Acta Oto-Laryngologica
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Eustachian Tube Function and Mastoid Pneumatization Shiro Shimada, Nobumasa Yamaguchi & Yoshio Honda To cite this article: Shiro Shimada, Nobumasa Yamaguchi & Yoshio Honda (1990) Eustachian Tube Function and Mastoid Pneumatization, Acta Oto-Laryngologica, 110:sup471, 51-55, DOI: 10.3109/00016489009124809 To link to this article: http://dx.doi.org/10.3109/00016489009124809
Published online: 08 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [University of California Santa Barbara]
Date: 23 March 2016, At: 19:46
Acta Otolaryngol (Stockh) 1990; Suppl. 471: 51-55
Eustachian Tube Function and Mastoid Pneumatization SHIRO SHIMADA, NOBUMASA YAMAGUCHI and YOSHIO HONDA From the Department of Otorhinolaryngology, Jikei University School
of
Medicine, Tokyo, Japan
Downloaded by [University of California Santa Barbara] at 19:46 23 March 2016
Shirnada S, Yamaguchi N, Honda Y. Eustachian tube function and mastoid pneumatization. Acta Otolaryngol (Stockh) 1990; Suppl. 471: 51-55. We investigated the relationship between the Eustachian tube’s ventilatory function and the pneumatization of mastoid air cells. In 65 adults (66 ears) with chronic otitis media (COM), ventilatory Eustachian tubal function was evaluated by the inflationdeflation test, while the area of mastoid air cells was measured by the rectangular method on X-ray film. Group I represents good function in both the inflation and deflation tests. Group 11 represents good function in the inflation test but poor function in the deflation test. Group I11 represents a poorly functioning Eustachian tube in both tests. The opening pressure in Group 111 was statistically higher than in Group I and Group 11. The area of mastoid air cells in Group I was statistically larger than in Group 111. There was no correlation between opening pressure and area of mastoid air cells in COM. Postoperative failure of the tympanic membrane was frequently found in Group 111. We discuss the tubal function and pneurnatization of mastoid air cells. Key words: uenfilatoryfunction, chronic otitis media, mastoid uir cells. Noburnasa Yamaguchi, Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku Tokyo, 105, Japan.
INTRODUCTION Many papers have been published concerning Eustachian tube ventilatory function in chronic otitis media (COM), as determined by the inflation-deflation test (1-9, 1 I ) and Valsalva maneuvre (7, 8, 10). HoImquist (3), Siedentop et al. (4), and Cohn et al. (9) showed that good Eustachian tube function leads to successful tympanoplasty, but Sharp (7) did not describe the preoperative assessment of tubal function. Ekvall (1 1) reported that failures were due to shortcomings in surgical technique or inadequate postoperative care. Eustachian tube function may lead to failure of tympanoplasty in COM with central perforation. Mastoid pneumatization in COM was shown to be suppressed in several investigations using planimetry (12-14) and volume studies (15). In our study, the area of mastoid air cells was measured by the simplified rectangular dimension method (16). We wanted to ascertain the relationship between active tubal ventilatory function and mastoid pneumatization in COM. We discuss three groups regarding Eustachian tube ventilatory function, mastoid air cells, and postoperative failure.
MATERIALS AND METHODS Sixty-five individuals (66 ears) with chronic otitis media, age range 20 to 69 years (20 males, 45 females) were examined. All of these COM patients had dry central perforation of the pars tensa. There were no cases of cholesteatoma. All patients underwent operation for the first time and the preoperative Eustachian tube function was examined. The ventilatory function was measured by inflation-deflation test according to a modification of Miller’s procedures (1). The external auditory canal was fitted with a catheter which was connected to a pressure transducer. First the active ventilatory Eustachian tube
Downloaded by [University of California Santa Barbara] at 19:46 23 March 2016
52
S.Shimada et al.
function was determined by the inflation-deflation test. In the inflation test, a positive pressure of 200 m m H 2 0 was created in the middle ear through the external ear canal, and after the patient had swallowed 4-5 times, the residual positive pressure was measured. That residual pressure was used as the landmark for ability to equilibrate the Eustachian tube. A residual pressure under 100 mmHzO was regarded as representing good Eustachian tube function, o r a good inflation test result, while a residual pressure exceeding 100 mmHzO was regarded as denoting poor ventilatory eustachian tube function, o r a poor inflation rest result. In the deflation test, a negative pressure of 200 m m H 2 0 was created in the middle ear and the patient’s ability to equilibrate was measured after swallowing 4-5 times. A residual pressure under 100 mmH2O was regarded as a good Eustachian tube function or a good inflation test result, while a pressure over 100 mmH2O represented poor ventilatory Eustachian tube function, o r a poor deflation test result. The passive ventilatory Eustachian tube function was denoted by the forced opening pressure through the external ear canal. The maximum positive pressure created in the middle ear was 800 m m H 2 0 . Eight ears with traumatic central perforation of the tympanic membrane, in patiens aged from 20 to 41 years, were employed as the controls. The area of 66 mastoid air cells in COM was measured by the rectangular dimension method ad modum Imai et al. (16), using Schuller view of the X-ray films. The area was obtained as the product of the maximum length of mastoid air cells on the orbito-meatal plane versus the maximum length of mastoid air cells on a line perpendicular to the orbito-meatal line. The Control Group consisted of 170 years of male flight crew candidates from 21 to 24 years old, who had no ear disease. The success o r failure of tympanoplasty was evaluated by postoperative perforation of the tympanic membrane. RESULTS The active and passive ventilatory Eustachian tube functions had been measured preoperatively. We classified active ventilatory tuba1 function into three groups, as shown in Table I. Group I represented good ventilatory Eustachian tube function in both the inflation and deflation tests. Group I1 represented good function in the inflation test but poor function in the deflation test. Group 111 represented poor ventilatory Eustachian tube function in both the tests. There were no cases showing poor function in the inflation test but good function in the deflation test. Group I comprised 37 ears (56%), Group 11, 19 ears (20%), and Group 111, 10 ears (15%). The relationship between the three groups of ventilatory function and the opening pressure is shown in Fig. 1. Mean opening pressure in Group I was 410 ( k l l 0 ) m m H 2 0 ,
Table I. Pattern of uctive tuba1 function clussifird into threr groiips Group I , good results in inflation and deflation tests: Group 11, good inflation teSt result but poor deflation test result; Group 111, poor results in both the inflation and deflation te\ts
Group I Group I1 Group 111
Inflation test
Deflation test
n
Good Good Poor
Good Good Poor
37 (56%) I9 (29 %) 10 (15%)
Eustacliiun tithe ficnction und mastoid pneumatization
-
e
800700
E E 600
f
500.
v1 v)
2
a
”.
E. p: :
400
p 300
... I
.-
5a zoo
.
Fig. 1. Control Group consi5ting of cases of traumatic perforation of the tympanic membrane. Ordinute. Opening pressure.
Downloaded by [University of California Santa Barbara] at 19:46 23 March 2016
100
I Trauma
Group I
Group II
Group IJ
!N=8J
lN=3li
!N=l3i
IN=lOi
while it was 432 (k114) m m h 2 0 in Group I1 and 633 (k166) m m H 2 0 in Group Ill. Mean opening pressure in the control group of traumatic ears with central perforation was 320 ( 3 3 2 ) mmHzO. The difference in opening pressure between Group I and Group I1 was not statistically significant, but differences between Groups I and 111 @
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Eustachian Tube Function and Mastoid Pneumatization Shiro Shimada, Nobumasa Yamaguchi & Yoshio Honda To cite this article: Shiro Shimada, Nobumasa Yamaguchi & Yoshio Honda (1990) Eustachian Tube Function and Mastoid Pneumatization, Acta Oto-Laryngologica, 110:sup471, 51-55, DOI: 10.3109/00016489009124809 To link to this article: http://dx.doi.org/10.3109/00016489009124809
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 9
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [University of California Santa Barbara]
Date: 23 March 2016, At: 19:46
Acta Otolaryngol (Stockh) 1990; Suppl. 471: 51-55
Eustachian Tube Function and Mastoid Pneumatization SHIRO SHIMADA, NOBUMASA YAMAGUCHI and YOSHIO HONDA From the Department of Otorhinolaryngology, Jikei University School
of
Medicine, Tokyo, Japan
Downloaded by [University of California Santa Barbara] at 19:46 23 March 2016
Shirnada S, Yamaguchi N, Honda Y. Eustachian tube function and mastoid pneumatization. Acta Otolaryngol (Stockh) 1990; Suppl. 471: 51-55. We investigated the relationship between the Eustachian tube’s ventilatory function and the pneumatization of mastoid air cells. In 65 adults (66 ears) with chronic otitis media (COM), ventilatory Eustachian tubal function was evaluated by the inflationdeflation test, while the area of mastoid air cells was measured by the rectangular method on X-ray film. Group I represents good function in both the inflation and deflation tests. Group 11 represents good function in the inflation test but poor function in the deflation test. Group I11 represents a poorly functioning Eustachian tube in both tests. The opening pressure in Group 111 was statistically higher than in Group I and Group 11. The area of mastoid air cells in Group I was statistically larger than in Group 111. There was no correlation between opening pressure and area of mastoid air cells in COM. Postoperative failure of the tympanic membrane was frequently found in Group 111. We discuss the tubal function and pneurnatization of mastoid air cells. Key words: uenfilatoryfunction, chronic otitis media, mastoid uir cells. Noburnasa Yamaguchi, Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku Tokyo, 105, Japan.
INTRODUCTION Many papers have been published concerning Eustachian tube ventilatory function in chronic otitis media (COM), as determined by the inflation-deflation test (1-9, 1 I ) and Valsalva maneuvre (7, 8, 10). HoImquist (3), Siedentop et al. (4), and Cohn et al. (9) showed that good Eustachian tube function leads to successful tympanoplasty, but Sharp (7) did not describe the preoperative assessment of tubal function. Ekvall (1 1) reported that failures were due to shortcomings in surgical technique or inadequate postoperative care. Eustachian tube function may lead to failure of tympanoplasty in COM with central perforation. Mastoid pneumatization in COM was shown to be suppressed in several investigations using planimetry (12-14) and volume studies (15). In our study, the area of mastoid air cells was measured by the simplified rectangular dimension method (16). We wanted to ascertain the relationship between active tubal ventilatory function and mastoid pneumatization in COM. We discuss three groups regarding Eustachian tube ventilatory function, mastoid air cells, and postoperative failure.
MATERIALS AND METHODS Sixty-five individuals (66 ears) with chronic otitis media, age range 20 to 69 years (20 males, 45 females) were examined. All of these COM patients had dry central perforation of the pars tensa. There were no cases of cholesteatoma. All patients underwent operation for the first time and the preoperative Eustachian tube function was examined. The ventilatory function was measured by inflation-deflation test according to a modification of Miller’s procedures (1). The external auditory canal was fitted with a catheter which was connected to a pressure transducer. First the active ventilatory Eustachian tube
Downloaded by [University of California Santa Barbara] at 19:46 23 March 2016
52
S.Shimada et al.
function was determined by the inflation-deflation test. In the inflation test, a positive pressure of 200 m m H 2 0 was created in the middle ear through the external ear canal, and after the patient had swallowed 4-5 times, the residual positive pressure was measured. That residual pressure was used as the landmark for ability to equilibrate the Eustachian tube. A residual pressure under 100 mmHzO was regarded as representing good Eustachian tube function, o r a good inflation test result, while a residual pressure exceeding 100 mmHzO was regarded as denoting poor ventilatory eustachian tube function, o r a poor inflation rest result. In the deflation test, a negative pressure of 200 m m H 2 0 was created in the middle ear and the patient’s ability to equilibrate was measured after swallowing 4-5 times. A residual pressure under 100 mmH2O was regarded as a good Eustachian tube function or a good inflation test result, while a pressure over 100 mmH2O represented poor ventilatory Eustachian tube function, o r a poor deflation test result. The passive ventilatory Eustachian tube function was denoted by the forced opening pressure through the external ear canal. The maximum positive pressure created in the middle ear was 800 m m H 2 0 . Eight ears with traumatic central perforation of the tympanic membrane, in patiens aged from 20 to 41 years, were employed as the controls. The area of 66 mastoid air cells in COM was measured by the rectangular dimension method ad modum Imai et al. (16), using Schuller view of the X-ray films. The area was obtained as the product of the maximum length of mastoid air cells on the orbito-meatal plane versus the maximum length of mastoid air cells on a line perpendicular to the orbito-meatal line. The Control Group consisted of 170 years of male flight crew candidates from 21 to 24 years old, who had no ear disease. The success o r failure of tympanoplasty was evaluated by postoperative perforation of the tympanic membrane. RESULTS The active and passive ventilatory Eustachian tube functions had been measured preoperatively. We classified active ventilatory tuba1 function into three groups, as shown in Table I. Group I represented good ventilatory Eustachian tube function in both the inflation and deflation tests. Group I1 represented good function in the inflation test but poor function in the deflation test. Group 111 represented poor ventilatory Eustachian tube function in both the tests. There were no cases showing poor function in the inflation test but good function in the deflation test. Group I comprised 37 ears (56%), Group 11, 19 ears (20%), and Group 111, 10 ears (15%). The relationship between the three groups of ventilatory function and the opening pressure is shown in Fig. 1. Mean opening pressure in Group I was 410 ( k l l 0 ) m m H 2 0 ,
Table I. Pattern of uctive tuba1 function clussifird into threr groiips Group I , good results in inflation and deflation tests: Group 11, good inflation teSt result but poor deflation test result; Group 111, poor results in both the inflation and deflation te\ts
Group I Group I1 Group 111
Inflation test
Deflation test
n
Good Good Poor
Good Good Poor
37 (56%) I9 (29 %) 10 (15%)
Eustacliiun tithe ficnction und mastoid pneumatization
-
e
800700
E E 600
f
500.
v1 v)
2
a
”.
E. p: :
400
p 300
... I
.-
5a zoo
.
Fig. 1. Control Group consi5ting of cases of traumatic perforation of the tympanic membrane. Ordinute. Opening pressure.
Downloaded by [University of California Santa Barbara] at 19:46 23 March 2016
100
I Trauma
Group I
Group II
Group IJ
!N=8J
lN=3li
!N=l3i
IN=lOi
while it was 432 (k114) m m h 2 0 in Group I1 and 633 (k166) m m H 2 0 in Group Ill. Mean opening pressure in the control group of traumatic ears with central perforation was 320 ( 3 3 2 ) mmHzO. The difference in opening pressure between Group I and Group I1 was not statistically significant, but differences between Groups I and 111 @
