Outcome of Balloon Eustachian Tuboplasty in SCUBA Divers.

OBJECTIVES: Good Eustachian tube (ET) function is necessary in order to equalize middle ear (ME) pressure with ambient pressures and avoid barotrauma among divers. Since placement of ventilation tubes is not compatible with diving, balloon eustachian tuboplasty is a potential surgical solution for divers with ET dysfunction (ETD). This is the first report of the outcome of balloon tuboplasty for ETD among divers. METHODS: A retrospective analysis of medical records and clinical examinations of adult divers treated in a single tertiary medical center. RESULTS: Four male divers (age range 21-71 years, 5 ETs) underwent balloon tuboplasty for ETD. None had identifiable risk factors for ETD. Symptom duration ranged from 2 to 5 years and was restricted to diving in 3 patients. The most common symptom was difficulties in equalizing air pressure during descent and ascent, followed by aural fullness and hearing loss. The validated Hebrew version of ETD-7 questionnaire (ETDQ-7H) results were normal in 3 ears and pathological (2.9 and 3.3) in 2 ears. The averaged postoperative ETDQ-7H score was 1.2 points, significantly better than the preoperative score (P < .05). While diving, pressure-equalizing sensation improved in all ears. CONCLUSION: Balloon eustachian tuboplasty is a safe method for treating diving-induced baro-challenge ETD. This procedure can improve symptoms and enable the patient to resume diving.

Tegmen attenuation in patients with idiopathic intracranial hypertension is progressive.

OBJECTIVES: To prove that temporal bone tegmen attenuation in patients with idiopathic intracranial hypertension (IIH) is progressive. STUDY DESIGN: Retrospective blind study at a tertiary academic medical center. METHODS: Enrolled were medical records of patients with IIH that included at least two sequential computed tomography (CT) scans. The vertical distances between the floor of the middle fossa to the superior and lateral semicircular canals (SSC and LSC, respectively), to the scutum and minimal squama thickness were measured. The same measurements were made in scans of control subjects. The impact of demographics and metabolic variables including opening lumbar puncture (LP) pressure were evaluated. RESULTS: Twenty medical records were enrolled. Median age at diagnosis was 21 years; 16 were females. The median body mass index (BMI) was 32 kg/m2 . Initial LP pressure was 195 mm cerebrospinal fluid (CSF). The median time interval between CT scans was 58 months. A median attenuation of 0.35 mm and 0.25 mm over the right and left LSC and of 0.5 mm and 0.3 mm over the right and left scutum, was found, respectively. The thicknesses of the SSC and squama remained stable. No attenuation was present in controls. The opening pressure on initial LP (median 195 mm CSF), was positively correlated with the degree of tegmen attenuation, but the age at diagnosis and BMI were not. CONCLUSIONS: Tegmen attenuation may be progressive in patients with idiopathic increased intracranial pressure and correlated with the opening pressure on LP. Tegmen defects and CSF leak should be looked for in these patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

Tri-dimensional model for ventilation tube permeability.

PURPOSE: Ventilation tubes (VT) in the tympanic membrane expose the middle ear (ME) to the external auditory canal and its content. It carries the risk of penetration of contaminated material and could provide a pathway for the delivery of drugs into the ME. The aim of this study was to use a printed 3D-model of the external auditory canal (EAC) and ME to assess the permeability of various VTs to different fluids. METHODS: CT scan of the external and ME was 3D-reconstructed and printed. Five different types of VT were inserted in the model's tympanic membrane and the minimal pressure for penetration to the ME was measured. Liquids with different viscosities, including commonly used ear drops, were tested. RESULTS: Water passed through the standard 1.14 mm diameter VTs after filling the EAC with a volume of 2 ml and through a narrower grommet or a T-tube after filling the canal with 2.5 ml. Soapy-water had the highest penetration in all VTs (1-2 ml). The initial volume of dexamethasone needed for penetration was 2.5 ml in the standard tubes. It did not pass at any volume through the narrow grommet or the T-tube. CONCLUSION: In the printed 3D-model, the volume of most solutions, including water, required to provide enough pressure in order to pass through the VTs was as high as the EAC volume or exceeded it. Soapy water had the highest penetrance while Dexamethasone needed volume of 2.5 ml to pass through the VT, questioning its reliability as a passive drug delivery channel to the ME.