[Physiology and physiopathology of middle ear ventilation. I. Middle ear volume and its gas content. Physiology of the eustachian tube].
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Long-term middle ear ventilation.
Successful long-term middle ear ventilation was established in 12 patients with chronic eustachian tube hypofunction that had failed to respond to repeated myringotomy and tympanotomy tube insertions by conventional techniques. The 12 patients (13 ears) had insertion of an untrimmed large flange "Per-Lee" type tube through a posterior-inferior tympanomeatal flap approach. The flange extended under the long process of the malleus, and into the hypotympanum and middle ear opening of the eustachian tube. The stem of the tube was brought out through the inferior central pars tensa. All tubes have remained in place for more than three years without serious complications providing adequate middle ear ventilation and preventing adherence of the tympanic membrane to the promontory.
Adolescent↗
Effects of middle ear ventilation on cholesteatoma development in experimental animals.
This study was designed to evaluate the effect of middle ear ventilation on cholesteatoma formation following propylene glycol application in experimental animals. Fifteen chinchillas had stainless steel ventilation tubes chronically implanted in their bullae and 60% propylene glycol was subsequently instilled into the middle ear cavities. The animals were kept alive for 4 weeks, during which time the middle ear pressure was monitored tympanometrically and the tubes were frequently inspected to verify patency. Of the 30 ears in the study, 20 (66.6%) developed middle ear cholesteatoma--a rate of occurrence comparable to that found in earlier studies in which middle ear ventilation was not provided. These results indicate that negative middle ear pressure is not a necessary factor for cholesteatoma development following application of chemical irritants in experimental animals.
Animals↗
Middle ear ventilation mechanism.
The ventilation mechanism of the middle ear is very important as regards the pathogenesis of middle ear disease, but its mode of function is still obscure. Therefore, we tried to measure the ventilation and clearance of the middle ear using radio-isotope imaging techniques and 133Xe in order to gain a clearer picture of the ventilation mechanism. In normal Eustachian tube cases, approximately 10% of the initially insufflated gas immediately entered into the middle ear cavity and mastoid air cells. The gas introduced into the middle ear diminished at a rate of 8% of volume per hour in the normal resting state. Two hours after the first procedure, air was insufflated, and gas volume in the middle ear cavity immediately diminished by 30%. In stenotic tube cases, it proved difficult to insufflate the gas into the middle ear, however, its diminishing rate with the passage of time was slightly faster than in normal tube cases. From this data, it was evident that air could easily and quickly enter into even the periphery of the mastoid air cells by insufflation via the Eustachian tube, despite the fact that the middle ear and mastoid air cells form a closed cavity. In the resting state, moreover, the air in the middle ear was thought to be absorbed mainly into the middle ear mucosa at a regular rate. It was confirmed that the insufflation procedure as a therapy for tubal stenosis and OME is very useful for the ventilation of the middle ear.
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A clinical evaluation of gold-plated tubes for middle-ear ventilation.
Gold-plated tympanostomy tubes have been recently marketed as possessing qualities making them ideal for middle-ear ventilation. The performance of these tubes was compared with that of similarly designed Teflon tubes in a controlled, prospective study. Twenty-eight children underwent bilateral myringotomy and tube placement. One ear was randomly chosen for intubation with a gold-plated tube, and a Teflon tube was inserted into the other ear. Patients were examined monthly for 12 months and evaluated for otorrhea, tube occlusion, and early tube extrusion. Although the incidence of otorrhea and tube occlusion were higher for the gold-plated tube, these differences were not statistically significant. The gold-plated tube had a significantly higher rate of early extrusion than the Teflon tube. Based on these findings, there appears to be no advantage to using gold-plated tubes for middle-ear ventilation.
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Swimming unprotected with long-shafted middle ear ventilation tubes.
Patients, parents, and physicians are all concerned about the risks of swimming unprotected with middle ear ventilation tubes. The risks have not previously been carefully quantified or correlated with the degree of swimming activity. In this study, 53 children with tympanometrically proven patent long-shafted tubes were allowed to swim unprotected. They suffered six middle ear infections that were clearly caused by swimming. Five of these infections occurred in divers. The rate of infections for divers was approximately one per 100 days of swimming activity. The rate for non-divers was approximately one per 600 days. Unprotected swimming was well accepted by almost all parents and patients. The need for earplugs for all children who swim with long-shafted ventilation tubes is questioned.
Child↗
Otorrhoea in children with middle ear ventilation tubes: a comparison of different types of tubes.
Otorrhoea is a troublesome complication of middle ear ventilation tubes. This investigation of children with various ventilation tubes shows that the incidence of this complication varies with the type of tube used. In particular, Paparella type 2 tubes are associated with a higher rate of otorrhoea, and should be reserved for use when long-term ventilation is necessary.
Adolescent↗
Results of middle ear ventilation with Goode's tubes.
The results of a retrospective study of the effect and outcome of middle ear ventilation by Goode's tubes are presented. 83 ears from 50 patients were analyzed both as a group and in age-related sub-groups over a mean follow-up period of 1.83 years. The mean period of ventilation by Goode's tubes before removal or extrusion was 18.4 months. The tubes became infected in 70.4% and were spontaneously extruded in 44.9% of patients. Permanent perforation of the tympanic membrane ensued in 47.5% of patients and significantly more often in those aged between 10 and 20 years (P less than 0.002). Patients aged less than 10 years were significantly less likely to develop a retraction of their tympanic membranes after removal of the Goode's tube than those older (P less than 0.02). No significant relationship was found between the development of these complications and the period of ventilation, past experience of otitis media, consistency of effusion, degree of tympanosclerosis or the preoperative presence of tympanic retraction.
Adolescent↗
Middle ear ventilation in conjunction with adenotonsillectomy.
This report continues the evaluation of the use of a ventilation tube in the middle ear at the time of adenotonsillectomy. This series of 72 cases has been followed for 1 to 3 years. Each patient had bilaterally similar middle ear effusions. A myringotomy was performed in both ears. In one of the ears a ventilation tube was inserted, the other ear acting as a control. In 3 out of 4 of the patients in this study, adenotonsillectomy and evacuation of the middle ear fluid were sufficient to clear the middle ear indefinitely, and the use of the ventilation tube was redundant.
Adenoidectomy↗
A rare complication of use of the middle ear ventilation tube (PVC).
Purulent otitis media was observed following operations for insertion of middle ear ventilation tubes by the same surgeon in 2.2% of 226 patients. Conservative treatment given with the tube still in situ rarely effected cure, whereas removal of the tube brought about prompt resolution and perforation closure, The cause of these infections remains unknown, but adverse reaction of the mucous membrane to polyvinylchloride could be regarded as a possible cause.
Ear, Middle↗
Middle ear ventilation in conjunction with adenotonsillectomy.
If the tonsils and adenoids are causing eustachian tube dysfunction with middle ear effusion, the need for a ventilation tube at the time of the T&A and myringotomy is unresolved. Thirty-one patients with bilateral symmetrical middle ear effusion had T&A and myringotomies. In one ear, a ventilation tube was inserted; the other ear acted as a control. In addition to the clinical impressions, preoperative and serial postoperative audiograms and tympanograms are compared through a 12-month time frame. Discussion is presented regarding middle ventilation at the time of the primary operation.
Adenoidectomy↗
T-tube with tragus cartilage flange in long-term middle ear ventilation.
This was a study of the use of tragus cartilage as a flange for a T-tube in the hope of achieving long-term middle ear ventilation. This procedure was performed on 31 ears in 25 patients. Average length of follow-up was 24.2 months, ranging from 6 to 39 months. Five patients had tympanomastoid procedures done in conjunction with the cartilage tube. One of the patients with a tympanomastoid procedure had rejection of the T-tube and cartilage at 11 months postoperatively. None of the tubes without another procedure was rejected.
Bioprosthesis↗
Use of middle ear ventilation tubes in recurrent acute otitis media.
A method of treatment of recurrent acute otitis media with polythene middle ear ventilation tubes in young children is presented. 56 ears in which infection had persisted for one to six months despite antibiotic therapy and multiple myringotomies were included in the study. The tubes were inserted under topical anaesthesia and cure within one week was obtained in 73 per cent of ears. In another 9 per cent the otorrhoea stopped within 3 weeks, but in 18 per cent reinsertion of the tube became necessary and in this latter group 11 per cent resolved in two weeks following adenoidectomy as well. In 7 per cent the problem remained unresolved. Therefore with this regimen a total of 93 per cent of recurrent infections settled. It is emphasized that the ventilation tube should remain 'in situ' for over 3 months.
Acute Disease↗
Gas composition of the normal and the ventilated middle ear cavity.
Epidemiologic and controlled studies indicate that late minimal hearing impairment is a sequelae after the use of a ventilation tube in early childhood. The patho-physiology is unknown, but abnormal middle ear gas composition might be important. Therefore it is mandatory to measure middle ear gas composition in order to understand the gas exchange in the normal middle ear, as well as the change in gas composition associated with ventilation tubes. Accordingly, the aim of this study was to measure middle ear gas composition both in the physiologic state and in artificial ventilation by a transtympanic tube. Employing puncture of the typanic membrane, through a liquid seal, we aspirated 300 microliters of middle ear gas. The procedure was carried out under the otomicroscope on adults without any anesthesia. A total of 58 normals participated, along with 10 persons with unilateral ventilation tubes and 1 with a patent Eustachian tube. The mean values of physiologic state were: Partial pressure of oxygen in the middle ear cavity = 39 mm Hg, and partial pressure of carbondioxide in the middle ear cavity = 48 mm Hg. The mean values of artificially ventilated ears were: Partial pressure of oxygen in the middle ear cavity = 138 mm Hg, and partial pressure of carbondioxid in the middle ear cavity = 15 mm Hg. The total imprecision was 4.2/4.4 mm Hg and the accuracy seems fair,--especially because we found a quasi equilibrium to the "most probable value", the venous blood gases. It is concluded that artificial ventilation of the middle ear cavity, with a ventilation tube increases the oxygen content of the middle ear cavity with a factor 3.2. This constitutes a relative hyperoxic atmosphere with a subsequent possibility for a toxic tissue damage.
Adolescent↗
A comparison of retention and complication rates of large-bore (Paparella II) and small-bore middle ear ventilating tubes.
Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.
Adolescent↗
Middle ear ventilation after acute otitis media.
The investigation includes 43 children (82 ears) with acute otitis media who were treated with paracentesis and antibiotics. The middle ear pressure was measured 7 days, 14 days, 1 month, and 2 months after the otitis. A follow-up examination was performed 4-12 months after the otitis. The normalization process was extremely slow: 3 months after the otitis only 37% of the ears had a pressure between 0 and -50 mm H2O, and 24% had flat curves and chronic secretory otitis. 3-12 months after, 49% of the ears had a normal pressure. A discussion on whether the middle ear ventilation had been reduced before the present otitis, or whether the slow normalization process is due to the changes in the mucous membrane is presented. The first assumption seems to be more probable. The significance of poor ventilation in the occurrence of recurrency is emphasized. Tympanometry is recommended 1-3 months after otitis, especially in recurrent otitis media.
Acute Disease↗
[The effects of a high placed jugular bulb on middle ear ventilation (author's transl)].
A study of healthy and inflammed mucosal folds within the middle ear has demonstrated another although narrow airway across the tympanic cavity to the aditus and antrum. The anatomical anomaly of a high placed jugular bulb can interfere not only with ventilation and drainage of mesotypanum but also of the epitympanum and antrum.
Adolescent↗
[Middle ear ventilation by blowing up a balloon with the nose].
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Child↗