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.

Restoring middle ear pressure equalization in divers by laser Eustachian tuboplasty.

INTRODUCTION: Impaired Eustachian tube function can limit one's fitness to dive. This study investigated the effect of minimally invasive laser Eustachian tuboplasty (laser tuboplasty) on tube function in divers and its long-term effect on their diving habits. METHODS: In a prospective surgical trial in nine divers with tubal dysfunction, laser tuboplasty was performed and the results were controlled pre- and postoperatively with impedance measurement in a pressure chamber. MAIN OUTCOME MEASURE: Tube function was analyzed pre- and postoperatively by pressure chamber and standard clinical tests. Eustachian tube closing pressure was evaluated as a measure of tissue pressure. With severely impaired Eustachian tube function a "blocked" pattern was evident, and no measurement of closing pressure was possible. All divers were interviewed four years postoperatively for their diving habits. RESULTS: Before laser tuboplasty, five divers showed a blocked pattern in pressure chamber testing. However, in four of them a normal opening pattern was restored postoperatively. Closing pressure was reduced from 7.40 +/- 1.52 mbar (0.74 +/- 0.152 kPa) to 2.85 +/- 1.11 mbar (p < 0.005). In the long term, all subjects reported a restored ability for pressure equalization, and seven of nine were diving again. CONCLUSION: Divers with tubal dysfuction seem to benefit from the minimally invasive laser tuboplasty.

Pressure regulating ear plug testing in a pressure chamber.

INTRODUCTION: Middle ear barotrauma is a condition frequently associated with flying. It is usually caused by Eustachian tube (ET) dysfunction. Pressure-regulating earplugs (PREP) should improve complaints due to pressure equalization problems. METHODS: There were 21 patients with a history of pressure equalization problems while flying who were examined. ET function was measured with exploratory tests and in a pressure chamber. In a double-blind study, PREP were examined using continuous impedance measurement in the pressure chamber. Eardrum deflection and pressure-equalizing maneuvers were also examined. During pressure exposure the subjective state of patients with and without PREP was compared. RESULTS: Evidence of ET dysfunction was found in twice as many patients with the impedance method in a pressure chamber compared to tympanometry or the Valsalva test. Use of PREP reduced the rate of pressure changes in the external auditory canal. Maximum pressure was reached with a delay of about 7 min. The number of pressure-equalizing maneuvers did not differ significantly. Using PREP the patients reported a significantly better subjective state on the VAS scale of 2.19 +/- 1.50 compared to 3.38 +/- 2.33 without PREP. CONCLUSIONS: Continuous impedance measurements in the pressure chamber identified ET dysfunction more often than the exploratory ET function tests commonly used in routine diagnostics. This novel finding requires further validation. Although use of PREP showed no signs of improving ET function, it did significantly improve individual subjective state during sudden pressure changes.

Medial and mediolateral orbital decompression in intractable Graves' Orbitopathy.

OBJECTIVE: Graves' Orbitopathy (GO) has well established treatment guidelines; however, its management is still controversial. The aim was to evaluate the results of medial and mediolateral orbital decompression (OD) in intractable GO. METHODS: Retrospective chart review of all patients with advanced stages of GO, who underwent medial (1-wall) or mediolateral (2-wall) OD between May 2012 and November 2014 in our institution. Ophthalmologic examinations included visual acuity, Hertel exophthalmometry (proptosis), intraocular pressure (IOP), visual field (30:2) and diplopia. Follow-up was performed 1 week, 3 months and 1 year postoperatively. Additionally, a questionnaire was used to investigate subjective benefits. RESULTS: The study included 34 eyes of 20 patients. In our study, GO patients who underwent mediolateral OD had significantly higher IOP preoperatively (p<0.05) and lower visual acuity, proptosis and visual field compared with patients who underwent medial OD. After 1- and 2-wall OD, visual acuity, proptosis, visual field and IOP in upgaze improved significantly. Using a questionnaire, the patients reported significant improvements in impaired vision, eye pain and pressure, vitality and social life. 94% of all patients reported they would repeat the operation. After 2-wall OD, the surgical scar had little effect. CONCLUSION: With GO patients in advanced stages, both medial (1-wall) and mediolateral (2-wall) OD procedures are convincing therapeutic options. In more advanced GO stages with high IOP, 2-wall OD should be prioritized, as mediolateral OD had superior long-term functional outcomes.

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.

Multiple craniocervical chordomas presenting as a parapharyngeal mass.

BACKGROUND: Chordomas are malignant neoplasms of the axial skeleton that have rarely been seen in the cervical area. METHODS: A 55-year-old woman presented to our department with a history of a left cervical mass protruding into the throat with the symptoms of dysphagia and hoarseness. RESULTS: The radiological examination revealed 3 polycyclic masses in the neck, 2 on the left side and 1 small mass on the right side. After the neurosurgical excision of the intraspinal parts of the tumor, we performed the surgical resection of the cervical tumors via a lateral collotomy. The histological examination showed a chordoma. Because of the advanced stage of the tumor, a postoperative radiotherapy was performed. CONCLUSIONS: Meticulous radiological workup is essential in order to identify the exact extension of the tumor and to reveal possible multifocal lesions. The current literature and treatment recommendations for this rare tumor at this localization are discussed.

Laser Eustachian tuboplasty: efficiency evaluation in the pressure chamber.

OBJECTIVE: Laser Eustachian tuboplasty (LETP) with ablation of the epipharyngeal orifice of the Eustachian tube (ET) shows good results in clinical observation. However, to this day, there are no reports evaluating the surgical procedure with valid test methods. The purpose of this study was to test the effect of minimally invasive LETP by means of a pressure chamber ET function test. STUDY DESIGN: Prospective surgical trial. SETTING: Tertiary and university hospital. PATIENTS: Thirty patients with a history of ET dysfunction during pressure changes were examined. INTERVENTION: Minimally invasive LETP was performed with an 812-nm diode laser under local anesthesia as an outpatient procedure. MAIN OUTCOME MEASURE: The ET function was tested preoperatively and postoperatively by pressure chamber ET function test. Eustachian tube closing pressure (ETCP) was evaluated as a measure of the tissue pressure of the ET. In cases of a severely impaired ET function, a "blocked" pattern was evident, and no measurement of ETCP was possible. RESULTS: Before minimally invasive LETP, 17 patients showed a completely blocked pattern. Postoperatively, 13 patients of this group showed an improved ET function with a restored normal opening pattern (p < 0.001). The ETCP was reduced from 6.24 ± 3.46 mbar preoperatively to 4.06 ± 2.36 mbar postoperatively (p < 0.013). CONCLUSION: The results strongly indicate that the effect of minimally invasive LETP can be proven by measuring the ET function in a pressure chamber. Results must be interpreted in combination with clinical methods like Valsalva maneuver and tympanometry. Patients with ET dysfunction during pressure changes seem to benefit from the minimally invasive LETP.