Concordance Analysis of the Pressure Chamber and Tubomanometer According to Estève for the Determination of Eustachian Tube Opening Pressure.

INTRODUCTION: For the diagnosis of Eustachian tube dysfunction (ETD), clinical procedures such as tympanometry, micro-otoscopy, and maneuvers according to Toynbee and Valsalva only allow an indirect assessment for the moment. With a prevalence of up to 5%, the selection of patients with ETD and its subtypes is clinically relevant. Dynamic methods of Eustachian tube function assessment include a hypo/hyperbaric pressure chamber and Estève's tubomanometer (TMM). One method of assessing ETD is the evaluation of Eustachian tube opening pressure (ETOP). MATERIAL AND METHODS: We performed a concordance analysis between pressure chamber and TMM to determine ETOP. For this purpose, we analyzed the measurements of both methods from 28 healthy subjects using Bland-Altman plots, regression according to Passing-Bablok and Lin's concordance correlations coefficient. The maximum tolerated clinical deviation of measured values was set at 10%. RESULTS: A maximum of 53 measurements of ETOP between pressure chamber and TMM were compared. Mean ETOP for TMM was 28.7 hPa, passive opening was 32 hPa, Toynbee maneuver was 28.4 hPa, and Valsalva maneuver was 54.6 hPa. Concordance analysis revealed following results: passive opening versus TMM: Bland-Altman mean difference 3.3 hPa, limits of agreement ±31.8 hPa; Passing-Bablok regression y = 0.67 x + 9.36; Lin's rccc = 0.18. Toynbee versus TMM: Bland-Altman mean difference 0.7 hPa, limits of agreement ±35.8 hPa; Passing-Bablok regression y = 0.47x + 14.03; Lin's rccc = 0.14. Valsalva versus TMM: Bland-Altman mean difference 24.2 hPa, limits of agreement ±117.5 hPa; Passing-Bablok regression y = 0.17x + 25.12; Lin's rccc = 0.18. CONCLUSION: Estève's tubomanometer and pressure chamber measurements of ETOP are not concordant. The two methods cannot be interchanged without reservation.

[Results of a nationwide survey on the treatment of salivary gland diseases in German hospitals]. / Ergebnisse einer deutschlandweiten Umfrage zur Behandlung von Speicheldrüsenerkrankungen im Krankenhaus.

BACKGROUND: Salivary gland diseases are an important part of the work of ENT physicians in hospitals. The treatment strategies depend, among other things, on the doctrine at the respective location. OBJECTIVE: The aim of this questionnaire-based study was to assess the current diagnostic workup and therapeutic strategies for salivary gland diseases in German otorhinolaryngology departments. MATERIALS AND METHODS: A survey was performed using a 25-question online questionnaire sent to all German otorhinolaryngology department directors. RESULTS: The questionnaire was answered by 92 of 175 otorhinolaryngology departments (52.6%). In the diagnosis of salivary gland tumors, a dominance of sonography and MRI was shown. Fine- and core-needle aspiration were not performed by more than 50% of the clinics. The dominant technique for parotidectomy was under microscopic control (82%). In 99% of clinics, EMG was used during resection of the parotid gland for intraoperative monitoring of the facial nerve. There was a trend towards performing partial parotidectomies (85%), lateral parotidectomies (70%), and extracapsular dissections (57%) for benign tumors of the parotid gland. The treatment concepts for malignant tumors were inconsistent. CONCLUSION: In particular, the treatment strategy and extent of surgery for benign and malignant salivary gland tumors differed depending on location. The choice of palliative (drug) therapy was also diverse. Prospective multicenter studies could help to develop evidence-based treatment strategies.

Prospective study on the Eustachian tube function during Frenzel maneuver in a hypobaric/hyperbaric pressure chamber.

INTRODUCTION: The Frenzel maneuver describes a technique for middle ear equalizing which is frequently used by apnea divers. It offers advantages compared to the most commonly used techniques such as the Valsalva or Toynbee maneuver. Until now, there is insufficient literature about the pressure dynamics and Eustachian tube (ET) function during the Frenzel maneuver. The aim of the present study was to characterize the ET function during the Frenzel maneuver. MATERIALS AND METHODS: By means of an established standardized profile of compression and decompression in a hypo/hyperbaric pressure chamber, we examined different parameters such as the ET opening pressure (ETOP), ET opening duration (ETOD), and ET opening frequency (ETOF) in 11 experienced apnea divers and compared them to the parameters during the Valsalva and Toynbee maneuver. RESULTS: Standard values for ETOP, ETOD, and ETOF could be established for the Frenzel maneuver under standardized conditions in a hypo/hyperbaric pressure chamber. Compared to the Frenzel maneuver, ETOP was higher and ETOD longer (both p < 0.001) during the Valsalva maneuver whereas ETOP was lower and ETOD shorter (both p < 0.001) during the Toynbee maneuver. No difference regarding ETOF was observed between the Frenzel, Valsalva, and Toynbee maneuver. DISCUSSION: The Frenzel maneuver was shown to be at least as effective as the Valsalva maneuver concerning ET opening. We believe that knowledge of the Frenzel technique might facilitate the pressure equalization during diving and recommend implementation of an appropriate equalization training in apnea and scuba diving education.

Survival after parotid gland metastases of cutaneous squamous cell carcinoma of the head and neck.

PURPOSE: Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous cell carcinomas (CSCC) of the head and neck area. The aim of this study was to analyse and compare the clinical behaviour of primary as well as CSCC metastatic parotid cancers with special emphasis on therapy and oncologic outcome. METHODS: Clinical and histopathological data of 342 patients with parotid gland malignomas surgically treated in a tertiary referral centre between 1987 and 2015 were retrospectively assessed. Oncologic outcomes of all cases with CSCC metastasis of the parotid gland (n = 49) were compared to those of primary parotid gland carcinomas (n = 293). RESULTS: Mean age at diagnosis was 72.3 years for CSCC patients versus 56.8 years in patients with primary parotid carcinoma. A total of 83.7% of CSCC patients were male, compared to 48.8% in the group of primary carcinomas. Forty-five out of 49 CSCC patients underwent total parotidectomy and neck dissection (91.8%). A total of 93.9% out of all CSCC patients received adjuvant radiotherapy. Five-year overall survival (OS) was 32.6% in CSCC patients versus 77.2% in primary parotid carcinoma patients. CONCLUSION: As compared to primary parotid cancers, we could show that patients suffering from CSCC metastases to the parotid gland presented with significantly higher age and worse survival.

Subjective and Objective Effectiveness of Eustachian Tube Balloon Dilatation for Patients With Eustachian Tube Dysfunction-Evaluation in a Pressure Chamber.

INTRODUCTION: The Eustachian tube plays a crucial role in pressure equalization between the middle ear and ambient pressure for fast and large pressure differences. In patients with chronic Eustachian tube dysfunction, Eustachian tube balloon dilatation is increasingly used as surgical therapy. Subjectively, many patients report an improvement of the symptoms postoperatively. Hence, there is a need to objectively measure this effect. METHODS: The objectivity of Eustachian tube balloon dilatation was evaluated using a precise method of measuring Eustachian tube function. In a hypo/hyperbaric pressure chamber, 23 ears in 13 patients were exposed to a standardized profile of compression and decompression before Eustachian tube balloon dilatation and 4 weeks afterwards. Standardized parameters of Eustachian tube function were determined and statistically compared before and 4 weeks after intervention. In addition, an Eustachian Tube Dysfunction Questionnaire-7 (ETDQ7) questionnaire was completed beforehand and 4 weeks postoperatively to determine subjective surgical success. RESULTS: The results from the ETDQ7 questionnaire showed a significant improvement in symptoms after Eustachian tube balloon dilatation (p = 0.0002). Objective measurements results showed a significant reduction of the Eustachian tube opening pressure during pressure decrease 4 weeks after intervention (p = 0.0012). CONCLUSION: Eustachian tube balloon dilatation significantly reduced Eustachian tube opening pressure, in addition to subjective improvement of symptoms determined by ETDQ7.

Repetitive freshwater diving: risk factors and prevalence of barotrauma.

OBJECTIVE: The aim was to investigate the influence of repetitive scuba diving in fresh water on the middle ear mucosa. The prevalence of middle ear barotrauma (MEB) and risk factors for MEB were evaluated. STUDY DESIGN: Prospective cohort study, Level of evidence 1b. METHODS: During three days, 23 divers made 144 repetitive dives in a freshwater lake. Participants underwent otoscopic examinations and were questioned about ENT-related complaints in the morning before the first dive, in between the dives and after the last dive. Otoscopic findings were documented and classified according to the TEED scale (0 = normal eardrum to 4 = perforation), for the right and the left ear separately. RESULTS: In total, 416 examinations were performed. ENT-related complaints during diving, mostly failed pressure equalization (74%), were reported after 10% of all dives. Most common pathology was MEB (TEED 1-3, 26%). Valsalva maneuver was possible during all exams. Significant increase of MEB (TEED⟩0) occurred with an increasing cumulative number of dives per day (P ⟨ .0001). Diving depth significantly influenced the MEB distribution (P = .035). MEB with higher TEED levels (2 and 3) was present only in the less experienced and intermediate divers. With increasing TEED level, more participants reported ENT-related problems (P ⟨ .0001). However, 74.4% of divers with MEB were still asymptomatic. CONCLUSION: During three days of diving, the MEB prevalence increased with a cumulative number of dives per day. The major risk factors were diving depth and diving experience. Higher TEED level correlated with an increasing number of subjective ENT-related disorders during diving.

Prevalence of Barotrauma in Recreational Scuba Divers After Repetitive Saltwater Dives.

INTRODUCTION: The aim was to investigate the prevalence of middle ear barotrauma (MEB) and to establish risk factors of MEB after repeated saltwater dives. METHODS: In this prospective observational cohort study 28 divers were examined over 6 consecutive days of diving in the Red Sea, Egypt. Participants underwent an otoscopic examination before the first dive, between each dive and after the last dive. In addition, they performed Valsalva maneuver (VM) and were questioned about dive-related complaints. Otoscopic findings were classified according to TEED classification for MEB (0 = normal otoscopy to 4 = perforation) separately for each ear. First examination was conducted before the first dive. Final examination, including a questionnaire, was conducted at least 12 h after the last dive. RESULTS: In total, 436 dives were performed and 1161 otoscopic findings were analyzed. All participants showed a normal eardrum and a positive VM during initial exam. MEB prevalence (TEED >0) was 36.5% at final examination. Prevalence increased significantly with number of dives per day (p < 0.001) as with number of diving days (p = 0.032). Neither depth nor duration of dives significantly influenced MEB prevalence (all p > 0.05). More experienced divers (>200 dives lifetime) showed significantly less barotrauma (p < 0.0001). Despite the high prevalence of MEB, 81.7% (316 of 387) of all dives were reported asymptomatic. CONCLUSIONS: After 6 days of repetitive diving, MEB prevalence was high (36.5%). It was the most often cause of otalgia in divers. Cumulative pressure exposure during repetitive dives resulted in significant increase of MEB. Diving experience significantly reduced the MEB prevalence. Interestingly, the severity of MEB did not correlate with subjective complaints.

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.

Is there a difference between active opening of the Eustachian tube in a hypobaric surrounding compared to a hyperbaric surrounding?

INTRODUCTION: The Eustachian tube (ET) is the key to pressure equalization between the middle ear and ambient pressure. To date, little is known about differences of the opening mechanisms under hyper- or hypobaric conditions. Aim of this study was to compare standard ET opening parameters during standardized hypo- and hyperbaric exposures. METHODS: Thirty healthy participants were exposed to a standardized profile of decompression and compression (SPDC) in a hypo-/hyperbaric pressure chamber. Impedance, expressed as tympanic membrane compliance, was recorded at intervals during the excursions from 1 atmosphere absolute (atm abs) to 0.8 and 1.2 atm abs respectively. Parameters for tubal opening were obtained during SPDC: ET opening pressure (ETOP), ET opening duration (ETOD) and ET opening frequency (ETOF), hypobaric (Phase 1) and hyperbaric (Phase 2) data were compared. RESULTS: Mean value for Valsalva maneuver ETOP was 40.10 ± 19.02 mbar in Phase 2 vs. 42.82 ± 21.75 mbar in Phase 1. For ETOD it was 2.80 ± 2.09 seconds in Phase 2 vs. 2.51 ± 1.90 seconds in Phase 1. For swallowing, mean value for ETOP was 33.47 ± 14.50 mbar in Phase 2 vs. 28.44 ± 14.04 in Phase 1. ETOD was 0.82 ± 0.60 seconds in Phase 2 vs. 0.76 ± 0.55 seconds in Phase 1. There was no statistical significance for ETOP, ETOD and ETOF between the two phases. CONCLUSION: No statistical significant difference was evident for active pressure equalization (Valsalva and swallowing) between a hyperbaric setting (dive) and a hypobaric setting (flight) in healthy subjects.

Treatment of chronic recurrent juvenile parotitis using sialendoscopy.

CONCLUSION: The combination of sialendoscopy and an intraductal application of corticosteroids can be recommended for children with chronic recurrent juvenile parotitis (CRJP) as there is growing evidence for a positive effect in the absence of side effects. OBJECTIVE: CRJP is a disorder with painful, episodic swelling of the parotid gland in children. The majority of cases have a self-limiting character within 5-10 years, but the disease may also continue into adulthood. CRJP can occur on one or both sides and up to now the etiology has been unclear. The aim of this study was to analyze the therapeutic effect of a sialendoscopic application of corticosteroids on the clinical course of patients with CRJP. METHODS: We retrospectively analyzed the clinical course of 9 children with 10 parotid glands affected by CRJP, who all underwent sialendoscopy and intraductal application of corticosteroids. In all cases the procedure was conducted under general anesthesia. The average follow-up period was 15 months. RESULTS: There were no side effects associated with the sialendoscopy. All duct systems showed signs of chronic inflammation with an atrophic or thickened epithelium. At the follow-up visit, CRJP symptoms had completely resolved in eight children. One child still showed slight parotid swellings without the need for antibiotics. None of the parents reported that symptoms had continued at an equal level or worsened after sialendoscopy.