Morpho-functional characterization of the submucosal glands at the nasopharyngeal end of the auditory tube in humans.

BACKGROUND: The auditory tube (AT), an osteocartilaginous channel, connects the nasopharynx to the middle ear cavity. At the nasopharyngeal opening of the AT, there are dense collections of submucosal glands. In a recent article, Valstar et al. proposed these nasopharyngeal tubal glands conglomerate as salivary glands, which starkly contrasts with their previously known anatomy for being a component of the respiratory tract. This study examines the contesting views regarding the taxonomical categorization of the nasopharyngeal tubal glands. MATERIALS AND METHODS: The AT glands in context were examined in human cadavers grossly, and microscopically using routine and special (Hematoxylin and Eosin [H&E] and Periodic acid-Schiff [PAS] respectively), as well as immunohistochemical (for alpha-SMA and salivary amylase) staining methods and compared with the major and minor salivary glands and the submucosal glands in the trachea. Further, a biochemical analysis was performed to detect the presence of salivary amylase in the oral and nasopharyngeal secretions of the four living human subjects, representing major salivary glands and tubal glands, respectively. RESULTS: The submucosal seromucous glands with a surface lining of respiratory epithelium were observed at the nasopharyngeal end of AT. The cells in the tubal glands showed cytoplasmic positivity for alpha-SMA, which indicated the presence of the myoepithelial cells; however, this expression was significantly lower than in the seromucous submucosal glands within the trachea. Salivary alpha-amylase was undetectable in the cadaveric tissue samples. Moreover, the amylase level in the nasopharyngeal swabs was negligible compared to the oral swabs. CONCLUSION: The anatomical location along the respiratory tract, the presence of respiratory epithelium in the overlying mucosa, their morpho-functional resemblance to the seromucous glands in the trachea, and the absence of salivary amylase strongly indicate that the tubal glands are taxonomically different from the salivary glands. Given the available evidence, their existing recognition as a part of the respiratory tract and an integral component of the AT seems more appropriate.

[Morphological changes in the epithelium of the auditory tube with prolonged respiratory support in children of the first year of life]. / Morfologicheskie izmeneniya epiteliya slukhovoi truby pri dlitel'noi respiratornoi podderzhke u detei pervogo goda zhizni.

OBJECTIVE: To analyze the condition of the epithelium of the cartilaginous part of the auditory tube in premature and full-term infants with prolonged respiratory support using noninvasive assisted ventilation (continuous positive airway pressure - CPAP) and artificial lung ventilation (ventilator). MATERIAL AND METHODS: All the obtained material is distributed relative to the gestation period into the main and control groups. The main group (25 children) is represented by premature and full-term live-born children who were on respiratory support for a period of several hours to 2 months, the average gestation period of which was 30 weeks and 40 weeks, respectively. The control group (8 children) is represented by stillborn newborns with an average gestation period of 28 weeks. The study was conducted posthumously. RESULTS: Prolonged use of respiratory support in premature and full-term children, regardless of the type (CPAP or ventilator), leads to a violation of the row of cilia of the ciliated epithelium, various inflammatory processes, as well as to the expansion of the ducts of the mucous glands of the epithelium of the auditory tube, which affects its drainage system. CONCLUSION: Prolonged respiratory support causes destructive changes in the epithelium of the auditory tube, which make it difficult to evacuate the mucous discharge from the tympanic cavity. This negatively affects the ventilation function of the auditory tube and in the future may lead to the development of chronic exudative otitis media.

A new "practical" plane for Eustachian tube measurements and its application in predicting middle ear dysfunction in patient with acquired cholesteatomas.

SETTING: The Eustachian tube plays a vital role in middle ear physiology. There has been evidence that Eustachian tube (ET) and angle are correlated with middle ear function. The measurements of these Eustachian tube features are now made possible with computed tomography and multiplanar reconstruction techniques. However, there has not been a standardised protocol devised to these measurements in limited window cone-beam CT scans of temporal bones. OBJECTIVE: The primary object of the present study is to establish and validate a new landmark in closer proximity to the middle ear that is consistently captured, thereby allowing ET angle and length to be measured from the majority of cone-beam CT scans. Secondarily, the ET anatomies of patients with middle ear dysfunction manifesting as acquired cholesteatoma are analysed with this new method of measurement. METHODS: This study undertook a step-by-step method to first validate the methods of ET measurement with Reid's standard plane, then identifying an alternative landmark, thus a new plane visible on limited window cone-beam CT scans of temporal bones and lastly, validating the application of this new plane in the measurements of ET angle and length. This new method of measurement was coined the Ku-Copson plane and was applied to 30 cochlear implant patients and 30 patients with acquired cholesteatomas. Their ET anatomies were analysed and compared. RESULTS: It was found that the new Ku-Copson mandibular fossa plane was a reliable and accurate plane for the measurement of ET angle and length. Furthermore, it was found that patients with acquired cholesteatomas have statistically significant smaller ET angles and shorter ET lengths when compared with patients with cochlear implants, of normal middle ear function. CONCLUSION: The newly proposed method utilising the right mandibular fossa as an anatomical landmark for ET angles and lengths measurement appears to be viable. The close proximity of this landmark to the middle ear means that it is highly likely to be captured in most cone-beam CT scans of the petrous temporal bones. This enables the retrospective examination ET angles and lengths to be conducted on CB CT scans. This study reports statistically significant difference in ET anatomy in patients with middle ear dysfunction.

[Approaches to the correction of auditory tube dysfunction in children with allergic rhinitis]. / Podkhody k korrektsii disfunktsii slukhovoi truby u detei s allergicheskim rinitom.

Allergic diseases are a global public health problem. One of the most common among them is allergic rhinitis (AR), which affects up to 40% of adults and 2-25% of children. OBJECTIVE: To assess the state of ventilation of the middle ear in various forms of AR in children and the effectiveness of drug correction. MATERIAL AND METHODS: We conducted a comprehensive examination of 100 children with various forms of AR. The examination complex included the analysis of anamnestic data, the clinical picture of the disease, subjective otological symptoms, data from otoscopy, acoustic impedansometry and tonal threshold audiometry.There are 3 groups of children.Group 1 - 40 children suffering from intermittent allergic rhinitis with pollen sensitization.Group 2 - 20 children with persistent allergic rhinitis with household sensitization.Group 3 - 40 children suffering from persistent allergic rhinitis in combination with an allergic form of bronchial asthma. CONCLUSIONS: 1. Regardless of the form of AR, every third patient has auditory tube dysfunction, which develops mainly on both sides, is asymptomatic and is not accompanied by otoscopic changes.2. As a result of combination therapy, including irrigation agents, montelukast and cetirizine, an improvement in the ventilation of the tympanic cavity was noted with a decrease in the number of recording tympanograms of type «B¼ and «C¼ from 30.5 to 22.0%.

[Auditory tube dysfunction in children. Part 2]. / Disfunktsiya slukhovoi truby v detskom vozraste. Chast' 2.

The presented literature review examines in detail the methods for diagnosing the auditory tube, the history of development of studies of the Eustachian tube and the treatment of its dysfunction in children. The issue of dysfunction of the auditory tube as one of the causes of the formation of chronic hearing loss in childhood is increasingly being identified because of the rapid development of technologies and methods for examining patients. Aim is to study the multiple etiologic factors of the disease and the need for an integrated approach to the study of this condition.

[Auditory tube dysfunction in children (literature review, part 2)]. / Disfunktsiya slukhovoi truby v detskom vozraste (obzor literatury, chast' 2).

The presented literature review examines in detail the methods for diagnosing the auditory tube, the history of development of studies of the Eustachian tube and the treatment of its dysfunction in children. The issue of dysfunction of the auditory tube as one of the causes of the formation of chronic hearing loss in childhood is increasingly being identified because of the rapid development of technologies and methods for examining patients. Aim is to study the multiple etiologic factors of the disease and the need for an integrated approach to the study of this condition.

[Two-year experience in the balloon dilatation treatment of children with persistent auditory tube dysfunction]. / Dvukhletnii opyt lecheniya detei so stoikoi disfunktsiei slukhovoi truby metodom ballonnoi dilatatsii.

OBJECTIVE: Is to study the effectiveness of the of balloon dilatation of the auditory tube in children with persistent dysfunction of the auditory tube. Examination and treatment of 28 children aged 5 to 16 years with persistent dysfunction of the auditory tube was performed. To diagnose and objectify the results of the treatment, taking of complaints and medical history of the patient, examination of ENT organs, endoscopic examination of the nose, nasopharynx and otoendoscopy, functional multispiral computed tomography of the auditory tubes, audiological examination (tympanometry, tonal threshold audiometry) were performed. Treatment included balloon dilatation of the auditory tubes. In 25 (89.3%) children, upon repeated examination after 2, 6, 12 months, the clinical, radiological, and audiological parameters were normal.

[Auditory tube dysfunction in children (literature review, part 1)]. / Disfunktsiia slukhovoi truby v detskom vozraste (obzor literatury, chast' 1).

We present the review of the literature on the anatomical and physiological features of the structure of the auditory tube in children, epidemiology, etiology, and the pathogenesis of the formation of auditory tube dysfunction is presented. The first part of the article presents in more detail the structural and functional differences in the Eustachian tube in children, the classification and mechanism of the occurrence of the auditory tube dysfunction in pediatric practice.

[Eustachian tube drug delivery to the tympanum in patients with otitis media with effusion]. / Otsenka transtubarnoi dostavki lekarstvennykh preparatov v barabannuyu polost' pri ekssudativnom srednem otite.

There are no reliable data on the volume of the drug reaching the affected tympanic cavity during the catheterization of Eustachian tube (ET). Objective: to conduct an experiment and to study the effectiveness of administering a drug into the tympanic cavity of the middle ear using an original ear catheter, which allows catheterization of ET in the direction of its lumen. The study included patients with unilateral OME (n=21, the duration of the disease from 2 to 3 months), who were recommended for the ventilation tube insertion. The main inclusion criterion was 3 degree of patency of the ET. The experiment was performed under endotracheal anesthesia. ET was catheterized before insertion of the ventilation tube, with a 0.9% saline in a volume of 7 ml, which was previously tinted with Brilliant Green. A syringe with a contrast solution was connected to an ear catheter and the drug was injected into the middle ear by the air-liquid substitution method. Otoscopically evaluated the following parameters: the volume of the injected drug (in ml) for the initial (V1), partial (V2) and complete filling of the tympanic cavity (V3). As a result, it was found that 18 patients (85.7%) achieved full or partial filling of the tympanic cavity with a stained preparation: V1=2.25 ml, V2=7.0 ml in 11 (52.4%) patients, V3=4.29 ml - in 7 (33.3%) patients. In this case, the minimum loss of the liquid form of the drug during CT catheterization is 1:2. In 3 (14.3%) patients there were no endoscopic signs of contrasting of the tympanic cavity.

[Treatment of exudative (secretory) otitis media in young children taking into account the anatomical features of the auditory tube]. / Lechenie ékssudativnogo srednego otita u detei rannego vozrasta s uchetom anatomicheskikh osobennostei slukhovoi truby.

AIM: To study the efficacy and safety of treatment of exudative (secretory) otitis media (EOM) in children of early age taking into account the anatomical features of the auditory tube. MATERIAL AND METHODS: We examined and treated 30 children (51 ears) by balloon dilatation (BD) at the age of 1 to 3 years, with recurrent EOM (more than 6 months). The 21st child was diagnosed with a 2-sided process, and 9 with a one-sided process. All patients have previously unsuccessfully used conservative methods of treatment. According to the results of the examination and treatment, the children were divided into 2 groups. In group 1 (16 children, 30 ears) included children suffering from ESR in combination with hypertrophy of adenoids 2-3 art. with a block of pharyngeal mouths of auditory tubes, which at stage 1 of treatment was carried out endoscopic adenotomy and shunting of the tympanic cavities. In follow-up, this group of children after shunt loss was diagnosed with relapse of EOM (type B was registered on tympanometry). In this group, balloon dilation of auditory tubes was performed in the second stage after adenotomy and bypass surgery. In group 2 (14 children, 21 ear) included children with relapsing course of EOM, the adenoid vegetation 1 degree without block the pharyngeal orifices of the auditory tubes, which in the first phase was conducted on bypass the tympanic cavity. After the loss of shunts, during the control examination, a relapse of EOM was diagnosed, in connection with which, the children underwent balloon dilation of the auditory tubes. RESULTS: During tympanometry in 1 month. complete restoration of middle ear function in 17 children (56.7%, 28 ears) (tympanograms type A) was revealed. 4 children (13.3%, 6 ears) were diagnosed with partial recovery of middle ear function (tympanograms type C). 9 children (30%, 17 ears) retained exudate in the tympanic cavity, these patients underwent a second course of conservative therapy, after which the function of the middle ear was restored. 9 children after BD with persistent exudate in the middle ear cavities underwent tympanostomy (in this case, long-term wearing shunts were used). CONCLUSION: Balloon dilation of the cartilaginous part of the auditory tube is minimally invasive, effective in 70% of cases and a safe approach to the treatment of children suffering from a recurrent course of EOM.

[The pressure-equalizing function of the Eustachian tube : Evaluation in a hypo-/hyperbaric pressure chamber]. / Druckausgleichende Funktion der Eustachischen Röhre : Evaluation in einer hypo-/hyperbaren Druckkammer.

BACKGROUND: The Eustachian tube connects the tympanic cavity (cavum tympani) and the nasopharynx, and enables pressure equalization between the middle ear and ambient pressure. Functional pressure compensation is very important for flying and diving in particular, due to non-physiologically large pressure differences. OBJECTIVE: Evaluation of the pressure-equalizing function of the Eustachian tube is still a clinical challenge. This review article evaluates the existing data. METHODS: Based on a selective literature search, different methods for evaluation of tube function are presented and evaluated, with special reference to evaluation of the pressure-equalizing function in a hypo-/hyperbaric pressure chamber. RESULTS: The pressure chamber enables the dynamics of active and passive pressure compensation to be provoked and also permits accurate measurement of pressures in the millibar range. CONCLUSION: A pressure chamber seems to be suitable to evaluate Eustachian tube function and therapeutic approaches to tube dysfunction. Further studies are needed to assess the value of the pressure chamber in combination with other functional tests.

Histological identification of nasopharyngeal mechanoreceptors.

The auditory tube plays a fundamental role in regulating middle ear pressure. A "system" sensitive to a pressure gradient between the middle ear and the ambient environment is necessary. The presence of mechanoreceptors in the middle ear and the tympanic membrane has been studied, but the presence of these receptors in the nasopharyngeal region remains unclear. The aim of this study is to confirm the presence of pressure sensitive corpuscles in the nasopharynx. An experimental study was conducted on five fresh and unembalded human cadavers. The pharyngeal ostium of the auditory tube and its periphery was removed in one piece by video-assisted endonasal endoscopy. Samples were fixed in formaldehyde solution, embedded in paraffin, and cut. Slides were analyzed by HES (Hematoxyline Eosine Safran) coloration, by S100 protein and neurofilament protein immunostaining. Encapsulated nerve endings were researched and identified by slides analysis. Eight samples were included in our study. On seven samples, Ruffini corpuscles were identified in the mucosa of the posterior area of the pharyngeal ostium, with a higher concentration in the pharyngeal recess and in the posterior nasopharyngeal wall. Our study identified nasopharyngeal mechanoreceptors that could detect the nasopharyngeal pressure and, by extension, the atmospheric pressure. These findings support the theory of the neuronal reflex arc of isobaric system of the middle ear, based on the existence of a "system" sensitive to a pressure gradient between the middle ear and the ambient environment. Understanding of this system has been helpful in the diagnosis and management of middle ear diseases.

The posterior or tubal sphenoidal plate extending into the tympanosquamous fissure - A novel finding.

OBJECTIVE: The tympanic plate typically joins the articular tubercle in the medial glenoid wall. It is aimed to report a peculiar anatomic variant of the latter. METHODS: The computed tomography scans of two adult male cases were documented for the anatomical details of the temporomandibular joint. RESULTS: The absence of the tubal processes of the tympanic plates was found bilaterally. The medial glenoid walls were penetrated by posterior or tubal sphenoidal plates extending posteriorly from the sphenoidal spines, 6.6 mm/12.2 mm on the right/left sides in the first case, and 9.8/8.4 mm on the right/left sides in the second case. These plates formed the lateral tubal walls and modified the tubal sulci on the sphenopetrosal fissures into musculotubal pseudo-canals. On the sides of the tubal sphenoidal plates formed in the medial wall of the glenoid fossa additional fissures, an anterolateral sphenotemporal one and a postero-medial sphenotympanic one. CONCLUSION: As far as the authors know, the tubal plate of the sphenoid bone was not observed previously to participate in the glenoid fossa's medial wall. It could be regarded as a rare anatomic variation.

Rigid normograde rhinoscopy-assisted traction-avulsion removal of small middle ear polyps from the auditory tube in five cats.

CASE SERIES SUMMARY: This study aims to describe a novel minimally invasive technique for the removal of small middle ear polyps from the auditory tube openings in cats. Five cats with clinical signs of otitis externa and/or otitis media, and/or upper respiratory tract inflammation were included. All cats underwent pharyngolaryngoscopy under anaesthesia, CT scan of the head, neck and thoracic cavity, video-otoscopic examination, retrograde nasopharyngoscopy and normograde rhinoscopy. The five cats described in this study were all found to have significant respiratory tract inflammation (rhinitis, sinusitis, nasopharyngitis, otitis media) with small polypous protrusions from the auditory tube openings. A normograde rhinoscopy-assisted traction-avulsion (RATA) removal of these small polyps was performed in all cases without complications. The rostral nasopharynx was visualised by a unilaterally normograde advanced rigid endoscope passing the choana, and polyps were removed using a grasping forceps introduced in the contralateral nostril. Telephone follow-up revealed clear improvement in all cases. One of the cases was re-evaluated with a CT scan and endoscopy 4 weeks after treatment. The CT scan showed a significant improvement with no abnormalities in both external ear canals and air opacity in both tympanic bullae. Video-endoscopic examination revealed intact tympanic membranes with mild chronic abnormalities and patent auditory tube openings upon normograde rhinoscopy. RELEVANCE AND NOVEL INFORMATION: Rigid normograde RATA is a novel, minimally invasive and effective technique for the removal of small middle ear polyps from auditory tube openings in cats with otitis media.

Informed consent in balloon Eustachian tuboplasty: a systematic review of possible complications and preventive measures.

OBJECTIVE: To systematically identify the complications associated with balloon Eustachian tuboplasty and their frequency of occurrence. This study will also highlight the measures that can be employed to avoid these complications and perform this procedure more safely. METHODS: Systematically reviewed relevant papers published until January 2023. Each reference was checked and evaluated for any potential manuscripts. There was no registered protocol; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. RESULTS: Sixty-nine publications were found, from which 14 publications met our inclusion criteria: 2 randomised clinical trials, 5 retrospective studies, 2 systematic reviews, 2 case series and 3 case reports. Studies with balloon Eustachian tuboplasty procedure only were included, regardless of ethnicity, gender and age. All studies were excluded in which more than one procedure was performed. CONCLUSION: Balloon Eustachian tuboplasty is a relatively safe procedure with an overall complication risk of 1.66 per cent. Major complication rate was 0.43 per cent. Surgical emphysema was the most common, around 0.40 per cent.

Flight After Stapes Surgery: An Evidence-Based Recommendation.

Objective: Recommendations for air travel after stapes surgery, specifically stapes surgery, vary, with no standard recommendation to guide patients and surgeons. According to our search, no previous article has explored the physics of middle ear changes during flight and its effects on poststapedectomy patients in a systematic way. The aim of this study is to bring together 2 arms of expertise, otology, and aviation, to produce an evidence-based recommendation for flight after stapes surgery. Data Sources: The database MEDLINE was searched during August 2022. The search strategy had the goal of identifying studies that discovered the effects of flying on stapes surgery patients and the effects of atmospheric pressure on middle ear structures. Review Methods: The articles yielded from the search strategy were transferred to the online citation manager Rayyan. Included in the review were those studies reporting patient outcomes after flying following ear surgery; additional studies included those reporting pressure changes in the middle ear and ossicular chain displacement whether in experimental or animal conditions. Conclusion: Modern-day commercial air travel is safe for patients who have undergone stapedotomy surgery, even very shortly after hospital discharge if they have to. Implications for Practice: If stapedotomy patients wish to fly after hospital discharge, otologists are to reassure them that it is safe to do so. Patients are to be reminded to perform a gentle Valsava maneuver about every 4 minutes during airplane descent.

Nasopharyngeal sialocoele with underlying auditory tube neoplasia in a cat.

Case summary: An 8-year-old cat was presented with recent signs related to upper airway obstruction. CT revealed a hypoattenuating mass, with rim enhancement, in the nasopharynx. Paracentesis yielded a viscous fluid, consistent with saliva on cytology. The sialocoele was aspirated, and surgical excision of the ipsilateral mandibular and sublingual salivary glands was performed. The sialocoele recurred 3 months later, associated with a polypoid structure in the auditory tube region. This was surgically extirpated. Histology was consistent with a tubulopapillar adenocarcinoma. Relevance and novel information: To our knowledge, this is the first case report of a nasopharyngeal sialocoele with confirmed underlying neoplasia in a cat, and the first description of CT imaging features of a nasopharyngeal sialocoele in a cat.

Nasopharyngeal Warthin's Tumors: A Case Report and Minireview.

Warthin's tumors of the head and neck are more common in the parotid and salivary glands and are extremely rare in the nasopharynx. This paper reports the clinical data of a patient with a nasopharyngeal Warthin's tumor and posterior nostril atresia who underwent nasal endoscopic nasal mass resection combined with posterior nostriphoplasty, and the patient has no tumor recurrence during the postoperative follow-up of until 14 months. This case report, combined with a literature review, conducted an in-depth analysis of nasopharyngeal Warthin's tumors to enable more otolaryngology specialists to deepen their understanding of such diseases.

Position of the midline septum of the guttural pouches in horses subjected to computed tomography.

Standing computed tomographic (CT) examination of the equine guttural pouch frequently reveals deviation of the midline septum. The significance of deviation is currently unknown. The aims of this retrospective, single-centre study were to determine the prevalence of deviation of the midline septum of the guttural pouch and determine whether there was an association between the presence and degree of deviation of the septum, and guttural pouch disease. Case records were reviewed, identifying 95 horses that had undergone a standing, sedated, head CT and guttural pouch endoscopy. The presence, laterality, subjective degree and angle of deviation of the midline septum on CT was recorded. A total of 69 (72.6%) horses were identified with deviation of the midline septum, with the mean angle of deviation 13.4o and a maximum deviation of 52.6o. No significant association between the presence of deviation of the midline septum (P = .722) or severity of deviation (P = .428) and an endoscopic abnormality within the guttural pouch was found. The laterality of deviation and guttural pouch abnormalities were also not associated (P = .000). Deviation of the midline septum of the guttural pouch is a common finding on CT examination, and does not have clinical significance in this study.

Role of ectodysplasin signalling in middle ear and nasal pathology in rat and mouse models of hypohidrotic ectodermal dysplasia.

Patients with mutations in the ectodysplasin receptor signalling pathway genes - the X-linked ligand ectodysplasin-A (EDA), the receptor EDAR or the receptor adapter EDARADD - have hypohidrotic ectodermal dysplasia (HED). In addition to having impaired development of teeth, hair, eccrine sweat glands, and salivary and mammary glands, HED patients have ear, nose and throat disease. The mouse strains Tabby (EdaTa ) and downless (Edardl-J/dl-J ) have rhinitis and otitis media due to loss of submucosal glands in the upper airway. We report that prenatal correction of EDAR signalling in EdaTa mice with the agonist anti-EDAR antibody rescues the auditory-tube submucosal glands and prevents otitis media, rhinitis and nasopharyngitis. The sparse- and wavy-haired (swh) rat strain carries a mutation in the Edaradd gene and has similar cutaneous HED phenotypes to mouse models. We report that auditory-tube submucosal glands are smaller in the homozygous mutant Edaraddswh/swh than those in unaffected heterozygous Edaraddswh/+ rats, and that this predisposes them to otitis media. Furthermore, the pathogenesis of otitis media in the rat HED model differs from that in mice, as otitis media is the primary pathology, and rhinitis is a later-onset phenotype. These findings in rodent HED models imply that hypomorphic as well as null mutations in EDAR signalling pathway genes may predispose to otitis media in humans. In addition, this work suggests that the recent successful prenatal treatment of X-linked HED (XLHED) in humans may also prevent ear, nose and throat disease, and provides diagnostic criteria that distinguish HED-associated otitis media from chronic otitis media with effusion, which is common in children.