated significantly in the AWWET groups, and the whole course of ET was significantly shortened, specially in the blocked group. The angle between the bony ET and the cartilaginous ET was decreased and the horizontal angle of the ET increased in the AWWET groups, the difference was considered to indicate statistical significance(P<0.05). Conclusions: AWWET with MA is rare, a male predominance, left ear predominance, and with high incidence of hemifacial microsomia. The middle ear deformity is more serious than common MA, especially in the blocked group. The incidence of otitis media in the communicated group is significantly lower than that in the common MA, and the blocked group may be accompanied by ET inflammation.

Evaluation of Eustachian tube dimensions by temporal bone computed tomography in patients with chronic otitis media.

OBJECTIVE: To clarify the relationship between Eustachian tube dimensions and chronic otitis media aetiology using temporal bone computed tomography. METHODS: The data of 231 adults who had undergone surgery for unilateral chronic otitis media were reviewed retrospectively. Diseased and healthy ears were enrolled in groups 1 and 2, respectively. Group 1A included chronic otitis media with cholesteatoma (n = 28) and group 1B included chronic otitis media without cholesteatoma (n = 203). The Eustachian tube dimensions of groups 1 and 2 were compared, to clarify the relationship between the Eustachian tube dimensions and chronic otitis media aetiology. Groups 1A and 1B were compared to assess the effect of Eustachian tube dimensions on cholesteatoma development. RESULTS: The Eustachian tube was shorter, narrower and located more horizontally in ears with chronic otitis media. No significant difference was found between groups 1A and 1B. CONCLUSION: Eustachian tube dimensions are closely related to chronic otitis media aetiopathology, but are not related to cholesteatoma development.

[Imaging evaluation of cerebrospinal fluid otorrhea associated with inner ear malformation in children].

Objective: To explore the imaging evaluation of cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (IEM) in children. Methods: The clinical data of 28 children with CSF otorrhea associated with IEM confirmed by surgical exploration in Beijing Children's Hospital, from Nov, 2016 to Jan, 2021, were analyzed retrospectively,including 16 boys and 12 girls, aged from 8-month to 15-year and 8-month old, with a median age of 4-year old. The shapes of stapes were observed during the exploration surgery, and the imaging features of temporal bone high resolution CT(HRCT) and inner ear MRI pre- and post-operation were analyzed. Results: In 28 children with CSF otorrhea, 89.3%(25/28) had stapes footplates defect during exploration. Preoperative CT showed indirect signs such as IEM, tympanic membrane bulging, soft tissue in the tympanum and mastoid cavity. IEM included four kinds: incomplete partition type I (IP-Ⅰ), common cavity (CC), incomplete partition type Ⅱ (IP-Ⅱ), and cochlear aplasia (CA); 100%(28/28) presented with vestibule dilation; 85.7%(24/28) with a defect in the lamina cribrosa of the internal auditory canal. The direct diagnostic sign of CSF otorrrhea could be seen in 73.9%(17/23) pre-operative MRI: two T2-weighted hyperintense signals between vestibule and middle ear cavity were connected by slightly lower or mixed intense T2-weighted signals, and obvious in the coronal-plane; 100%(23/23) hyperintense T2-weighted signals in the tympanum connected with those in the Eustachian tube.In post-operative CT, the soft tissues in the tympanum and mastoid cavity decreased or disappeared as early as one week. In post-operative MRI, the hyperintense T2-weighted signals of tympanum and mastoid decreased or disappeared in 3 days to 1 month,soft tissues tamponade with moderate intense T2-weighted signal were seen in the vestibule in 1-4 months. Conclusions: IP-Ⅰ, CC, IP-Ⅱ and CA with dilated vestibule can lead to CSF otorrhea. Combined with special medical history, T2-weighted signal of inner ear MRI can provide diagnostic basie for most children with IEM and CSF otorrhea.HRCT and MRI of inner ear can also be used to evaluate the effect of surgery.

Comparative study of optical coherence tomograph and histological images of eustachian tube nasopharyngeal region and adjacent structures in vivo and ex-vivo miniature pigs.

OBJECTIVES: Optical Coherence Tomograph (OCT) imaging technology can be used to examine, in vivo, the human ET. At present, it is impossible to achieve the OCT scanning vivo and ex vivo in the same individual human body, or study the consistency between OCT images and histological images of the eustachian tube nasopharyngeal region and adjacent structures. The aim of this study was to determine the consistency between OCT images and histological sections in vivo and ex vivo in miniature pigs. METHODS: OCT imaging was performed on five adult miniature pigs in vivo and ex vivo. The images of the eustachian tube OCT (ET-OCT), nasopharynx OCT (NP-OCT) and histological cross sections were further studied. RESULTS: All five miniature pigs achieved the OCT scan successfully, acquiring ET-OCT and NP-OCT images in vivo and ex vivo on both sides. The acquired ET OCT images closely matched the histological images, revealing details of the cartilage, submucosa, glands, and mucosa. The lower segment of the ET wall mucosa had an abundance of glands and submucosal tissues, with more low-signal areas appearing in the ex vivo images. The NP-OCT images of the nasopharynx matched the details of the mucosa and submucosal tissues. The ex-vivo OCT images showed thicker mucosa and more scattered slightly lower signal areas compared to the vivo OCT images. CONCLUSIONS: ET-OCT images and NP-OCT images matched the histological structure of eustachian tube nasopharyngeal region structures in miniature pigs both in vivo and ex vivo. OCT images may be sensitive to changes in edema and ischemia status. There is a great potential for morphological assessment of inflammation, edema, injure, mucus gland status.

The feasibility and safety of eustachian tube dilation with a standard endovascular balloon: a clinical pilot study.

BACKGROUND: Obstructive eustachian tube dysfunction is a common pathology, generally accepted as the underlying cause for chronic ear diseases. Eustachian tube dilation has shown promising results in randomized controlled trials, but is a costly procedure. The aim of the current study was to assess the feasibility of transnasal balloon dilatation of the eustachian tube with an endovascular balloon in the context of ease of use, maneuverability, and safety. METHODS: Clinical pilot study carried out at a university tertiary care facility. In total, twelve patients, were included over a period of 6 months. All patients underwent tympanoplasty or tympanomastoidectomy surgeries. Eustachian tube dilation was carried out transnasal using an endovascular balloon. A computed tomography was carried out after surgery to assess for any potential damages and compared to preoperative imaging studies. Postoperative endoscopy was performed intraoperatively and at follow up to assess for any potential damages. RESULTS: All eustachian tube dilations were carried out successfully. No severe adverse events were noted during the procedure, in the postoperative period, or on imaging studies. Minor adverse events such as mild intraoperative bleeding was managed in a routine fashion. CONCLUSIONS: Balloon dilation of the eustachian tube with the endovascular balloon was feasible and safe in all cases. It is likely a more cost-effective alternative to commercially available balloons with similar designs and specifications. Trial registration The study was registered at clinicaltrials.gov; NCT04809753, initial release February 24th, 2021.

Three-Dimensional Assessment of Eustachian Tube in Patients With Cleft Palate Versus Controls: A CBCT Study.

To compare the morphological characteristics of the Eustachian tube (ET) between patients with cleft palate and healthy controls with the use of cone-beam computed tomography (CBCT).Retrospective assessment of treated nonsyndromic patients with cleft palate and a control group.CBCT images of 51 patients with cleft palate who had previously undergone surgery to close the cleft palate and a control group of 51 patients were included in this study. Syndromic patients were excluded.The cleft group were divided into 3 groups according to the palatoplasty technique, which was done in the infancy period to close the cleft palate (Nadjmi modification of Furlow, Sommerlad, and V-Y pushback). Finally, ET length (ETL), ET angle, and auditory tube angle (ATA) were measured in all patients.The ETL, ETA, and ATA in the cleft and the normal control groups were 29.73 ± 3.14 and 32.18 ± 3.34 mm, 33.18 ± 2.57 and 35.40 ± 3.93, and 141.64 ± 4.13 and 138.87 ± 4.96, respectively. All 3 features were statistically significant among the groups (All Ps < .05). ETL and ETA were significantly higher in Nadjmi modification of Furlow and Sommerlad palatoplasty techniques compared to the V-Y pushback technique, while there was no significant difference in the ATA between the palatoplasty groups.Cleft palate can significantly affect the morphological characteristics of the ET. Type of the infancy palatoplasty can influence some of its dimensions.

Measurements of The Pediatric Cartilaginous Eustachian Tube: Implications for Balloon Dilation.

OBJECTIVES: (1) Measure the cartilaginous Eustachian tube (ET) length using a computed tomography (CT) scan and (2) develop a prediction model to measure this length without the need of a CT scan. STUDY DESIGN: CT measurements in children. SETTING: Children's Hospital. METHODS: CT scans were reformatted to project the cranial and caudal limits of the cartilaginous ET. The length was measured in 193 children who underwent a neck CT scan for nonotologic indications. Five physicians independently reviewed all or some of these measures. Four different models based on age, age ranges, weight, and height were created and compared to predict ET length. RESULTS: The cartilaginous ET length was 25.3 ± 3.1 mm for the right and for the left ear. The mean ET length for the females was statistically significantly less than the length in males. The lower ET lengths in children as old as 5 years of age were less than the 2 cm adult criteria used for catheter insertion. All 4 models performed equally well in predicting ET length. Model number 4, which is based on height, was the easiest to calculate ET length. CONCLUSION: The cartilaginous portion of the pediatric ET can be measured with good precision using reformatted CT images. We caution against using the "adult" criteria of 2 cm for catheter insertion in children, especially those younger than 5 years of age. We recommend using a model utilizing height measures to estimate ET length or direct measurements from a reformatted CT scan. LEVEL OF EVIDENCE: NA Laryngoscope, 133:396-402, 2023.

Radiological dimensions of the Eustachian tube in patients with adhesive otitis media.

OBJECTIVE: This study aimed to analyse the computed tomography parameters for effective ventilation in patients with adhesive otitis media. METHODS: Twenty-six patients with unilateral adhesive otitis media were included in the study. The patients' temporal bone computed tomography images were retrospectively reviewed. Eustachian tube length and diameter were measured. Mastoid pneumatisation and middle-ear size were evaluated by measuring petroclival and Eustachian tube-tympanic cavity ventilation angles. RESULTS: The average Eustachian tube length was 38.4 mm and 38.9 mm in adhesive otitis media and healthy ears, respectively. The Eustachian tube diameter of the adhesive otitis media ears (1.47 mm) was significantly narrower than that of the healthy ears (1.83 mm). There were no significant differences in the angles between adhesive otitis media and healthy ears. CONCLUSION: A narrow Eustachian tube diameter was associated with developing adhesive otitis media. Measuring Eustachian tube diameter is simple and can be routinely performed when examining temporal bone computed tomography images for Eustachian tube function evaluation.

Place of Tubomanometry in Patulous Eustachian Tube Diagnosis.

OBJECTIVE: The aim of our study was to describe the diagnostic performances of tubomanometry (TMM) and to determine tubomanometric parameter thresholds for the diagnosis of patulous eustachian tube (PET). STUDY DESIGN: We performed a retrospective, monocentric study, including patients treated for PET vs control group. SETTING: This study was performed at the Otolaryngology Department of a tertiary-care hospital in the south of France. METHODS: We collected epidemiologic and clinical data, as well as adjusted opening latency index ("R"-index), rhinopharyngeal pressure threshold of tubal opening (Po), and velar contraction index (IVC) on TMM. Receiver operating characteristic (ROC) curves were used for determination of R index and Po thresholds. RESULTS: Twenty-one patients (26 patulous ears) and 14 controls (24 normal ears) were included. The R index values and Po values were significantly lower in the PET group vs controls (0.46 vs 0.80, respectively; P < .05 for R index and 13.89 vs 26.42 mbar, respectively; P < .05 for Po). No significant difference was reported between the 2 groups on IVC measurement (P = .784). After ROC curve analysis, R index was the most discriminating factor to classify PET patients with 89% specificity and 76% sensitivity with a threshold ≤0.6. Po value ≤10 mbar could support this diagnosis with more than 83% specificity. CONCLUSION: TMM is a reliable noninvasive method for positive diagnosis of PET. TMM could provide an accurate positive PET diagnosis and an objective evaluation for PET management.

The role of Eustachian tubography and Valsalva CT in Eustachian tube balloon dilation.

BACKGROUND: Not many imaging techniques have been reported in Eustachian tube imaging. PURPOSE: To investigate the role of selective Eustachian tubography (SET) and Valsalva computed tomography (CT) in patients who underwent Eustachian tube balloon dilation (ETBD). MATERIAL AND METHODS: Eligible patients were aged 18 years and older with chronic Eustachian tube dysfunction who had failed medical treatment. On the day of the procedure, Valsalva CT and SET were performed. Participants underwent fluoroscopic ETBD with a 6×20-mm balloon catheter. Clinical examinations to check for the ability to perform the Valsalva maneuver and ETDQ-7 score change were conducted at one week and then at one, two, and six months. Follow-up Valsalva CT was performed in the one-month follow-up. RESULTS: A total of 30 ears in 23 patients (16 right ears, 14 left ears; 10 women, 13 men) underwent ETBD from August 2018 to November 2019. Positive CT patency was higher in follow-up Valsalva CT than baseline Valsalva CT (40% and 23.3%, respectively) (P = 0.006). In SET, positive patency was observed in 13 of 25 ears. Response to balloon dilation was observed in 18 of 25 patients. Clinical success was achieved in 16 of 27 ears. Response to balloon dilation was the only significant predictor of clinical success (P = 0.012). CONCLUSION: SET depicted the lumen of the Eustachian tube; thereby, it could be a potentially valuable tool in ETBD. Valsalva CT provides additional information about the cartilaginous portion of the Eustachian tube.

Tapered self-expandable metallic stent optimized for Eustachian tube morphology in a porcine ET model.

Several investigations on the feasibility of stent placement into the Eustachian tube (ET) are being conducted. However, stents optimized for the anatomical structure of the ET have not yet been developed. In this study, the efficacy and safety of a self-expandable metallic stent (SEMS) optimized for porcine ET morphology was investigated. Silicone was injected into a cadaveric porcine ET to analyze the ET morphology. The three-dimensional-reconstructed porcine ET phantom images obtained after a computed tomography scan were measured to determine the dimensions of the porcine ET. The SEMS was designed as a tapered structure on the basis of the morphological findings of the porcine ET. The tapered SEMS (T-SEMS) and conventional SEMS (C-SEMS) were placed into the porcine ET to compare the safety and efficacy of the two types of SEMSs. Stent-induced tissue hyperplasia in the T-SEMS group was significantly lower than that in the C-SEMS group (p < 0.001). The T-SEMS optimized for the porcine ET was effective in maintaining stent patency. T-SEMS seems to be better than C-SEMS in suppressing stent-induced tissue hyperplasia, owing to the reduced stent-mediated mechanical injuries and maintaining ET patency.

The relationship between dimensions of the Eustachian tube and acquired attic cholesteatoma.

OBJECTIVE: This study investigated the relationship between physical dimensions of the Eustachian tube and the emergence of primary attic cholesteatoma. METHODS: A total of 31 patients with unilateral attic cholesteatoma were selected for radiological comparison. Standard point measurements as well as specific measurements were performed using imaging software. The length, narrowest diameter and bony segment volume, and pharyngeal orifice diameter of both sides of the Eustachian tube (attic cholesteatoma and healthy control ears) were measured and compared. RESULTS: Comparison of the values did not reveal any statistically significant difference between the attic cholesteatoma ears and the healthy control ears in terms of: Eustachian tube height, narrowest diameter, bony segment volume or pharyngeal orifice diameter. CONCLUSION: No statistically significant difference was found between the cholesteatoma ears and the healthy control ears in terms of the osseous Eustachian tube size. The findings indicate that the Eustachian tube bony segment dimensions and pharyngeal orifice diameter are not factors in attic cholesteatoma development.

Radiological Evaluation of the Recesses on the Posterior Wall of the Nasopharynx with Cone-beam Computed Tomography.

BACKGROUND: The posterior wall of the nasopharynx is composed of loose connective tissue that includes many important anatomical structures. Various structures, such as the opening of the Eustachian tube (ET), the Rosenmüller fossa (RF), and the pharyngeal bursa (PB) are found here. AIM: To evaluate the nasopharynx posterior wall anatomic structures, including the Eustachian tube, Rosenmüller fossa, and pharyngeal bursa with cone-beam computed tomography. MATERIALS AND METHODS: The depth, width, and length of the Eustachian tube, Rosenmüller fossa, and pharyngeal bursa were measured in 150 patients using axial-sagittal cone-beam computed tomography. The Eustachian tube and Rosenmüller fossa distance to the midsagittal plane, the coronal region passing through the posterior end of the nasal septum, the superior-inferior extremity of the recesses, and the nasal floor plane distance were measured. The relationship between Rosenmüller fossa types and other parameters were evaluated. RESULTS: The incidence of right Rosenmüller fossa types 1, 2, and 3 were 16%, 18%, and 66%, respectively, and that of the left Rosenmüller fossa types 1, 2, and 3 were 16%, 19.3%, and 64.7%, respectively. The mean pharyngeal bursa width, length, and depth were 10.8, 5.7, and 4.0 mm, respectively; those of the Eustachian tube were 5.6, 7.1, and 7.3 m, respectively; those of the right Rosenmüller fossa were 4.0, 12.4, and 10.5 mm, respectively; and those of the left Rosenmüller fossa were 3.8, 12.5, and 10.9 mm, respectively. CONCLUSIONS: The posterior wall of the nasopharynx contains several important anatomical structures. Evaluation of these using cone-beam computed tomography has many clinical and radiological advantages. To understand and interpret the coincidental findings in CBCT, dental radiologists should have access to more detailed information concerning the anatomy of the nasopharynx.

[Evaluation of Eustachian tube function in children with adenoid hypertrophy by nasopharyngeal digital photography and ETDQ-7 scores].

Objective:To evaluate the Eustachian tube function of children with simple adenoid hypertrophy and adenoid hypertrophy with secretory otitis media（OME） by using the A/N value of lateral radiograph of nasopharyngeal X-ray and EDQ-7 scale scores. Methods:Sixty cases of children with adenoid hypertrophy admitted from February 2019 to August 2021 were all underwent nasopharyngeal X-ray lateral radiographs to determine the adenoid/nasopharyngeal cavity ratio（A/N ratio） and then determine the size of adenoids. The Eustachian tube function ETDQ-7 survey was used to evaluate the patient's self-evaluation of the severity of the disease and ear symptoms, and the degree of influence were scored. Subsequently, the correlation between adenoid hypertrophy with OME and ETDQ-7 scores was statistically analyzed by using the Spearman rank correlation statistical method. Results:In adenoid hypertrophy with OME group, the ETDQ-7 scores of A/N≤0.60, A/N 0.61-0.70 and A/N≥0.71 were 4.15±1.75, 14.55±6.67 and 23.95±6.63, respectively. The higher the grade of adenoid hypertrophy, the higher the ETDQ-7 scores. In adenoid hypertrophy with OME group, the degree of adenoid hypertrophy was positively correlated with the ETDQ-7 scores（P<0.05）. Conclusion:Adenoid hypertrophy is also one of the potential factors causing OME in children.

Enlargement of Eustachian Tube Lumen in Patulous Eustachian Tube Patients Compared to that by Aging.

OBJECTIVE: To evaluate the Eustachian tube (ET) dimensions in patulous ET (PET) patients compared with that by aging using sitting 3D computed tomography (CT). STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: A retrospective survey of medical records in Sen-En Rifu Hospital identified 105 ears of 76 PET patients and 65 ears of 34 patients without ET dysfunction findings (non-PET). Subjects in both PET and non-PET groups were then divided into two age groups. Groups A and C defined as non-PET and PET subjects respectively, who were under the age of 60 years, while Groups B and D defined of non-PET and PET subjects respectively, who were 60 years and above. 3D CT (Accuitomo; Morita, Kyoto, Japan) was performed on all subjects in the sitting position. The ET lumen from the ET pharyngeal orifice to 15 mm was analyzed. RESULTS: No significant difference in the ET lumen near the pharyngeal orifice was found between Group A and C; however, there was a significant difference in the ET at points lateral to the pharyngeal orifice. The ET lumen was significantly larger at the site close to the pharyngeal orifice in Group B as compared to that of Group A. For the two groups of PET classified according to the size of the pharyngeal orifice and area close to the isthmus, age was only significantly different between two groups of pharyngeal orifice. On the contrary, sonotumometry and Ohta method were significantly different between the two groups of the area close to the isthmus. CONCLUSION: The lumen of the ET is enlarged in both PET and aging. However, the responsible site was found to be different. While the enlargement of the ET lumen in 60 years and above subjects without PET mainly occurred near the pharyngeal orifice of the ET, it was near the isthmus in under 60 years PET patients. Further study of possible clinical implications of these findings as well as treatment strategy are required.

The Value of Ultrashort Echo Time MR in Depiction of the Eustachian Tube at 3 Tesla.

OBJECTIVES: To investigate the feasibility of ultrashort echo time (UTE) imaging in the visualization of Eustachian tubes (ETs). METHODS: The local institutional review board approved the study protocol. Twenty volunteers were involved in this study. The scanning scheme consisted of T2-sampling perfection with application-optimized contrasts by using different flip angle evolutions (T2-SPACE) MR imaging with water excitation, a UTE scan with a prototype sequence and a CT scan. The UTE images were compared with both the T2-SPACE and CT images. The quality of the images was rated by two radiologists blindly. Interobserver agreement was assessed using the kappa statistic. Statistical analysis was performed using SPSS software (version 17, SPSS Inc.). A value of p < 0.05 was considered statistically significant. RESULTS: For all subjects, the T2-SPACE images successfully displayed the cartilaginous part of the ET (Fig. 1). The CT images fully showed the bony part of the ET for all the subjects (Fig. 2). The UTE images successfully displayed both the cartilaginous and bony parts of the ET (Fig. 3). However, the UTE images showed the cartilaginous and bony portions of the ET as a whole. CONCLUSIONS: By analyzing the depiction of the ET from UTE images and comparing it with that from MR and CT images, we found that UTE images could display not only the cartilaginous structure of the ET that cannot be seen by conventional MR sequences, but also the bony structure that previously could only be seen on CT images. This imaging modality could help provide a convenient and new method to display the overall shape of the ET.

Transeustachian Middle Ear Endoscopy Using a Steerable Distal-Camera Tipped Endoscope.

OBJECTIVE: Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear. PATIENTS: Three cadaveric temporal bone specimens were used in this work. INTERVENTION: Diagnostic transeustachian endoscopy of the middle ear was performed. MAIN OUTCOME MEASURE: Diagnostic image quality. RESULTS: A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity. CONCLUSIONS: A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.