Recent advances in otitis media. 2. Eustachian tube, middle ear, and mastoid anatomy; physiology, pathophysiology, and pathogenesis.
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Animals↗
Biomedical subjects
Samir N Ghadiali
Publications and source records attributed to Samir N Ghadiali.
On morphometric measurement of oxygen diffusing capacity in middle ear gas exchange.
An accurate mathematical model of transmucosal gas exchange is prerequisite to understanding middle ear (ME) physiology. Current models require experimentally measured gas species time constants for all extant conditions as input parameters. However, studies on pulmonary gas exchange have shown that a morphometric model that incorporates more fundamental physiochemical and anatomic parameters accurately simulates transport from which the species time constants can be derived for all extant conditions. Here, we implemented a variant of that model for ME gas exchange that requires the measurement of diffusional length (tau) for the ME mucosa. That measure contributes to the mucosal diffusing capacity and reflects the resistance to gas flow between air space and capillary. Two methods for measuring tau have been proposed: linear distance between the air-mucosal boundary and capillary and the harmonic mean of all contributing pathway lengths. Oxygen diffusing capacity was calculated for different ME mucosal geometries by using the two tau measures, and the results were compared with those predicted by a detailed, two-dimensional finite element analysis. Predictive accuracy was improved by incorporating the harmonic tau measure, which captures important information regarding variations in capillary shape and distribution. However, compared with the oxygen diffusing capacity derived from the finite element analysis, both measures yielded nonlinear, positively biased estimates. The morphometric techniques underestimate diffusion length by failing to account for the curvilinear gas flow pathways predicted by the finite element model.
Animals↗
Finite element analysis of active Eustachian tube function.
The inability to open the collapsible Eustachian tube (ET) has been related to the development of chronic otitis media. Although ET dysfunction may be due to anatomic and/or mechanical abnormalities, the precise mechanisms by which these structural properties alter ET opening phenomena have not been investigated. Previous investigations could only speculate on how these structural properties influence the tissue deformation processes responsible for ET opening. We have, therefore, developed a computational technique that can quantify these structure-function relationships. Cross-sectional histological images were obtained from eight normal adult human subjects, who had no history of middle ear disease. A midcartilaginous image from each subject was used to create two-dimensional finite element models of the soft tissue structures of the ET. ET opening phenomena were simulated by applying muscle forces on soft tissue surfaces in the appropriate direction and were quantified by calculating the resistance to flow (R(v)) in the opened lumen. A sensitivity analysis was conducted to determine the relative importance of muscle forces and soft-tissue elastic properties. Muscle contraction resulted in a medial-superior rotation of the medial lamina, stretching deformation in the Ostmann's fatty tissue, and lumen dilation. Variability in baseline R(v) values correlated with tissue size, whereas the functional relationship between R(v) and a given mechanical parameter was consistent in all subjects. ET opening was found to be highly sensitive to the applied muscle forces and relatively insensitive to cartilage elastic properties. These computational models have, therefore, identified how different tissue elements alter ET opening phenomena, which elements should be targeted for treatment, and the optimal mechanical properties of these tissue constructs.
Adolescent↗
Effect of tensor veli palatini muscle paralysis on eustachian tube mechanics.
Several physiological functions, such as regulating middle ear (ME) pressure and clearing ME fluid into the nasopharynx, require an opening of the collapsed eustachian tube (ET). The ability to perform these functions has been related to several mechanical properties of the ET: opening pressure (Popen), compliance (ETC), and hysteresis (eta). These global properties may be influenced by the mechanics of the surrounding tissue and/or the mucosa-air interface. In this study, we investigated the influence of tissue mechanics by paralyzing the right tensor veli palatini (TVP) muscle in 12 cynomolgus monkeys via botulinum toxin injection. A previously developed modified forced-response protocol was used to measure Popen, ETC, and eta under normal conditions and after muscle paralysis. The loss of muscle tone and/or stiffness resulted in a significant decrease in Popen (p < .01) and a significant increase in ETC (p < .01). In addition, muscle paralysis reduced the viscoelastic properties of the TVP muscle and therefore resulted in a significant decrease in eta (p < .05). A comparison with previous measurements on the influence of surface tension mechanics indicates that the ET's compliance is primarily determined by tissue elastic properties. The ET hysteresis, however, is equally affected by viscoelastic tissue properties and surface tension hysteretic properties. Knowledge of how these physical components affect the global mechanical environment may lead to improved treatments for ET dysfunction that target the underlying mechanical abnormality.
Acoustic Impedance Tests↗
Measurement of the viscoelastic compliance of the eustachian tube using a modified forced-response test.
OBJECTIVES: Eustachian tube compliance (ETC) was suggested to be an important determinate of function. Previous attempts to quantify ETC used summary measures that are not clearly related to the physical properties of the system. Here, we present a new method for measuring ETC that conforms more closely to the engineering definition of compliance. METHODS: The forced response test was modified to include oscillations in applied flow after the forced tubal opening. Pressure and flow were recorded during the standard and modified test in 12 anesthetized cynomolgus monkeys. The resulting pressure-flow, hysteresis loops were compared with those predicted by a simple fluid-structure model of the Eustachian tube with linear-elastic or viscoelastic properties. The tubal compliance index (TCI) and a viscoelastic compliance (C(v)) were calculated from these data for each monkey. RESULTS: The behavior of a viscoelastic, but not a linear elastic model accurately reproduced the experimental data for the monkey. The TCI and C(v) were linearly related, but the shared variance in these measures was only 63%. CONCLUSIONS: This new method for measuring ETC captures all information contained in the traditional TCI, but also provides information regarding the contribution of wall viscosity to Eustachian tube mechanics.
Animals↗
Model-based evaluation of eustachian tube mechanical properties using continuous pressure-flow rate data.
Eustachian tube (ET) dysfunction has been implicated in the development of chronic otitis media, a common childhood disorder. An impaired ability to open the collapsible ET results in fluid accumulation in the middle ear and subsequent infection and inflammation. Abnormal ET function has been casually related to an abnormal mechanical environment. Previous attempts to quantify ET mechanics used summary measures that are not clearly related to the physical properties of the system. In this study, we modified a testing technique to obtain pressure and flow rate measurements in the ET and analyzed these data with a simple model of airflow in a collapsible tube. This model is based on fully developed flow in a noncircular duct and a nonlinear, time-dependent pressure-area relationship. The ability of this model to capture the observed pressure-flow phenomena was demonstrated in 12 cynomolgus monkeys. Correlation between model and experimental data resulted in quantitative estimates of ET compliance and wall viscosity. This technique, which can be implemented in a clinical setting, provides a more accurate description of ET mechanics and may, therefore, prove to be an important diagnostic tool. Future studies will use this technique to quantify the influence of various physiological parameters on ET mechanics.
Animals↗
Effect of surface tension and surfactant administration on Eustachian tube mechanics.
Development of otitis media has been related to abnormal Eustachian tube (ET) mechanics. ET is a collapsible tube that is periodically opened to regulate middle ear pressure and to clear middle ear fluid into the nasopharynx. The ability to perform these physiological functions depends on several mechanical properties, including the ET's opening pressure (P(open)), compliance (ETC), and hysteresis (eta). In this study, a previously developed modified force-response protocol was used to determine ET mechanical properties after experimental manipulation of the mucosal surface condition. Specifically, these properties were measured in the right ear of six cynomologous monkeys under baseline conditions after "washing out" the normal ET mucous layer and after instillation of a pulmonary surfactant, Infasurf. Removal of the normal mucosa did not significantly alter P(open) but did result in a decrease in ETC and eta (P < 0.05). Treatment of the mucosa with Infasurf was effective in reducing P(open) and increasing both ETC and eta to baseline values (P < 0.05). These results indicate that the mucosa-air surface tension can affect the overall ETC and eta properties of the ET. In addition, this study indicates that surfactant therapy may only be beneficial in patients with rigid or inelastic ETs (large P(open) and low ETC and eta).
Animals↗