Analyzing eustachian tube function in patients with symptoms of chronical Eustachian tube dysfunction by pressure chamber measurements.

PURPOSE: The determination of Eustachian tube dysfunction (ETD) subtypes in daily routines is based on symptoms of the patient, otoscopy, nasopharyngoscopy, tympanometry, pure tone audiometry, and Valsalva's test, even though this clinical assessment is often not sufficient to clearly diagnose the subtype. In the study, we have evaluated the possibility of the determination of different subtypes of ETD by pressure chamber measurements. METHODS: In a single-person pressure chamber, we exposed 17 patients to pressure increases and decreases. The pressure profile of the continuous impedance of each tympanic membrane during the 5-min lasting measurement and the Eustachian tube (ET) pressure equilibration function reflecting parameters-ET opening pressure (ETOP), ET opening duration (ETOD), ET closing pressure (ETCP), and ET opening frequency (ETOF)-were documented and analyzed. RESULTS: By interpretation of the pattern of the continuous impedance of the tympanic membrane, we could relate patients to a subtype of ETD. Clearly identified by pressure chamber-based measurements could be patients with patulous ETD (n = 2) and baro-challenged-induced ETD (n = 4). The remaining 11 patients were classified as ETD not further classified. Patients diagnosed as patulous ETD did not show a pressure response on the tympanic membrane during the phases of pressure increase and decrease. In patients with baro-challenged-induced ETD, the measurement had to be interrupted due to the development of otalgia during progressive pressure increase as a result of insufficient possibility to equalize pressure variations. CONCLUSIONS: Pressure chamber-based measurements enable an objective and safe dynamic testing of the ET pressure equalization function in patients with ETD. In addition, via continuous impedance measurement, it is possible to identify patients with patulous ETD and baro-challenge-induced ETD. These results are a relevant preliminary work to identify and assess patients for different therapy options.

Characterizing the active opening of the eustachian tube in a hypobaric/hyperbaric pressure chamber.

OBJECTIVE: Active and passive opening of the Eustachian tube (ET) enables direct aeration of the middle ear and a pressure balance between middle ear and the ambient pressure. The aim of this study was to characterize standard values for the opening pressure (ETOP), the opening frequency (ETOF), and the opening duration (ETOD) for active tubal openings (Valsalva maneuver, swallowing) in healthy participants. DESIGN/PARTICIPANTS: In a hypobaric/hyperbaric pressure chamber, 30 healthy participants (19 women, 11 men; mean age, 25.57 ± 3.33 years) were exposed to a standardized profile of compression and decompression. The pressure values were recorded via continuous impedance measurement during the Valsalva maneuver and swallowing. Based on the data, standard curves were identified and the ETOP, ETOD, and ETOF were determined. RESULTS: Recurring patterns of the pressure curve during active tube opening for the Valsalva maneuver and for active swallowing were characterized. The mean value for the Valsalva maneuver for ETOP was 41.21 ± 17.38 mbar; for the ETOD, it was 2.65 ± 1.87 seconds. In the active pressure compensation by swallowing, the mean value for the ETOP was 29.91 ± 13.07 mbar; and for the ETOD, it was 0.82 ± 0.53 seconds. CONCLUSION: Standard values for the opening pressure of the tube and the tube opening duration for active tubal openings (Valsalva maneuver, swallowing) were described, and typical curve gradients for healthy subjects could be shown. This is another step toward analyzing the function of the tube in compression and decompression.

Impact of xylomethazoline on eustachian tube function in healthy participants.

INTRODUCTION: The use of decongestants is common in otitis media eustachian tube (ET) dysfunction. However, the underlying mechanism and the type of action on the complex middle ear pressure equalization system are poorly understood. Here, by use of the pressure chamber, we investigated the impact of intranasal decongestive therapy (xylomethazoline) on ET function. MATERIALS AND METHODS: Thirty healthy participants (60 ears) were exposed to a predetermined profile of phases of compression and decompression in a hypobaric and hyperbaric pressure chamber. ET opening pressure, ET opening duration, ET opening frequency, and ET closing pressure were determined before and after intranasal application of xylomethazoline. RESULTS: A significantly higher number of ET openings (ET opening frequency) in passive equalization condition could be measured after application of decongestants than before. No significant difference could be found in the values of ET opening pressure, ET opening duration, and ET closing pressure parameters before in comparison with the values after application of xylomethazoline. CONCLUSION: We conclude that xylomethazoline might only have a minor effect during active and passive middle ear pressure equalization. Larger cohorts and targeted application of decongestants should be tested to confirm these preliminary data and to find new evidence on the effects of decongestants.