Resultados de la dilatación de la trompa de Eustaquio en adultos con disfunción tubárica crónica / Results of Eustaquian tube dilation in adults with chronic tubal disfunction

Introducción: la dilatación endoscópica con balón ha mostrado ser una herramienta terapéutica y efectiva para el tratamiento de la disfunción de la trompa de Eustaquio. Al momento se desconocen los resultados en la población colombiana. Objetivos: determinar la mejoría clínica de la dilatación de la trompa de Eustaquio en pacientes adultos con disfunción tubárica crónica, en un centro de IV nivel de atención en Bogotá. Diseño: estudio observacional retrospectivo con componente analítico. Métodos: se revisaron los registros clínicos de pacientes intervenidos con la dilatación endoscópica de la trompa de Eustaquio; se describen los cambios objetivos y subjetivos en el posoperatorio. Resultados: se obtuvieron 22 pacientes entre los 18 y 66 años con seguimiento de 6 a 22 meses. Al 84,5 % se les realizó la intervención bilateral y al 15,8 % la unilateral, para un total de 38 oídos intervenidos. El 60 % lograron la normalización del timpanograma. Hubo una mejoría de las presiones del oído medio de -102,5 a -3,5 daPa (p = 0,005). Se alcanzó una mejoría estadísticamente significativa en 6/7 síntomas según la escala de severidad y reducción del gap aéreo-óseo en 7 dB y 4 dB del promedio de tonos puros por vía aérea (PTA) (p = 0,249; p = 0,711). Además, se generó un impacto positivo promedio de +32 en la escala de calidad de vida según el Glasgow Benefit Inventory (GBI). Conclusión: la dilatación de trompa de Eustaquio resulta ser una terapéutica segura y eficaz en población adulta, con mejoras estadísticamente significativas en la severidad de los síntomas y en las presiones del oído medio, lo cual genera un impacto positivo en la escala de calidad de vida según el GBI.

Introduction: Endoscopic balloon dilation has been shown to be a therapeutic and effective tool for the treatment of eustachian tube dysfunction. Now, the results in the Colombian population are unknown. Aim: Describe the clinical improvement of eustachian tube dilation in adult patients with chronic tubal dysfunction, in a 4th level complexity hospital in Bogotá. Design: Retrospective observational study with analytical component. Methods: The clinical records of patients undergoing endoscopic dilatation of the Eustachian tube were reviewed. Objective and subjective changes in the postoperative period are described. Results: 22 patients were obtained between 18 and 66 years and follow-up from 6 to 22 months. 84.5 % underwent bilateral intervention and 15.8 % unilaterally for a total of 38 operated ears. 60 % achieved tympanogram normalization. There was improvement of middle ear pressures from -102.5 to -3.5 daPa (p = 0.005). Statistically significant improvement in 6/7 symptoms according to the severity scale and reduction of air-bone Gap in 7 dB and 4 dB of airway PTA (p = 0.249; p = 0.711). Generating an average positive impact of +32 on the quality-of-life scale according to the Glasgow Benefit Inventory (GBI). Conclusions: Eustachian tube dilation proves to be a safe and effective therapy in an adult population with statistically significant improvements in the severity of symptoms, and in middle ear pressures. Generating a positive impact on the scale of quality of life according to the GBI.

Otitis Media: Long-Term Effect on Central Auditory Nervous System.

OBJECTIVES: To analyze the central auditory nervous system function through behavioral and electrophysiological tests in children with a history of otitis media and subsequent bilateral tubes placement surgery. METHODS: The participants were divided into two groups between eight and 14 years old: control group (CG) consisted of 40 children with no history of otitis media; experimental group (EG) consisted of 50 children with documented history of otitis media and undertook a surgery for bilateral tubes placement. All children completed audiological evaluation (audiometry, speech audiometry, and immittance audiometry), behavioral evaluation (tests: dichotic digits, synthetic sentence identification with ipsilateral competing message, gaps-in-noise, frequency pattern), and electrophysiological evaluation (Auditory Brainstem Response, ABR, Frequency Following Response, FFR (verbal), and Long Latency Auditory Evoked Potential, LLAEP). RESULTS: The EG group showed significantly poorer performance (p<0.001) than the CG for all auditory abilities studied. The results revealed significant latency delays and reduced amplitude (p<0.05) of waves III and V for ABR; significant latency delay was seen of potentials P2, N2, and P300 for LLAEP; significant latency delays and reduced amplitude (p<0.05) were observed for FFR in children with a history of otitis media. CONCLUSION: The results demonstrate negative effect of otitis media in the auditory abilities and electrophysiological measures in children with a history of otitis media.

Curvature inversion technique: a novel tuboplastic technique for patulous Eustachian tube--a preliminary report.

OBJECTIVE: To assess the laser-assisted curvature inversion technique for the treatment of patients with patulous Eustachian tube (PET). STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: Eleven patients with Eustachian tube dysfunction underwent laser-assisted curvature inversion technique (CIT) of the medial and lateral lamina of the Eustachian tube. A KTP laser is used to cross-hatch the medial and lateral lamina of the tube to modify the curvature and to alter the spring of the posterior cushion. A change in the direction of the cartilaginous structure curvature is created to promote full closure of the patulous gap without interfering with the tube's muscular activity. None of the patients had any concurrent disease or additional surgical procedure. RESULTS: There were no surgical complications. Following CIT, subjective symptoms of autophony on nasal breathing improved in 9 of 11 patients (81.8%), while voice autophony improved in 8 patients (72.7%); posterior cushion curvature became inverted and less wide, and the valve was seen more closed postoperatively on simple endoscopy and slow-motion video-endoscopic analysis. On otoscopy, abnormal tympanic membrane excursions disappeared in 10 of 11 patients (90.9%). Mean immittance changes in tympanometric measurements for the forced respiration conditions improved postoperatively at least 0.05 mmhos in 9 of 11 patients (81.1%; P = .015). The follow-up period was 24 months. CONCLUSION: CIT appears to be a promising and relatively feasible technique for the treatment of PET.

Cross-hatching: a novel technique for Eustachian tuboplasty. Preliminary report.

OBJECTIVE: To evaluate laser-assisted cross-hatching technique for treatment of patients with Eustachian tube dysfunction. STUDY DESIGN: Prospective, institutional review board-approved surgical trial. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: A total of 25 patients with Eustachian tube dysfunction underwent laser Eustachian tuboplasty with cross-hatching technique (CHT). Surgery involved use of the argon laser to cross-hatch the posterior cushion to modify the curvature of the cartilage of the posterior cushion and to alter the spring of the cartilage to make it wider and larger, thereby alleviating the obstructive dysfunction of the tube. None of the patients had any concurrent disease or surgical procedure. RESULTS: There were no surgical complications. Following CHT, subjective symptoms of an ear blockage improved in 23 of 25 (92%) patients. Posterior cushion curvature became softer and wider, and the valve appeared more open postoperatively on simple endoscopy (SE) and slow motion video endoscopic analysis (SMVEA). Mean pure-tone average improved by 10 dB (30 dB preoperatively vs 20 dB postoperatively; P = 0.015). Abnormal tympanogram improved in 24 of 25 (96%) patients. Failure of the procedure correlated with severity of cartilage deformation and valve obstruction as measured by both SE and SMVEA. Mean follow-up was 15 months (range 3-37 months). CONCLUSION: Cross-hatching technique for Eustachian tuboplasty appears to be a safe and useful technique for treatment of Eustachian tube dysfunction.

Actualización en disfunción tubaria: rol de la endoscopía nasal en su evaluación y tratamiento / Auditory tube dysfunction update: role of nasal endoscopy in its evaluation and treatment

La disfunción tubaria es uno de las patologías más estudiadas como responsable de diversas afecciones del oído medio. Dentro de sus factores causales se ha postulado un potencial rol de la rinitis alérgica, el reflujo gastrolaríngeo y la exposición a humo de tabaco, lo cual no ha podido ser comprobado consistentemente en estudios clínicos. En los últimos años, la endoscopía del extremo nasofaríngeo de la trompa de Eustaquio ha surgido como una nueva herramienta para evaluar el funcionamiento de esta estructura. Es así como el uso de cámara lenta ha podido mostrar que la mayoría de sus alteraciones parecen ser funcionales más que anatómicas u obstructivas. Por otra parte, esta evaluación endoscópica ha fomentado el desarrollo de nuevas técnicas quirúrgicas, basadas en la resección del colchón posterior del torus tubario mediante el uso del láser o microdebridador De este modo, en un futuro la endoscopía nasal pudiera tener un rol importante en la evaluación y manejo de la disfunción tubaria. Sin embargo, todavía no se establecen los candidatos ideales para dichos procedimientos.

Auditory tube dysfunction is one of the most studied middie ear diseases. Among its proposed risk factors, the etiologic role of allergic rhinitis, gastrolaryngeal reflux and tobacco smoke has not been demonstrated yet in clinical trials. In the last few years, endoscopic visualization of the nasopharyngeal end of the auditory tube became a new tool to evaluate this structure, particularly in association to slow motion video recordings. These techniques have shown that in most cases, the alterations seem to be functional rather than anatomic or obstructive. In addition, endoscopic evaluation has encouraged the development of new surgical techniques based on the resection of the posterior cushion of the torus tubarius, with the use of a laser or a microdebrider In the future, nasal endoscopy could have an important role in the evaluation and management of auditory tube dysfunction. However, the ideal candidates for these procedures are yet to be established.

Estudo das funçöes equipressiva e de drenagem da tuba auditiva e sua correlaçäo com resultados cirúrgicos de miringoplastia / Equipressive and drainage function study of the auditive tube and their relation with myringoplasty surgical results

O sucesso da miringoplastia depende, entre outros fatores, da funçäo da tuba auditiva. Neste estudo, avalia-se a funçäo tubária em trinta doentes portadores de otite média crônica simples com indicaçäo de miringoplastia, pré-operatoriamente, para verificar a relaçäo entre funçäo tubária e resultados cirúrgicos. A funçäo equipressiva é avaliada através da prova de insuflaçäo e desinsuflaçäo, e a funçäo de drenagem através da instilaçäo de técnico na orelha média. A prova de desinsuflaçäo é o melhor teste de funçäo tubária empregado neste estudo. Mas a disfunçäo tubária näo contra-indica a cirurgia, pois nem todos os doentes com disfunçäo nesta prova tiveram maus resultados cirúrgicos

Avaliaçäo da orelha média de ratos pós-eletrocauterizaçäo da tuba auditiva / Evaluation of rats middle ear post electrocauterization of auditive tube

Esse estudo analisou as alteraçöes otoscópicas e histopatológicas das orelhas médias de ratos albinos submetidos à eletrocauterizaçäo do óstio nasofaríngeo tubário. Por uma técnica pouco invasiva e de fácil realizaçäo, a otoscopia demonstrou ser de importância fundamental na seleçäo prévia dos animais a serem utilizados e no acompanhamento seriado das alteraçöes induzidas. A análise histopatológica ressaltou que três dias após a cauterizaçäo, o principal sinal observado foi a transudaçäo dos vasos submucosos. Maiores alteraçöes foram observados de sete a 60 dias pós-cauterizaçäo, decorrentes da infecçäo e da açäo dos mecanismos de defesa