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Tire wear particles (TWPs) released during vehicle driving can enter water bodies, leading to leaching of tire additives (TAs) in aquatic environments. However, the transformation behavior and related ecological impacts of TAs and their transformation products (TPs) remain unclear. In this study, laboratory-based simulation experiments and field investigations were conducted to explore the transformation mechanisms and ecological risks of TAs. After being placed in river water for 24 h, about 7-95% of 12 investigated TAs in TWPs were leached. Forty-eight TPs from eight TAs were tentatively identified along with different transformation pathways via suspect screening by high-resolution mass spectrometry. Semiquantitative results indicated that TPs derived from N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylene-diamine (6PPD) were predominant in leachates, while aryl hydrolysis and quinone pathways were the main transformation pathways. Field investigations on urban surface water samples from 16 sites in Hong Kong revealed the occurrence of 17 TAs and 1 TP, with concentrations ranging from 13.9 to 2230 ng/L (median ± standard deviation: 226 ± 534 ng/L). Sixteen TPs from six TAs were additionally identified via suspect screening. It is estimated that 6PPD-quinone and seven TAs could pose medium to high ecological risk, while N-(1,3-dimethylbutyl)-N'-phenyl-p-quinonediimine, a frequently detected TP, was identified as a persistent-bioaccumulative-toxic substance.
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Rios , Poluentes Químicos da Água , Rios/química , Medição de Risco , Monitoramento Ambiental , Hong KongRESUMO
This study aimed to analyze the long-term care insurance for older adults in South Korea in terms of community care. An analytical framework was designed for the study, focusing on comprehensiveness, adequacy, and integration. The findings suggest that Korean LTCI is significantly limited for the development of community care. First, in terms of comprehensiveness, the use of visiting nurses and the availability of short-stay services have been significantly reduced, and the supporting services for informal caregivers are at the beginning stage of their introduction. Second, in terms of adequacy, the quantity of benefits, such as three to four hours of care a day, are insufficient to meet older adults' substantial needs. Furthermore, the overall quality of home care services is low, particularly with regard to short-stay services and welfare equipment. Finally, in terms of integration, basic linkage of organizations has not been properly conducted in local areas, and there remains an absence of care managers in the LTCI system. To cope with these challenging issues, the following policy measures are suggested: the activation of rehabilitation services, the expansion of benefit quantities, the improvement of service quality, and the creation of organizational linkages through local authorities and long-term care centers.
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This study conducted real-time monitoring of size-resolved particle concentrations ranging from 9 nm to 10 µm simultaneously at four sites on the park ground and the roof of a five-story apartment buildings in the upwind and downwind areas of the Olympic Expressway next to apartment complex areas of Seoul, Korea. Using a positive matrix factorization model for source apportionment, eight factors were resolved at each monitoring site: four exhaust emissions of vehicles, one non-exhaust emission of vehicle, two regional sources, and one unknown source. After categorizing monitoring data into three cases by wind conditions, impact and contribution of each vehicle-related source on the local road to the roadside pollution was quantified and characterized by subtracting the urban background concentrations. Throughout the measurement period, the contribution of vehicle-related sources to the particle number concentration at each monitoring site ranged from 61 % to 69 %, while that to the particle mass concentration ranged from 39 % to 87 %. During periods of steady traffic flow and wind blowing from the road to three downwind sites at speeds exceeding >0.5 m/s during working hours, the particle number concentrations at the downwind sites were 2.2-2.5 times higher than the average levels. Among vehicle-related sources, gasoline vehicles with multiple injections or high-emitting diesel vehicles showed the highest contribution to particle number concentrations at all sites. As wind speed increased, the number concentrations of particles from vehicle exhaust and non-exhaust emissions decreased and increased, respectively, probably due to enhanced dilution and transport, respectively. In addition, particle number concentrations showed a parabolic curve-like trend with traffic volumes increasing to approximately 10,000 vehicles/h, and then decreasing for both vehicle exhaust and non-exhaust emissions. These results can be utilized in numerical modeling studies and in establishing traffic-related environmental policies to reduce seasonal and temporal particle exposure near the roadsides.
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OBJECTIVE: Blood-labyrinthine barrier leakage has been reported in sudden sensorineural hearing loss (SSNHL). We compared immediate post-contrast 3D heavily T2-weighted fluid-attenuated inversion recovery (FLAIR), T1 spin echo (SE), and 3D T1 gradient echo (GRE) sequences, and heavily T2-weighted FLAIR (hvT2F) with and without deep learning-based reconstruction (DLR) in detecting perilymphatic enhancement. METHODS: Fifty-four patients with unilateral SSNHL who underwent ear MRI with three sequences were included. We compared asymmetry scores, confidence scores, and detection rates of perilymphatic enhancement among the three sequences and obtained 3D hvT2F with DLR from 35 patients. The above parameters and subjective image quality between 3D hvT2F with and without DLR were compared. RESULTS: Asymmetry scores and detection rate of 3D hvT2F were significantly higher than 3D GRE T1 and SE T1 (respectively, 1.37, 0.11, 0.19; p < 0.001). Asymmetry scores significantly increased with DLR compared to 3D hvT2F for experienced and inexperienced readers (respectively, 1.77 vs. 1.40, p = 0.036; 1.49 vs. 1.03, p = 0.012). The detection rate significantly increased only for the latter (57.1% vs. 31.4%, p = 0.022). Patients with perilymphatic enhancement had significantly higher air conduction thresholds on initial (77.96 vs. 57.79, p = 0.002) and 5 days after presentation (63.38 vs. 41.85, p = 0.019). CONCLUSION: 3D hvT2F significantly increased the detectability of perilymphatic enhancement compared to 3D GRE T1 and SE T1. DLR further improved the conspicuity of perilymphatic enhancement in 3D hvT2F. 3D hvT2F and DLR are useful for evaluating blood-labyrinthine barrier leakage; furthermore, they might provide prognostic value in the early post-treatment period. CLINICAL RELEVANCE STATEMENT: Ten-minute post-contrast 3D heavily T2-weighed FLAIR imaging is a potentially efficacious sequence in demonstrating perilymphatic enhancement in patients with sudden sensorineural hearing loss and may be further improved by deep learning-based reconstruction. KEY POINTS: ⢠3D heavily T2-weighted FLAIR (3D hvT2F) is a sequence sensitive in detecting low concentrations of contrast in the perilymphatic space. ⢠3D hvT2F sequences properly demonstrated perilymphatic enhancement in sudden sensorineural hearing loss compared to T1 sequences and were further improved by deep learning-based reconstruction (DLR). ⢠3D hvT2F and DLR are efficacious sequences in detecting blood-labyrinthine barrier leakage and with potential prognostic information.
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Aprendizado Profundo , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Perda Auditiva Neurossensorial/diagnóstico por imagem , Imageamento Tridimensional/métodos , Adulto , Imageamento por Ressonância Magnética/métodos , Idoso , Perda Auditiva Súbita/diagnóstico por imagem , Orelha Interna/diagnóstico por imagem , Adulto Jovem , Estudos Retrospectivos , Meios de Contraste , Interpretação de Imagem Assistida por Computador/métodosRESUMO
Palatine tonsils (PT) are B cell-predominant lymphoid organs that provide primary immune responses to airborne and dietary pathogens. Numerous histopathological and immunological studies have been conducted on PT, yet no investigations have been conducted on its metabolic profile. We performed high-resolution magic angle spinning nuclear magnetic resonance spectroscopy-based metabolic profiling in 35 pediatric and 28 adult human palatine tonsillar tissue samples. A total of 36 metabolites were identified, and the levels of 10 metabolites were significantly different depending on age. Among them, partial correlation analysis shows that glucose levels increased with age, whereas glycine, phosphocholine, phosphoethanolamine, and ascorbate levels decreased with age. We confirmed the decrease in immunometabolic activity in adults through metabolomic analysis, which had been anticipated from previous histological and immunological studies on the PT. These results improve our understanding of metabolic changes in the PT with aging and serve as a basis for future tonsil-related metabolomic studies.
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Envelhecimento , Tonsila Palatina , Humanos , Criança , Adulto , Tonsila Palatina/patologia , Envelhecimento/patologia , Linfócitos B , MetabolômicaRESUMO
In urban areas, particulate matter emitted from vehicles directly affects the health of citizens near roads. Thus, in this study, particle size distribution was measured by the horizontal and vertical distances along a highway road with heavy traffic to characterize the dispersion phenomena of particulate matter emitted from vehicles. In addition, the contribution of pollution sources was analyzed using a source-receptor model. A concentration gradient was observed in which the concentration decreased with the increase in the distance from the road when the wind blew from the road to the monitoring locations. The concentration was slightly higher within 50 m of the road when the wind blows parallel to the road, and similar concentrations were found at the other monitoring locations further away from the roads. In particular, the higher the turbulence intensity of the wind, the lower is the concentration gradient coefficient because of the more enhanced mixing and dispersion. A positive matrix factorization (PMF) model with the measured particle size distribution data in the range of 9-300 nm resulted in a contribution of about 70 % (number) and 20 % (mass) to particle concentrations because of six types of vehicles including LPG, two gasoline vehicles (GDI, MPI), and three diesel vehicles with 3rd, 4th, and 5th emission classes. It showed a decrease in the vehicular contribution as the distance from the road increased. Particle number concentrations decreased with increasing altitude up to 30 m above the ground. The results of this study can be useful in deriving generalized gradient equations of particle concentrations exposed by distance and wind direction at the roadside using traffic and meteorological conditions and for establishing environmental policies, such as roadside exposure assessment, in the future. A CAPSULE ABSTRACT: Dispersion of particles emitted from vehicles on a busy highway was characterized by roadside measurements of horizontal and vertical profiles of particle size distributions measured at four locations. The source profiles and contributions were estimated by major sources using a source-receptor model such as PMF.
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This study aims to examine the characteristics of long-term care (LTC) financing in Organization for Economic Cooperation Development (OECD) countries. To this end, the 26 OECD countries that have introduced LTC systems were classified into three types of models: tax-based, health insurance, and LTC insurance (LTCI) systems. Thereafter, these systems were analyzed using Gilbert and Terrell's policy analysis framework. The results indicated differences in the characteristics of each type of financing in terms of allocation, benefit provision, service delivery, and finance. It is likely that while the LTC insurance model was mainly based on universalism and showed the highest level of coverage, the tax-based and health insurance models adopted selectivism with lower level of benefits per capita. In terms of service delivery, local authorities tended to have the responsibility to decide LTC service users and provide services in many countries, regardless of the type of model. In terms of finance, LTC insurance-based countries had the highest LTC expenditure as a percentage of GDP, followed by countries with tax-based and health insurance systems.
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Tire-wear particles (TWPs) are potential source of microplastic (MP) pollution in marine environments. Although the hazardous effects of MPs on marine biota have received considerable attention, the toxicity of TWPs and associated leachates remain poorly understood. Here, to assess the toxicity of TWP leachate and the underlying mechanisms of toxicity, the phenotypic and transcriptomic responses of the rotifer Brachionus plicatilis were assessed with chemistry analysis of a TWP leachate. Although acute toxicity was induced, and a variety of metals and polyaromatic hydrocarbons were detected in the leachate, levels were below the threshold for acute toxicity. The results of particle analysis suggest that the acute toxicity observed in our study is the result of a toxic cocktail of micro- and/or nano-sized TWPs and other additives in TWP leachate. The adverse effects of TWP leachate were associated with differential expression of genes related to cellular processes, stress response, and impaired metabolism, with further oxidative stress responses. Our results imply that TWPs pose a greater threat to marine biota than other plastic particles as they constitute a major source of nano- and microplastics that have synergistic effects with the additives contained in TWP leachate.
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Rotíferos , Poluentes Químicos da Água , Animais , Poluição Ambiental , Estresse Oxidativo , Plásticos , Rotíferos/genética , Transcriptoma , Poluentes Químicos da Água/toxicidadeRESUMO
Electric vehicles (EVs) are regarded as zero emission vehicles due to the absence of exhaust emissions. However, they still contribute non-exhaust particulate matter (PM) emissions, generated by brake wear, tire wear, road wear, and resuspended road dust. In fact, because EVs are heavier than internal combustion engine vehicles (ICEVs), their non-exhaust emissions are like to be even higher. While total PM emissions, including exhaust and non-exhaust PM emissions, from ICEVs and EVs have been compared based on the emission factors (EFs) listed in national emission inventories, there have been no comparisons based on experimental determinations. In this study, exhaust and non-exhaust emissions generated from a gasoline ICEV, diesel ICEV, and EV were experimentally investigated. The results showed that the EFs for the total PM emissions of ICEVs and EV were dependent on the inclusion of secondary exhaust PM, the brake pad type, and the regenerative braking intensity of the EV. When only primary exhaust PM emissions were considered in vehicles equipped with non-asbestos organic (NAO) brake pads, the total PM10 EF of the EV (47.7-49.3 mg/V·km) was 10-17 % higher than those of the gasoline ICEV (42.3 mg/V·km) and diesel ICEV (43.2 mg/V·km). However, in vehicles equipped with low-metallic (LM) brake pads, the total PM10 EF of the EV (49.2-57.7 mg/V·km) was comparable or lower than those of the gasoline ICEV (56.3 mg/V·km) and diesel ICEV (57.2 mg/V·km). When secondary PM emissions were included, the EF was always significantly lower for the EV than ICEVs. The total PM10 EF of the EV (47.7-57.7 mg/V·km) was lower than those of the gasoline ICEV (56.5-70.5 mg/V·km) and diesel ICEV (58.0-72.0 mg/V·km). Since secondary PM particles are mostly of submicron size, the EFs of the PM2.5 fraction of the ICEVs (28.7-33.0 mg/V·km) were two times higher than those of the EV (13.9-17.4 mg/V·km).
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Poluentes Atmosféricos , Material Particulado , Poluentes Atmosféricos/análise , Monitoramento Ambiental , Gasolina , Veículos Automotores , Material Particulado/análise , Emissões de Veículos/análiseRESUMO
Tires generally wear out due to the friction between the tire and the road surface. Minimizing tire wear could reduce the non-exhaust particulate matter (PM) emissions from tires. Typically, tire treadwear grade can be used as an indicator of PM emissions from tires. Tires that wear out quickly will produce higher PM emissions than more durable tires. In this study, the effect of treadwear grade on the generation of tire PM emissions was investigated through laboratory and on-road driving measurements. In the laboratory measurements, a tire wear simulator installed in an enclosed chamber was used to eliminate artifacts caused by interfering particles during the generation and measurement of tire wear particles. For realistic on-road driving measurements, a mobile sampling vehicle was employed to sample road dust. The road dust was chemically analyzed using pyrolysis gas chromatography-mass spectrometry (GC-MS) to characterize the tire-road wear particles. Both measurements showed that the higher treadwear grade generated lower tire PM emissions due to the high strength of the rubber, except for the UTQG 700 tire. The UTQG 700 tire, which had the highest treadwear grade, produced higher PM emissions than the UTQG 350 and 500 tires because it readily formed the fine particles due to lamellar peeling rather than tearing or curling of tire treads. Notably, tire nanoparticles were observed in laboratory measurements due to the volatilization and nucleation of the sulphur (S) and zinc (Zn) compounds in the tire tread due to the frictional heat between the tire and paved road surface.
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Condução de Veículo , Material Particulado , Poeira/análise , Monitoramento Ambiental/métodos , Tamanho da Partícula , Material Particulado/análise , Emissões de Veículos/análiseRESUMO
Physical friction between a tire and the road surface generates tire wear particles (TWPs), which are a source of microplastics and particulate matter. This study investigated the trends of chemical leaching from TWPs depending on the treadwear rating of the tire. A road simulator was used to produce TWPs from tires with various treadwear ratings. Liquid chromatography-tandem mass spectrometry was used to analyze the chemical leaching from TWPs, with a particular focus on benzothiazole and its derivative 2-hydroxy benzothiazole. However, chemical mapping via high-resolution tandem mass spectrometry detected another derivative: 2-mercaptobenzothiazole. The benzothiazole groups were observed to have different leaching tendencies, implying that using benzothiazole as a marker compound may lead to incorrect TWP quantitation. The results of this research also suggest that the ecotoxicological influence of TWPs can vary with the treadwear rating of a tire.
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Material Particulado , Plásticos , Benzotiazóis , Cromatografia Líquida , Ecotoxicologia , Material Particulado/análise , Plásticos/análiseRESUMO
Condensable particulate matter (CPM) corresponds to primary particulate matter ≤2.5 µm (PM2.5) obtained through the condensation of gaseous air pollutants caused by temperature drops in the atmosphere. The internal combustion of vehicle engines can produce CPM because of the condensable compounds in the exhaust gas. Conventional CPM measurement methods have been developed for coal-fired power plants with stable emissions through sampling and off-site analyses. They are therefore unsuitable for detecting the rapidly changing vehicle-originated CPM. In addition, the current system for evaluating PM2.5 from vehicles, based on the particle measurement program (PMP) protocol, provides only the emission factors of total PM2.5 (and not CPM separately) at a fixed temperature (â¼25 °C) and dilution ratio (â¼ × 35). This study reports, for the first time, the development of a real-time detection method for vehicle-originated CPM through a thermodenuder (TD) integrated with real-time aerosol instruments. This method was designed to reduce the loss of CPM due to condensation and diffusion while sampling the exhaust gas. It permits the investigation of the effects of dilution gas temperature (5-45 °C) and dilution ratio (up to × 30) on the formation of CPM. During the feasibility test of this method using a diesel vehicle (Euro-4), the real-time total particle number concentrations (PNs) matched well with those obtained by a PMP protocol-based evaluation system. Moreover, this method detected PNs concentrations ten times higher than the detection limit (4 × 106 particles/cm3) of the PMP-based system. The emission factors of the total PM2.5 with a bulk density (1 g/cm3) measured by this method also showed consistency with the results of the PMP protocol. The mass emission factor of CPM determined by deploying the TD was â¼14.57 mg/km (â¼63% contribution to the total PM2.5).
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Poluentes Atmosféricos , Material Particulado , Aerossóis/análise , Poluentes Atmosféricos/análise , Carvão Mineral/análise , Monitoramento Ambiental , Gases/análise , Material Particulado/análise , Centrais Elétricas , Emissões de Veículos/análiseRESUMO
OBJECTIVES: To assess the clinical value of periventricular white matter hyperintensity (PWMH) found on brain magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL). METHODS: In this prospective study, 115 patients who were diagnosed with SSNHL aged between 55 and 75 years were analyzed. All subjects underwent brain MRI and were divided into a PWMH and control groups, depending on the presence of PWMH on MRI. PWMH was subdivided into 3 groups according to severity. Pure-tone average results and hearing gain were compared between the 2 groups before treatment and 2 months after treatment. Hearing improvement was assessed using Sigel's criteria. RESULTS: A total of 106 patients (43 in the PWMH group and 63 in the control group) finally completed the 2-month follow-up. Average hearing gain in the PWMH group was significantly higher than in the control group (34.8 ± 20.3 and 25.9 ± 20.3, respectively, P = .029). PWMH score 1 showed significantly better hearing levels and hearing gain compared to PWMH score 3 and the control group. Multivariate analysis revealed that younger age, better initial hearing level, and the presence of PVWM score 1 were associated with good recovery. CONCLUSIONS: The presence of PWMH score 1 on brain MRI in patients with SSNHL was associated with better treatment response and was a good prognostic factor in a multivariate analysis while the hearing recovery in more severe PWMH (scores 2, 3) was not different from the control group.
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Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Súbita/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Idoso , Estudos de Casos e Controles , Feminino , Perda Auditiva Neurossensorial/patologia , Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/patologia , Perda Auditiva Súbita/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Recuperação de Função FisiológicaRESUMO
This study aimed to investigate the factors associated with congenital auricular deformities and evaluate the long-term frequency of their self-correction. Ninety newborns were enrolled in the study, and data were collected within 2 weeks after birth and at 1 year. The shape of the auricle was classified into seven categories using a digital image. At 2 weeks after birth, several birth-related factors were evaluated in the auricular deformity and normal groups. At 1 year after birth, the images of auricles were compared with the images at birth, and the changes in the auricle shape were investigated. Congenital auricular deformities were observed in 139 out of 180 ears, and the major type noted was helix rim deformity (47 ears), followed by normal ears (41 ears), and cup ears (33 ears). Male sex was found to have a statistically significant association with the occurrence of auricular deformity. In the longitudinal study, among 43 neonates (86 ears) followed-up 12 months later, the self-correction rate was approximately 50%. The normal auricle and prominent ear increased, helix rim deformity and cup ear decreased significantly. The prognosis of deformity varied depending on the type of deformity. Considering the low self-correction rate in the prominent and cup ears, newborns with these deformities might be recommended to undergo management such as auricle molding technique, as required.
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Anormalidades Congênitas/patologia , Pavilhão Auricular/anormalidades , Pavilhão Auricular/patologia , Pavilhão Auricular/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Remissão Espontânea , Fatores SexuaisRESUMO
OBJECTIVES: To compare the outcomes of medial and lateral underlay endoscopic type I tympanoplasty for anterior tympanic membrane (TM) perforations. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care academic referral center. PATIENTS: Patients who were diagnosed with either chronic otitis media with dry and stable anterior TM perforations or traumatic anterior TM perforations and underwent endoscopic type I tympanoplasty between 2017 and 2019. INTERVENTIONS: Medial or lateral underlay type I endoscopic tympanoplasty. MAIN OUTCOME MEASURES: Patient demographics, size, and location of TM perforation, graft success rate, and hearing outcome. RESULTS: Of the 170 patients, 68 and 102 patients underwent the medial and lateral underlay techniques, respectively. Patient demographics were not significantly different between groups, except the middle ear mucosa status. Graft success rates were significantly different between groups regardless of the perforation size (85.3 and 95.1%, pâ<â0.001). The lateral underlay group had a significantly better outcome (pâ<â0.001) when anterior superior quadrant TM perforation was included than the medial underlay group (pâ=â0.552). Hearing outcomes did not significantly differ between groups, but a significant audiological improvement was observed in both groups (pâ<â0.05). CONCLUSION: Lateral underlay type I endoscopic tympanoplasty can be challenging as it requires dissection of the malleus. However, the lateral underlay group had a high graft success rate without sensorineural hearing loss in the repair of anterior TM perforations. Thus, lateral underlay type I endoscopic tympanoplasty should be considered for repairing anterior TM perforations, especially when the anterior superior quadrant is involved.
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Membrana Timpânica , Timpanoplastia , Humanos , Miringoplastia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: This study aimed to investigate the feasibility of using optical coherence tomography (OCT) to provide information about cochlear microanatomy at a cellular level, specifically of cochlear hair cells in mammals. MATERIALS AND METHODS: A total of 10 Sprague-Dawley rats were divided into 2 experimental groups for comparing the arrangement of normal and damaged hair cells. Postnatal day 3 Sprague-Dawley rats were used to test the swept-source OCT system, and the images recorded were compared with fluorescence microscope images. RESULTS: Intracochlear structures (the inner hair cells, outer hair cells, and auditory nerve fibers) were clearly visualized at the individual cellular level. CONCLUSION: These images reflect the ability of OCT to provide images of the inner hair cells, outer hair cells, and auditory nerve fibers (ex vivo). OCT is a promising technology, and these findings could be used to encourage research in the area of cochlear microstructure imaging in the future.
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Células Ciliadas Auditivas , Tomografia de Coerência Óptica , Animais , Cóclea , Audição , Ratos , Ratos Sprague-DawleyRESUMO
PURPOSE: To determine the usefulness of 'computed tomography (CT) with Valsalva maneuver (VM)' (Valsalva CT) for localizing lesions of the eustachian tube (ET) and identifying characteristics of ET dysfunction (ETD). MATERIALS AND METHODS: In this case-control study, 12, 17, and 25 patients with obstructive ETD (OETD), patulous eustachian tube (PET), and conductive hearing loss (control), respectively, underwent Valsalva CT in the supine position. The visualized length to total length ratio of the cartilaginous ET (VTRET) with and without VM were compared in the three groups. In the OETD group, obstructed areas of the ET were identified on multiplanar reconstructed images. RESULTS: VTRET without VM in the PET group was significantly higher than that in the control and OETD groups (p-values, 0.003 and 0.007, respectively). However, there was no significant difference between the control and OETD groups (p = 0.053). VTRET with VM in the PET group was significantly higher than that in the other two groups (p < 0.001), whereas that in the control group was significantly higher than that in the OETD group (p < 0.001). In the OETD group, the obstructed area was clearly identified, and there were one, one, six, and eight patients in the isthmus; bony portion and isthmus; bony portion, isthmus, and cartilaginous portion; and isthmus and cartilaginous portion subgroups, respectively. CONCLUSION: Valsalva CT is particularly valuable as a visualization assessment tool for identifying obstructed areas in the OETD. It may help future research of disease-specific mechanical characteristics of the ET on controlling pressure variables.
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Otopatias/diagnóstico por imagem , Tuba Auditiva/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Manobra de Valsalva , Estudos de Casos e Controles , Humanos , Estudos ProspectivosRESUMO
OBJECTIVES: Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD. METHODS: Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients' symptoms preoperatively and at the postoperative follow-up. RESULTS: Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient's final visit at 6 months post-procedure. CONCLUSION: Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.