Buteyko breathing technique for obstructive Eustachian tube dysfunction: Preliminary results from a randomized controlled trial.

PURPOSE: To assess the effectiveness of Buteyko breathing technique in patients with obstructive Eustachian tube dysfunction (ETD). MATERIALS AND METHODS: Fifty-one patients (77 ears) aged between 21 and 62 years were randomized to Buteyko breathing in conjunction with medical management (nasal steroid) group or medical management alone group. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) symptom scores, tympanogram, positive Valsalva maneuver were evaluated at baseline, 6-week and 12-week follow-up. RESULTS: Normalization of ETDQ-7 symptom scores at 6-week follow-up was observed in 30.0% (12/40) of the Buteyko breathing group versus 16.2% (6/37) of the controls (P > 0.05). At 12-week follow-up, the ratio rose to 50.0% (20/40) in the Buteyko breathing group and 24.3% (9/37) in the controls (P < 0.05). Tympanogram normalization at 12-week follow-up was observed in 53.6% (15/28) of the Buteyko breathing group versus 26.9% (7/26) of the controls (P < 0.05). The Buteyko breathing group showed slight improvement in positive Valsalva maneuver at 6- and 12-week follow-up (P > 0.05). CONCLUSIONS: Our study shows that Buteyko breathing technique might be an effective adjunctive intervention in treatment of obstructive ETD, especially for those patients who are refractory to medical treatment and cannot afford Eustachian tube balloon dilation surgery.

Pressurized transient otoacoustic emissions measured using click and chirp stimuli.

Transient-evoked otoacoustic emission (TEOAE) responses were measured in normal-hearing adult ears over frequencies from 0.7 to 8 kHz, and analyzed with reflectance/admittance data to measure absorbed sound power and the tympanometric peak pressure (TPP). The mean TPP was close to ambient. TEOAEs were measured in the ear canal at ambient pressure, TPP, and fixed air pressures from 150 to -200 daPa. Both click and chirp stimuli were used to elicit TEOAEs, in which the incident sound pressure level was constant across frequency. TEOAE levels were similar at ambient and TPP, and for frequencies from 0.7 to 2.8 kHz decreased with increasing positive and negative pressures. At 4-8 kHz, TEOAE levels were larger at positive pressures. This asymmetry is possibly related to changes in mechanical transmission through the ossicular chain. The mean TEOAE group delay did not change with pressure, although small changes were observed in the mean instantaneous frequency and group spread. Chirp TEOAEs measured in an adult ear with Eustachian tube dysfunction and TPP of -165 daPa were more robust at TPP than at ambient. Overall, results demonstrate the feasibility and clinical potential of measuring TEOAEs at fixed pressures in the ear canal, which provide additional information relative to TEOAEs measured at ambient pressure.

[Diagnosis and treatment of Eustachian tube dysfunction]. / Diagnostik und Therapie von Funktionsstörungen der Tuba auditiva.

The Eustachian tube protects against secretion, germs and sound pressure from the nasopharynx, it acts as a drain, and serves pressure equalization in both directions so that the ear drum and sound-conducting apparatus can vibrate optimally. The incidence of Eustachian tube dysfunction in adults is about 1%, in children almost 40%. Symptoms are often unspecific. For diagnosis, the Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum. Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children. Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter. The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated.

Tubomanometry value as an associated factor for medication outcomes in adult acute otitis media with effusion.

Tubomanometry (TMM) is a relatively novel method for testing the eustachian tube (ET) function, which is speculated to be closely related to otitis media with effusion (OME). The purpose of this study is to explore the predictive power of TMM value for medication outcomes in adult acute OME. A cohort of 41 adult acute OME patients with 53 affected ears was studied retrospectively. All these patients completed a 2-week treatment including oral Myrtol Standardized Enteric capsules, nasal steroid, and oral antihistamine. The results showed that the response rate was 41.5% (22/53). The ratio of tympanometry C and TMM value differed significantly between responders and non-responders (P < 0.05), and the TMM value is the only predictive variable for treatment outcomes (P < 0.001, odds ratio 1.873). A ROC analysis of the TMM value for the treatment outcome showed that the area under the curve could achieve 0.773 (P < 0.001), while the optimal cutoff value calculated by Youden index was 1.5, with 72.7% sensitivity and 74.2% specificity. The response rate of ears with 2-6 TMM values could reach 66.7% (16/24), which was significantly higher than that of ears with TMM values 0-1, 20.7% (6/29) (P < 0.001). These findings showed that acute OME patients with a high TMM value and tympanometry C of the affected ear could potentially benefit from medication. The TMM value was an independent predictive factor of the treatment outcomes that could guide treatment decisions.

Identifying eustachian tube dysfunction prior to hyperbaric oxygen therapy: Who is at risk for intolerance?

PURPOSE: Determine whether specific risk factors, symptoms and clinical examination findings are associated with hyperbaric oxygen therapy (HBOT) intolerance and subsequent tympanotomy tube placement. MATERIALS AND METHODS: A retrospective case series with chart review was conducted from 2007 to 2016 of patients undergoing HBOT clearance at a tertiary care university hospital in an urban city. Eighty-one (n=81) patient charts were reviewed for risk factors, symptoms and clinical examination findings related to HBOT eustachian tube dysfunction and middle ear barotrauma. Relative risk was calculated for each variable to determine risk for HBOT intolerance and need for tympanotomy tube placement. Risk factor, symptom, physical examination and HBOT complication-susceptibility scores were calculated for each patient. RESULTS: Mean risk factor, clinical and HBOT complication-susceptibility scores were significantly higher in patients who did not tolerate HBOT compared to patients who tolerated HBOT. Patients reporting a history of otitis media, tinnitus, and prior ear surgery were at a higher risk for HBOT intolerance. Patients reporting a history of pressure intolerance and prior ear surgery were more likely to undergo tympanotomy tube placement. Patients noted to have otologic findings prior to HBOT were at a higher risk for both HBOT intolerance and tympanotomy tube placement. CONCLUSIONS: A thorough otolaryngological evaluation can potentially predict and identify patients at risk for HBOT intolerance and tympanotomy tube placement.

Trans-tympanic catheter insertion for treatment of patulous eustachian tube.

OBJECTIVES: To evaluate the safety and therapeutic efficacy of trans-tympanic catheter insertion (TCI) in patients with refractory patulous eustachian tube (PET). METHODS: TCI was attempted in thirty-six ears of twenty-nine patients with chronic PET refractory to conservative treatment. The catheter was inserted under local anesthesia in an operating room through the bony orifice of the eustachian tube (ET) to occlude the isthmus of the tube via a myringotomy site on the tympanic membrane. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. Patients had no concurrent disease and did not undergo any additional surgical procedure. RESULTS: TCI was performed in all except one ear, in which it failed because of an abnormally narrow tympanic ET orifice. Follow-up durations ranged from 6 to 37 months, with an average of 19.3 months. Successful treatment of subjective autophony was achieved in twenty-nine (82.4%) of the thirty-five ears. Ventilation tube (VT) placement was performed in the two ears because of otitis media with effusion (OME) after TCI. In one ear, the inserted catheter was finally removed due to additional unilateral mastoiditis after VT extrusion. CONCLUSION: TCI seems to be a minimally invasive and was used successfully to treat PET. The procedure had a good overall success rate and complications were rare in the long-term.

Different reactions of human nasal and Eustachian tube mucosa after hyperbaric oxygen exposure: a pilot study.

Impairment of Eustachian tube function has been observed after hyperbaric oxygen treatment as well as after diving on oxygen used as breathing gas. The aim of the present study was to evaluate the influence of hyperbaric oxygen exposure on Eustachian tube ventilatory function and airflow characteristics of the nose. Six police task force divers performing two consecutive dives within a regular training schedule on oxygen were examined. Middle ear impedance, and nasal airflow velocities before and after diving as well as on the morning after the dive day were measured. Middle ear impedance decreased overnight in comparison to pre-dive values (P = 0.027) as well as compared to the value after the first dive (P = 0.032). Rhinoflowmetry did not reveal any changes of nasal airflow velocities related to the dives. Furthermore, no association between middle ear impedance and nasal airflow velocities was found. An impairment of Eustachian tube ventilatory function was obtained after hyperbaric oxygen exposure during dives employing oxygen as breathing gas. This impairment, however, was not associated with altered airflow characteristics of divers' noses. Thus, it seems unlikely that hyperbaric oxygen exerts an effect on the nasal mucosa similar to that on the Eustachian tube mucosa.

Audiometry with nasally presented masking noise: novel diagnostic method for patulous eustachian tube.

OBJECTIVE: Nasal-noise masking audiometry was developed to assess the acoustic transfer function from the nasopharyngeal cavity to the middle ear via patulous eustachian tube (ET). STUDY DESIGN: Prospective. SETTING: Tertiary referral center. PATIENTS: Twenty-seven ears of 18 patients with patulous ET and 20 ears of 10 healthy subjects with no history of ear disease or complaints of aural symptoms. MAIN OUTCOME MEASURES: Audiometric measurement was conducted with and without masking noise presented in the nasal cavity. RESULTS: The masking effect of nasally presented noise caused elevation of the threshold for the tone presented in the external auditory canal. This threshold elevation was significantly greater, particularly in the lower-frequency region, in ears with patulous ET and was decreased to the normal range after obstructive treatment of the patulous ET. CONCLUSION: Nasal-noise masking audiometry is a simple and effective way to identify patulous ET.

Prevention and cure of rhinogenous deafness at the Thermal Baths "Bagni delle Galleraie".

INTRODUCTION: Hearing is foundamental for human social life. Secretory Otitis Media (SOM) is the most important cause of trasmissive hypoacusis in early childhood. METHODS: The Department of Physiopathology, Experimental Medicine and Public Health of Siena University in collaboration with the Thermal Baths "Bagni delle Galleraie" proposed a prevention and cure campaign of rhinogenous deafness in June 2002 in some primary schools in the Colle val D'Elsa district. A sample of 87 children was involved in the study (average age of 5,64 +/- 1,41 years). On entering the thermal baths a questionnaire was administered to the parents, to point out possible risk factors. RESULTS: Among the 87 children, 28 cases of SOM and 21 cases of severe tubal disorder were found. Only 19 cases out of 49 were already known to the parents and only 28 joined the study and were examined for three years consecutively. DISCUSSION: Out of the 35 children examined in 2002, 28 returned to "The Galleraie" for the two following years. They repeated the thermal cure for two years as a preventive measure. At present they are not affected by SOM and during the winters suffered a lower number of infections in the primary airways and took less antibiotics. CONCLUSIONS: Our study focuses on infant school children because of their critical age for linguistic and social development. Early diagnosis and therapy prevent any negative social development.

Possible new assessment of patulous Eustachian tube function: audiometry for tones presented in the nasal cavity.

OBJECTIVE: To assess the acoustic transfer function of the Eustachian tube by means of audiometric measurements in order to evaluate the severity of the patulous condition. MATERIAL AND METHODS: Detection thresholds for tones presented in the nasal cavity (at the nostril) were measured in subjects with a patulous Eustachian tube (PET) and in normal subjects. RESULTS: In typical cases, these thresholds were lower in the subjects with PET and were markedly elevated to the same level as those of normal subjects by the insufflation of Lugol's solution (iodine solution). The pre- versus post-insufflation threshold differences seemed to reflect the effects of a patulous tube on the acoustic characteristics via the Eustachian tube. Based on the obtained results, sound patency via a patulous tube appeared to be dominant in lower frequency tones. CONCLUSION: The present method seems to be another easy way to assess PET.

Galbreath technique: a manipulative treatment for otitis media revisited.

Otitis media is a common disorder that results in numerous visits to the physician each year. Antimicrobials, antihistamines, steroids, and surgery have all been used to treat otitis media; however, the literature makes little mention of osteopathic manipulative treatment in this regard. This article describes a technique that was first described in 1929 by William Otis Galbreath, DO. By simple mandibular manipulation, the eustachian tube is made to open and close in a "pumping action" that allows the ear to drain accumulated fluid more effectively. Physicians can easily teach this procedure to parents for use at home.

Thermal myringotomy for eustachian tube dysfunction in hyperbaric oxygen therapy.

Otolaryngologists are frequently asked to manage eustachian tube dysfunction (ETD) in patients undergoing hyperbaric oxygen therapy (HBO). HBO patients with intractable ETD currently are treated by tympanostomy tube placement; typically, these tubes are indwelling far longer than is required by the duration of HBO. Also, tubes in this population are associated with higher complication rates of persistent perforation and otorrhea. We investigated the use of thermal myringotomy as an alternative to tympanostomy tube placement in this clinical setting. Potentially, thermal myringotomy avoids the risks and complications associated with indwelling tympanostomy tubes and would be a temporally more appropriate treatment during short- and intermediate-term HBO. In this study 13 patients undergoing HBO who would have required tympanostomy tube placement instead underwent bilateral thermal myringotomies. At the fifth postoperative week, 96% of myringotomies were patent; this duration is adequate for most HBO courses. No patient required a second myringotomy for premature closure. The persistent perforation rate was 15% (at the end of 6 months), which compares favorably with the rate observed with tympanostomy tubes in this unique population of poor wound healers. Only 1 patient had otorrhea; this resolved with dry ear precautions. This study demonstrates thermal myringotomy to be an effective technique for middle ear ventilation in patients undergoing HBO in whom ETD develops.

Inner and middle ear hyperbaric oxygen-induced barotrauma.

Patients receiving hyperbaric oxygen (HBO) therapy can sustain inner and middle ear barotrauma. The purpose of this study is to define the incidence and significance of HBO-related barotrauma, in addition to establishing guidelines for prophylactic myringotomy or tympanostomy tube placement. Thirty patients were stratified into two groups (those able to autoinflate and those unable to autoinflate the middle ear) and barotrauma was assessed by otoscopy, tympanometry, high-frequency audiometry, and distortion product otoacoustic emission (DPOAE) testing. Ten of 11 patients (91%) from the noninflater group suffered middle ear barotrauma, and seven of 19 patients (37%) from the autoinflater group sustained middle ear barotrauma. Patients unable to autoinflate the middle ear were shown to have a higher incidence and greater severity of barotrauma than patients able to autoinflate. Pretreatment pressure-equalizing tubes or myringotomies should be considered for patients undergoing HBO therapy who have an artificial airway or have eustachian tube dysfunction and have failed conservative medical intervention. A significant change in DPOAEs (loss of emissions over a 1-kHz range) was found in four of 15 autoinflaters (27%) and two of seven noninflaters (29%). There was no significant difference between the groups. The decrease in DPOAEs was not associated with a change in conventional audiometry.

Eustachian tube function and middle ear barotrauma associated with extremes in atmospheric pressure.

Eustachian tube (ET) function was studied by means of sonotubometry and tubotympano-aerodynamography (TTAG) prior to and following exposure to hypobaric or hyperbaric conditions. Forty normal adults were subjected to hypobaric pressure. Fifty adults who underwent hyperbaric oxygen (HBO) therapy also were studied. Following hypobaric exposure, 14 of 80 ears (17.5%) exhibited middle ear barotrauma. Following hyperbaric exposure, 34 of 100 ears (34%) exhibited middle ear barotrauma. Dysfunction of the ET, characterized by altered active and passive opening capacity, was more prevalent following exposure to extremes in atmospheric pressure compared to baseline. The ET function, which was impaired after the first HBO treatment, improved gradually over the next 2 hours. Overall, however, ET function was worse after the seventh treatment. The patients who developed barotrauma exhibited worse ET function prior to hypobaric or hyperbaric exposure. Thus, abnormal ET function can be used to predict middle ear barotrauma prior to exposure to hypobaric or hyperbaric atmospheric pressure.

[Effect of variations in middle ear pressure on ruptures of the round window membrane of the inner ear of the guinea pig (Cavia porcellus)]. / Untersuchungen zum Einfluss von Mittelohrdruckschwankungen bei Rupturen der runden Fenstermembran auf das Innenohr des Meerschweinchens (Cavia porcellus).

The electrical activity of the inner ear before and after rupture of the round window membrane was monitored in guinea pigs under different pressure conditions with the aid of electrocochleography. Following studies were conducted weekly over a period of 4 weeks. Findings showed that overpressure below the pressure needed to open the Eustachian tube caused strong temporary functional disturbance of the cochlea, especially at high frequencies. Irreversible changes that were pressure-dependent were observed and occurred mainly at high frequencies. Application of low pressure to the round window membrane caused a functional loss comparable to changes after overpressure. Animals with a predamaged cochlea reacted to overpressure that was below opening pressure of the tube and to corresponding low pressure with a longer lasting functional loss than did animals with an undamaged cochlea.

Seasonal allergic rhinitis and its effects on eustachian tube function and middle ear pressure.

Middle ear pressure was recorded from 396 ears and aural symptoms inquired of 198 adult subjects with seasonal allergic rhinitis. Evidence of eustachian tube dysfunction was found in 24% of subjects. Increased duration of exposure to pollen over a further 2 weeks increased the incidence of eustachian tube dysfunction to 48%. The development of eustachian tube dysfunction did not correlate with the severity of nasal symptoms.

Nasal physiology and inflammatory mediators during natural pollen exposure.

Nasal allergen challenges in allergic rhinitis subjects provoke characteristic alterations in nasal and eustachian tube (ET) function. The purpose of this study was to examine the effect of natural pollen exposure on nasal physiology and inflammatory mediators. Grass pollen counts, ET function (sonotubometry), nasal resistance (rhinomanometry), symptoms, mediator levels (saline wash), and skin test reactivity in nine adults with grass allergy were monitored weekly before (week 1), during (weeks 2 to 9) and after (weeks 10 and 11) grass pollen season. Pollen counts peaked at week 3, and then decreased gradually. Mean nasal resistance (cm H2O/L/sec) increased from a baseline of 2.4 +/- 0.5 to 3.7 +/- 1.1 at week 3, peaked at week 4 (5.3 +/- 1.2), remained elevated (weeks 5-8), peaked again at week 9 (6.6 +/- 1.4), and then decreased, Bilateral ET obstruction was not present in any of the subjects at baseline, but was present in five of the nine subjects at week 4. Symptom severity paralleled grass pollen counts. Peak mediator levels were observed at weeks 2 and 9 for histamine and at weeks 3 and 10 for leukotriene C4. Seasonal increases in grass and histamine-induced wheal sizes were also observed. These data show that measurable changes in the function of the nose and ET and the levels of nasal mediators and dermal reactivity accompany and track pollen counts during seasonal exposure and suggest that therapy for seasonal allergic rhinitis should be (1) directed at reducing airway inflammation and (2) continued well beyond the time of peak pollen exposure.

Eustachian tube dysfunction in children with ragweed hayfever during natural pollen exposure.

The role of upper respiratory allergy in the pathogenesis of otitis media with effusion (OME) is an interesting but still unresolved issue. In order to investigate this further, fifteen children with ragweed hayfever were studied for the development of eustachian tube obstruction (ETO), utilizing the nine-step pressure-swallow test, prior to, during, and after seasonal exposure to ragweed pollen. Daily symptom-medication diaries were maintained and serial physical examinations were performed. ETO was found in 60% of the ragweed sensitive children during natural pollen exposure. The development of ETO was found to correlate with ragweed skin test wheal size and daily patient symptom-medication scores (SMS) during pollen exposure. Treatment of hayfever symptoms with pseudoephedrine and/or chlorpheniramine did not prevent most patients from developing ETO. Despite the prevalence of ETO in the study group, only one child developed evidence of middle ear effusion. These findings suggest that children with ragweed hayfever develop eustachian tube (ET) dysfunction during natural pollen exposure. Seasonal allergy induced ETO is not, however, by itself sufficient to produce middle ear effusion.

Eustachian tube function associated with histamine-induced and ragweed-induced rhinitis.

Nasal allergies may contribute to Eustachian tube dysfunction and chronic middle ear problems. In exploring this association further, Eustachian tube function was measured in ten ragweed-allergic and eight non-allergic patients undergoing repetitive nasal provocation. Anterior nasal provocation was done using paper disks impregnated with either histamine or aqueous ragweed allergen. Increasing concentrations of the provocative agent were placed on both inferior nasal turbinates until moderate symptoms of rhinitis developed. Eustachian tube function was evaluated using the 9-step inflation-deflation tympanometric test before and immediately after each nasal challenge. Eustachian obstruction developed in 4 of 38 non-allergic ears during histamine nasal provocation. With ragweed nasal challenge, 9 of 42 allergic ears developed Eustachian tube obstruction. Four allergic ears gained Eustachian tube function despite being obstructed before the challenge. The observed changes in ear function for both groups were not significant due to variability in Eustachian response. At the concentrations which initiated symptoms of rhinitis, nasal provocation with histamine or ragweed did not consistently obstruct the Eustachian tube. We conclude that mild symptoms of allergic rhinitis may not cause significant Eustachian tube obstruction.