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Objectives: (1) Measure the cartilaginous Eustachian tube (ET) length using a computed tomography (CT) scan and (2) develop a prediction model to measure this length without the need of a CT scan., Study Design: CT measurements in children., Setting: Children's Hospital., Methods: CT scans were reformatted to project the cranial and caudal limits of the cartilaginous ET. The length was measured in 193 children who underwent a neck CT scan for nonotologic indications. Five physicians independently reviewed all or some of these measures. Four different models based on age, age ranges, weight, and height were created and compared to predict ET length., Results: The cartilaginous ET length was 25.3 ± 3.1 mm for the right and for the left ear. The mean ET length for the females was statistically significantly less than the length in males. The lower ET lengths in children as old as 5 years of age were less than the 2 cm adult criteria used for catheter insertion. All 4 models performed equally well in predicting ET length. Model number 4, which is based on height, was the easiest to calculate ET length., Conclusion: The cartilaginous portion of the pediatric ET can be measured with good precision using reformatted CT images. We caution against using the "adult" criteria of 2 cm for catheter insertion in children, especially those younger than 5 years of age. We recommend using a model utilizing height measures to estimate ET length or direct measurements from a reformatted CT scan., Level of Evidence: NA Laryngoscope, 133:396-402, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: Describe the relationship between the magnitude of eustachian tube (ET) dilation during swallowing observed on transnasal videoendoscopy and quantified by sonotubometry., Study Design: Descriptive observational study., Methods: Simultaneous transnasal videoendoscopic and sonotubometric recordings were done on 33 adults with no middle ear disease. Briefly, microphones were placed in the ear canals, a 45° telescope introduced through one side of the nose to visualize and record ipsilateral ET movements, and the probe from a sound generator placed in the opposite nostril. At a generated nasopharyngeal sound level, ET movements and ipsilateral microphone signals were continuously recorded while the subject performed a series of three swallows. For each swallow, relational movements among ET structures observed on video recordings and characteristics of the sonotubometry signal envelope at the ear canal were quantified at three times: swallow onset (T1), maximum soft-palate elevation (T2), and maximum ET luminal dilation (T3)., Results: A total of 99 swallows were analyzed. The average medial rotation of the ET cartilage and lateral wall over the T1-T2 interval were -32.7 ± 14.9° and 7.2 ± 25.1°, and over the T2-T3 interval were 4.6 ± 7.7° and 6.2 ± 14.6°, respectively. The transtubal sound transmission during a swallow peaked at an amplitude of 30.5 ± 35.7 mV during the 572.5 ± 292.6 ms of elevated sound-pressure time. Correlational analysis documented significant linear associations between the relational measures of ET component movements from videoendoscopy and the signal envelope measures from sonotubometry., Conclusions: There is a direct linear relationship between the degree of ET luminal dilation visualized on videoendoscopy and represented in the sonotubometry signal envelope., Level of Evidence: NA Laryngoscope, 126:2778-2784, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Assess the patency of the proximal and distal segments of the Eustachian tube in patients undergoing surgery for chronic ear disease., Study Design: Case study with control group., Methods: All consecutive patients presenting for surgery for chronic ear disease in our practice over 14 months underwent preoperative Valsalva computed tomography (CT), and an attempt was made intraoperatively using angled rigid scopes to evaluate obstruction of the protympanic segment of the Eustachian tube. Endoscopic examination of the same segment in 19 cadaver ears served as a control group., Results: Preoperative Valsalva CT showed patency of the distal one-third of the Eustachian tube in 51 of 53 ears. Intraoperative endoscopy allowed visualization of the protympanic opening of the Eustachian tube in 31 of 53 ears; 21 of 31 ears showed obstruction of the protympanic opening of the Eustachian tube., Conclusion: A clear obstruction was more likely to be present in the protympanic opening of the Eustachian tube in the patient population undergoing surgery for chronic ear disease than in the cadaver control group, and was equally likely to be present in the distal cartilaginous tube in patients as in the control population., Level of Evidence: 4., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM., Study Design: A retrospective case-control study., Methods: The study group comprised 125 patients (age range, 8-79 years; 64 males and 61 females) with 124 normal ears and 126 diseased ears, including ears with chronic suppurative otitis media (CSOM) with central perforation, intratympanic tympanosclerosis (ITTS), cholesteatoma, and a tympanic membrane with retraction pockets (TMRP). ET angle and length were measured using computed tomography employing the multiplanar reconstruction technique., Results: The ETa was significantly more horizontal in diseased versus normal ears of all study groups (P = .030), and there was no group difference in ETl (P = .160). ETl was shorter in CSOM versus ITTS ears and normal ears (P = .007 and P = .003, respectively) and in cholesteatoma versus TMRP ears (P = .014). In the unilateral COM group, there were no significant differences in the ETa or ETl of diseased versus contralateral normal ears (P = .155 and P = .710, respectively). The ETa was significantly more horizontal in childhood-onset diseased versus normal ears (P = .027), and there was no group difference in ETl (P = .732). The ETa (P = .002) and ETl (P < .001) were significantly greater in males than females., Conclusions: A more horizontal ETa and shorter ETl could be contributory (though not significantly) etiological factors in the development of COM., Level of Evidence: 3b., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: Assess the feasibility of using the Valsalva maneuver to visualize the cartilaginous eustachian tube lumen with computed tomography (CT) in subjects with no ear disease., Study Design: Prospective case series study., Methods: Thirty-eight consecutive patients undergoing CT of the sinuses for nose-related complaints with normal radiographic findings consented for a CT of the temporal bone while performing the Valsalva maneuver. Multiplanar reconstruction was performed along the axis of the tube. Images were assessed for visualization of the whole length of lumen of the tube, or partial visualization with ratio of visualized to nonvisualized segments., Results: The Valsalva maneuver allowed visualization of the whole length of the tube in 27/76 (35%) ears examined. It consistently visualized the distal one-third of the cartilaginous tube in 71/76 (94%) ears. Paradoxical collapse of the eustachian tube was present in three ears along with evidence of poor Valsalva technique., Conclusions: Valsalva CT consistently allows visualization of the lumen of the distal one-third of the eustachian tube in a majority of patients with no eustachian tube-related complaints. This technique might be helpful in localizing eustachian tube pathology in patients with obstructive tube symptoms., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To compare the anatomic features of the eustachian tube (ET) between children with and without otitis media with effusion (OME) and with adults., Methods: The angle and length of the ET in children with OME (54 ears, OME children) and without OME (50 ears, normal children), as well as those of normal adults (90 ears), were measured on computed tomography using the multiplanar reconstruction technique., Results: The angles of ET in the OME children group, the normal children group, and the normal adult group were 20.4 +/- 3.5 degrees and 21.2 +/- 4.8 degrees , 19.9 +/- 3.4 degrees and 20.0 +/- 3.6 degrees , and 27.3 +/- 2.7 degrees and 27.3 +/- 2.8 degrees on the right and the left sides, respectively. There was no significant difference between the right and the left side in any group (P = .541, P = .952, P = .978). The lengths of ET in the OME children group, the normal children group, and the normal adult group were 37.2 +/- 3.0 mm (mean +/- SD) and 37.6 +/- 3.2 mm, 37.5 +/- 3.3 mm and 38.0 +/- 3.2 mm, and 42.5 +/- 2.8 mm and 42.9 +/- 2.9 mm on the right and the left sides, respectively. There was no significant difference between the right and left sides in any group (P = .670, P = .597, and P = .545). Both the angles and lengths were significantly greater in the normal adult group than in either the OME children group or the normal children group (one-way analysis of variance and Fisher's protected least significant difference tests, P < .05), but there was no significant difference in either the angle or length of the ET between the OME and normal children groups (P > .05). In the OME and normal children groups, the angle was observed to constantly increase with age, and the values were found to be within the range of the adult size in all the patients older than 7.5 years and 7.7 years in the OME children group and the normal children group, respectively. As well as the angle, the lengths were observed to constantly increase with age, but the increase appeared to be greater at a younger age (until approximately 3 to 4 years) than at an older age, and the values were found to be within the range of the adult size in all the patients older than 6.8 years and 7.7 years in the OME children group and the normal children group, respectively., Conclusion: The angle and length of the ET are more horizontal and shorter in infants than in adults. However, there is no statistical difference between the angle and length of the ET in infants with and without OME. These results lead us to believe that a short and horizontal ET may not be a main etiologic factor related to high susceptibility to OME in infants and children.

Objectives/hypothesis: Objectives were to determine the incidence of petrous apex pneumatization and to define the relationship between a pneumatized petrous temporal bone and the eustachian tube lumen., Study Design: Retrospective study with institutional review board approval including only adult patients., Methods: One hundred head computed tomography (ct) scans and 204 petrous temporal bone CT scans performed at a tertiary teaching hospital were reviewed. The two senior authors (s.h.s., p.c.s.) independently reviewed the petrous temporal bone CT scans for grade of pneumatization. Pneumatized CT scans were then reviewed for the presence of a direct communication with the eustachian tube lumen. Significance was determined using the chi test and Pearson correlation of ranks., Results: The incidence of peritubal cells opening into the eustachian tube anterior to the tympanic orifice was 92%., Conclusion: The direct communication of peritubal cells with the bony eustachian tube may play a role in the development of persistent cerebrospinal fluid rhinorrhea after cerebellopontine angle surgery.

Permanent obliteration of the eustachian tube via the middle ear traditionally has met with limited success. Combinations of muscle, fascia, adipose tissue, bone fragments, and inert material such as Proplast have been used to seal the middle ear from the nasopharynx by inciting a fibrous reaction within the lumen of the eustachian tube. Long-term follow-up has demonstrated repneumatization of the middle ear cleft in the majority of cases, indicating failure of the obliteration technique. This report describes a technique for successful long-term obliteration using hydroxyapatite cement. This new biomaterial possesses osseointegrative and osseoconductive properties that result in permanent obliteration by producing new bone formation within the lumen of the eustachian tube. This technique eliminates the complication of cerebrospinal fluid rhinorrhea in lateral skull base procedures that expose the eustachian tube to cerebrospinal fluid.

Two hundred twenty-one cases with clinical suspicion of a cerebellopontine angle (CPA) and/or internal auditory canal (IAC) lesions were evaluated in our hospital in the last 21/2 years by various radiological modalities. Fifty-two tumors were diagnosed and surgically removed; 48 were acoustic neuromas (33 large tumors and 15 intracanalicular small tumors) and 4 meningiomas. Polytomography detected 10 lesions out of 15 (66.7%) with 5 false-negative (33.3%) and 4 false-positive (26.7%) studies. Routine CT scan visualized large and enhancing lesions (37 out of 52), but missed the small intracanalicular tumors (15 tumors) which were only visualized by CT scan combined with cisternography or magnetic resonance imaging (MRI). MRI diagnosed 23 lesions out of 23 (100%) with no false-positive or negative studies, including 8 intracanalicular small tumors missed on the routine CT scans. MRI is far more reliable in the radiological diagnosis of CPA and IAC lesions.