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BACKGROUND: Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS). METHODS: Sixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0- to 3-point scale, with ratings averaged for analysis. RESULTS: Interrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19 ± 0.81 vs. 0.78 ± 1.06; p = 0.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21-10.09; p = 0.021) and post-ESS (OR, 9.00; 95% CI, 1.95-41.5; p = 0.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44-104.85; p = 0.001). CONCLUSIONS: EDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery.

Background: The impact of otolaryngological diseases on sleep quality, anxiety, and depression has garnered significant attention. However, research has primarily focused on unveiling the effects of only one or two specific diseases, without analyzing the impact of multiple concurrent diseases. Furthermore, investigation into the interaction mechanisms among these factors has been lacking. Objectives: This study reveals the effects of different otolaryngological diseases on sleep quality, anxiety, and depression, and investigates their interaction mechanisms. Methods: In total, 2,080 patients with otolaryngological diseases were recruited from six centers in mainland China. Data on sociodemographics, history of smoking and alcohol consumption, diagnosis, anxiety, depression, and sleep quality were collected through hospital information system queries and questionnaires. We uncovered the psychological status and sleep quality of otolaryngology outpatients with different diseases and revealed the interaction mechanisms between these diseases and anxiety, depression, and sleep quality. Multivariable polynomial linear regression models explored the impact of different otolaryngological diseases on anxiety, depression and sleep quality, and mediation analysis explored the interaction mechanisms. Results: Chronic laryngitis, eustachian tube disorders, laryngeal swelling, laryngopharyngeal reflux, neck lymphatic inflammation, snoring, sudden deafness, tinnitus, nasopharyngeal lesions, and trauma had a significant impact on Pittsburgh Sleep Quality Index scores. Chronic tonsillitis, chronic laryngitis, and laryngopharyngeal reflux had a significant impact on Zung Self-Rating Depression Scale scores. Patients with giddiness (P = 0.006) and tinnitus (P = 0.006) tended to have higher Zung Self-Rating Anxiety Scale scores. Anxiety mediated the effect of tinnitus on sleep quality (70.41%; 95% confidence interval [CI]: 40.07, 76.00), and depression also had a mediation effect (13.24%; 95% CI: 4.46, 28.58). Other diseases also exhibited mediating effects and interactions with anxiety, depression, and sleep quality. Conclusions: Sleep quality significantly mediates the relationships of specific otolaryngological diseases with anxiety and depression. Similarly, anxiety and depression play important mediating roles in the relationships of different diseases with sleep quality. By revealing the interactive effects of different otolaryngological diseases on anxiety, depression, and sleep quality, this study could aid early interventions aiming to reduce anxiety and depression and improve patients' sleep quality and quality of life. [ABSTRACT FROM AUTHOR]

We present a case of a perilymphatic fistula (PLF) caused by Eustachian tube air inflation (ETAI) that was diagnosed using cochlin-tomoprotein (CTP) testing and successfully treated using transcanal endoscopic ear surgery to seal the inner ear window. A 77-year-old woman developed hearing loss and dizziness after undergoing ETAI at a local ear, nose, and throat clinic. Despite initial bed rest and steroid pulse therapy, the hearing did not improve, and transcanal endoscopic ear surgery was performed to repair the PLF. The CTP test confirmed the diagnosis of PLF, leading to a significant improvement in the patient's hearing and dizziness symptoms postoperatively. This case highlights the importance of considering PLF as a potential complication of ETAI and the value of CTP testing for diagnosing this condition. [ABSTRACT FROM AUTHOR]

Introduction: Cholesteatoma, a challenging entity in otologic surgery, necessitates a standardized classification system for effective communication among healthcare providers and consistent reporting of surgical outcomes. The ChOLE Classification System, introduced by Linder et al., stages cholesteatoma based on extension (Ch), ossicular chain status (O), life-threatening complications (L), and Eustachian tube function and mastoid pneumatization (E). Methods: We classified 199 patients who underwent cholesteatoma surgery between 2019 and 2023 in our University Hospital to assess the distribution of the ChOLE stages and to examine the relationship between the ChOLE stages and the duration of surgery. Results: This study revealed significant correlations between the ChOLE stage and respective subgroups of the classification and duration of surgery and thus complexity of procedure. Conclusion: Despite limitations, the ChOLE classification proves valuable in predicting surgical complexity and optimizing patient care. Further research is warranted to validate these findings and enhance cholesteatoma management strategies. [ABSTRACT FROM AUTHOR]

The article discusses the short- and long-term neurologic outcomes of patients undergoing an endoscopic endonasal transpterygoid approach (EETPA) for tumor resection. It highlights the main neurologic deficits associated with the approach, such as trigeminal neuropathy, hearing loss, and trismus, and how they evolve over time. The study found that the type of approach, preoperative deficits, and postoperative radiation can impact the resolution of these neurologic deficits. The research aims to provide data-driven patient counseling and optimize the management of neurologic deficits in patients undergoing an EETPA. [Extracted from the article]

The article published in the Journal of Neurological Surgery discusses the challenges of localizing and controlling the upper parapharyngeal internal carotid artery (upper-ppICA) during surgical procedures. The study identifies two anatomical triangles, named the "ACCESS" and "DANGER" triangles, as landmarks for localizing the upper-ppICA during endoscopic approaches to the infratemporal fossa and parapharyngeal spaces. These triangles, consisting of six key points, provide valuable guidance for surgeons in safely accessing and treating tumors or lesions in these regions. [Extracted from the article]

The article discusses a case of spontaneous pneumocephalus without an identifiable cerebrospinal fluid (CSF) leak, where a patient presented with a life-threatening condition. The patient underwent a less invasive surgery involving subtotal petrosectomy and eustachian tube obliteration, which successfully resolved the pneumocephalus. This alternative approach proved to be effective in treating the CSF leak, highlighting a potential option for cases with clinical suspicion of a temporal CSF leak. [Extracted from the article]

The article discusses the use of positron emission tomography (PET) and computed tomography (CT) in detecting cancer in the head, neck, and skull base. It explains how the radiopharmaceutical F-18 flourodeoxyglucose (FDG) is taken up by tumor cells due to their increased glucose utilization, leading to the detection of malignancies. The text also highlights how other factors like foreign body material, infection, and inflammation can mimic the appearance of neoplasms in the skull base, providing examples and insights into PET-CT imaging. [Extracted from the article]

The article "Cadaveric Endoscopic Transmeatal Approach to the Internal Acoustic Canal and the Middle Ear" published in the Journal of Neurological Surgery explores the neurosurgical perspective on using endoscopic techniques to access the middle ear and internal acoustic canal. The study documents step-by-step procedures for this approach, including identifying key anatomical landmarks and utilizing high-speed drills to open the internal acoustic canal. The authors successfully performed the endoscopic transmeatal approach, showcasing its potential as a minimally invasive option for certain cases in lateral skull base surgery. [Extracted from the article]

The article explores the impact of endoscopic transpterygoid eustachian tube management on long-term hearing outcomes in patients undergoing surgery for petroclival region malignancies. The study compares patients who had open resection with those who underwent endoscopic approaches, finding no significant difference in new or persistent hearing loss rates between the two groups. However, the endoscopic group experienced earlier hearing morbidity, more mastoid effusion, and unilateral hearing loss, despite achieving higher rates of gross total resection. The study suggests that further investigation may be needed to determine the optimal eustachian tube management strategy for these patients. [Extracted from the article]

This article from the Journal of Neurological Surgery explores the maneuverability of different surgical approaches in the infratemporal fossa. The endoscopic endonasal approach and the Fisch type C approach were compared using anatomical dissection on human cadaveric specimens. The study found that while the endoscopic approach is feasible for certain lesions, the Fisch type C approach offers enhanced maneuverability at the lateral aspect of the eustachian tube, although it may impact hearing function. This comparative analysis can aid in preoperative surgical planning for lesions in this complex anatomical region. [Extracted from the article]

The article discusses a novel surgical approach to expanding the limits of the endoscopic endonasal approach (EEA) to the petrous apex by incorporating the contralateral transmaxillary approach (CTMA) and stepwise mobilization of the paraclival internal carotid artery (ICA). Anatomic dissections in cadaveric heads showed that this technique significantly increased exposure and resection volume of the petrous apex, allowing for greater removal of the petrous bone. The study suggests that mastering this technique requires extensive training and understanding of anatomy, with further clinical studies needed to validate its safety and efficacy for patients. [Extracted from the article]

The article explores the anatomical study of accessing the petrous apex (PA) through the endoscopic endonasal approach (EEA) and the transorbital endoscopic approach (TOEA). The EEA primarily exposes the inferior and medial aspects of the PA, while the TOEA provides a view of the superior surface. Detailed step-by-step guides for both approaches are provided, emphasizing the importance of understanding the complex anatomy of the region for successful surgeries on PA tumors. [Extracted from the article]

The article discusses the technical nuances of the sublacerum versus supralacerum endoscopic endonasal transclival approach for resection of chordomas and chondrosarcomas. Through anatomical dissections and illustrative cases, the authors highlight key maneuvers and surgical adjuncts required for radical resection in both compartments. The study emphasizes the importance of understanding locoregional anatomy and utilizing specific techniques to ensure safe maximal resection of chondroid tumors, with implications for other lesions like petroclival meningiomas. [Extracted from the article]

Radiotherapy (RTx) is a highly effective treatment for head and neck cancer that can cause concurrent damage to surrounding healthy tissues. In cases of nasopharyngeal carcinoma (NPC), the auditory apparatus is inevitably exposed to radiation fields and sustains considerable damage, resulting in dysfunction. To date, little research has been conducted on the changes induced by RTx in the middle ear and the underlying mechanisms involved. Dexamethasone (DEX) is widely used in clinical practice because of its immunosuppressive and anti-inflammatory properties. The present study investigated the effects and underlying mechanisms of DEX delivered via intratympanic administration on RTx-induced damage to the middle ear and human middle ear epithelial (HMEE) cells. Sprague–Dawley (SD) rats were exposed to fractionated RTx (6.6 Gy/day for 5 days), and middle ear samples were collected at 1 and 4 months. Rats that received RTx presented a significant increase in the thickness of the submucosal layer in the middle ear and disorganization of the ciliated epithelium in the Eustachian tube (ET) mucosa. Importantly, intratympanic administration of DEX 30 min before RTx resulted in a lower degree of damage than that in the control group. Furthermore, DEX pretreatment downregulated the expression of cell death pathway markers in HMEE cells. Our collective results potentially support the use of DEX to reduce radiation-induced damage in the middle ear and may contribute to the development of future studies. [ABSTRACT FROM AUTHOR]

Tinnitus is a phantom auditory perception in the absence of external stimuli which can be caused by various etiologies including infectious causes, neurological etiologies such as whiplash injury and acoustic neuroma, side effects of certain medication and mechanical causes. Neoplasms that block the Eustachian tube (ET) may also lead to tinnitus. This is a case of fibrous dysplasia (FD) seen on Technetium-99m methyl diphosphonate (99mTc-MDP) whole body bone scintigraphy and SPECT/CT causing blockage of the ET. Fibrous dysplasia (FD) is a rare, congenital, and benign neoplasm that affects the bones. FD can be broadly categorized as mono-ostotic and poly-ostotic types. It often extends from its primary site into other bones and may cause symptoms due to compression, which may not be seen by conventional radiological imaging. We present a case of FD in a young woman, who had unilateral right-sided tinnitus and headache. Conventional imaging identified a lesion involving the paranasal bones with no involvement of the temporal bones or middle ear. 99mTc-MDP whole-body bone scintigraphy was performed to delineate the extent of the disease, which revealed complete blockage of the right sided paranasal sinuses that could have led to a Patulous ET (PET), hence indirectly causing tinnitus. This illustrates the role of nuclear medicine imaging, over conventional imaging, in accurately delineating the functional extent of fibrous dysplasia. [ABSTRACT FROM AUTHOR]

A 19-year-old male patient with a history of congenital left oval window defect has had recurrent admissions to a children's hospital for bacterial meningitis since the age of 7. Investigations revealed a left-sided type 1 incomplete partition deformity of the left ear with a congenital oval window defect, leading to communication between the cranium and the middle ear. The patient underwent a left canal wall down mastoidectomy and oval window defect repair, remaining well for 3 years. He experienced two more episodes of bacterial meningitis as he got older, prompting repeated exploratory tympanotomy and repair of the cerebrospinal fluid (CSF) leak after each episode. Recently, he was referred again for recurrent meningitis. Investigations showed a recurrent oval window defect. After undergoing left external ear canal transection, mastoid and middle ear obliteration, and left Eustachian tube obliteration, he remained well without further leaks or meningitis. Congenital oval window defect is rare and may present with recurrent bacterial meningitis secondary to spontaneous CSF leak via the oval window. Radiology plays a crucial role in identifying the source of the CSF leak, facilitating more precise preoperative counseling and surgical intervention. [ABSTRACT FROM AUTHOR]

Background and Objectives: Eustachian tube dysfunction (ETD) is prevalent among patients with ENT disorders, necessitating history-taking, clinical examination, and appropriate investigation for diagnosis. Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) is a valuable tool for subjectively assessing symptom severity related to this condition. This study aims to adapt and validate the ETDQ-7 in Greece, ensuring its accuracy and efficacy in outpatient settings. Subjects and Methods: The ETDQ-7 was translated into Greek following established methodology. Data were collected from 75 Greek patients diagnosed with ETD and 25 control patients without ETD. Participants completed the adapted ETDQ-7 and underwent a clinical examination, with statistical analysis correlating with their ETDQ-7 responses. Statistical analyses were performed to determine the questionnaire's reliability and validity. Results: Internal consistency and item analyses were performed to validate the questionnaire. Face and content validity were confirmed, and patients found the questionnaire easy to administer and complete. Test-retest reliability demonstrated similar internal consistency and a strong correlation between individual items and the total score. Discriminative validity revealed a statistically significant difference between the two patient groups, supporting the usefulness of the Greek version of ETDQ-7 in confirming the diagnosis of ETD. Conclusions: The Greek version of ETDQ-7 proves to be safe and effective for diagnosing ETD in Greek-speaking populations, complementing various investigative methods. [ABSTRACT FROM AUTHOR]

Introduction In recent years, transcanal endoscopic ear surgery (TEES) has gained widespread recognition as an excellent surgical field for blind spots such as the sinus tympani (ST) when compared to microscopic ear surgery (MES). Objective To investigate the postoperative hearing results for pars tensa cholesteatoma and the indications for utilizing endoscopy. Methods The medical records of 16 patients (10 men and 6 women) with pars tensa cholesteatoma, who received initial surgical treatment between 2018 and 2022, were reviewed. We performed MES, TEES, or endoscopy-assisted MES (dual approach) depending on the pathological involvement in the mastoid cavity and ST. Results The mean age of the patients was 45 years, and the surgical techniques utilized were MES in 2 cases, TEES in 7 cases, and dual approach in 7 cases. The preoperative pathological classification was stage I in 3 patients and stage II in 13 patients. The overall surgical success rates of postoperative hearing outcomes were 69% and 50% (1/2 patients) in the TEES group, 71% (5/7 patients) in the MES group, and 71% (5/7 patients) in the dual approach group. The successful cases (n = 11) were significantly younger and demonstrated better mastoid pneumatization than unsuccessful cases (n = 5). Conclusion Endoscopy-assisted MES is appropriate for treating pars tensa cholesteatoma when pathological involvement is present at the deep bottom of the ST. Early surgical intervention and good eustachian tube function are crucial for improving hearing prognosis. Transcanal endoscopic ear surgery can be particularly useful in identifying and removing residual cholesteatoma within the ST. [ABSTRACT FROM AUTHOR]

Ear, nose, and throat (ENT) disease is a disorder that occurs in the eustachian tube in one of the organs, be it the ear, nose, or throat. Early signs of ENT disease include sore throat, painful swallowing, swollen and red tonsils, runny nose, nosebleeds, blocked nose, discharge from the ears, and others. To determine the diagnosis, it is necessary to carry out a physical examination of the ears, nose, and throat as recommended by an expert, namely an ENT doctor. The research carried out was implementing data mining for the diagnosis of ENT diseases using the Naïve Bayes (NB) method. This method was chosen because it can increase the accuracy, efficiency, and accessibility of health services and is also easy to understand and apply to classify ENT disease symptom data. The NB method was used to build an ENT diagnosis classification model and the model performance was evaluated using accuracy, precision, and recall metrics. To increase the accuracy of the NB algorithm predictions, feature selection using a genetic algorithm can be used. Genetic algorithms can help select the most relevant and significant features, improving the accuracy of NB models by eliminating irrelevant or noisy features. By applying this method, predictions for ENT diseases can be produced with an accuracy of 95,67%. [ABSTRACT FROM AUTHOR]

Background/Objectives: Recurrent chronic otitis media (rCOM) is a major cause of hearing impairment, often linked to Eustachian tube (ET) dysfunction. Anatomical abnormalities, such as ET narrowing and obstructions, and functional impairments, including poor pressure regulation, play significant roles in rCOM recurrence. This study aimed to (1) identify anatomical variations of the ET in patients with rCOM using high-resolution imaging; (2) evaluate ET functional status using tympanometry, tubomanometry, and ET function tests; and (3) assess the correlation between anatomical variations and functional impairments in predicting rCOM recurrence. Methods: A cross-sectional study was conducted on 212 patients with rCOM and 212 controls. High-resolution CT and MRI were used to assess ET anatomy, while functional status was evaluated using tympanometry, tubomanometry, and Valsalva maneuver tests. Statistical analyses, including t-tests, Pearson correlation, and Cox proportional hazards models, were applied to examine the relationship between anatomical and functional impairments and rCOM recurrence. Results: Significant anatomical differences were observed in the rCOM group, including ET narrowing (24.53% vs. 11.32%, p = 0.014) and curvature (32.08% vs. 14.15%, p < 0.001). Functional impairments were also more prominent in rCOM patients, with higher ET opening pressure (120.56 ± 14.34 dPa vs. 85.78 ± 12.98 dPa, p < 0.001) and lower Valsalva maneuver success rates (62.32% vs. 89.56%, p < 0.001). Cox regression indicated that anatomical and functional impairments significantly predicted faster recurrence (HR for tympanometry peak pressure = 1.56, p < 0.001). Conclusions: The ETs anatomical and functional impairments are significant predictors of rCOM recurrence. A combined assessment of these factors can improve diagnostic accuracy and guide more targeted interventions to prevent recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Balloon dilation of the eustachian tube has gained ground in the treatment of chronic dysfunction. A new indication for a larger group of patients has emerged, which is characterized by barochallenge only, which affects even more patients. Given the recent validation of the balloon dilation, we set out to explore if this procedure could be useful in treating this specific sub‐group of patients in an in‐office setting. Methods: Balloon dilation was performed using inly nasal cottonoids soaked in 2% tretracainephenylephrine combined with xylocaine nasal spray and lidocaine/prilocaine gel and a mild oral sedative. The effect of eustachian tube balloon dilation on the function of the eustachian tube was evaluated by using the eustachian tube dysfunction questionnaire‐7 (ETDQ‐7) and a VAS score. The questionnaires were completed beforehand and 3 months and 12 months postoperatively to determine subjective surgical success. Results: Two hundred and forty‐six balloon dilation were performed in 132 participants. The results from the ETDQ‐7 questionnaire and VAS scores showed a significant improvement in symptoms during pressurization after eustachian tube balloon dilation (p = 0.0001). A mean pain score during procedure in local anesthesia was 3.4 on a scale from 1 to 10. Conclusion: Eustachian tube balloon dilation significantly reduced symptoms of eustachian tube dysfunction during non‐physiological pressure, which was determined by ETDQ‐7 and Vas scores. Additionally, we found that the procedure is well suited for private practice or the outpatient clinic, using local anesthetics and a mild sedative. Level of Evidence: 4 Laryngoscope, 135:361–365, 2025 [ABSTRACT FROM AUTHOR]

Objective: Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic‐associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention‐deficit hyperactivity disorder [ADHD], autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic‐associated conditions in children with recurrent acute otitis media (RAOM). Methods: A retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic‐associated conditions were defined using ICD‐9 and ICD‐10 codes. Results: The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 [0.55, 0.68]; p < 0.001), asthma (OR 0.8 [0.74, 0.87]; p < 0.001), allergic rhinitis (OR 0.72 [0.65, 0.81]; p < 0.001), and atopic dermatitis (0.78 [0.71, 0.86]; p < 0.001). Conclusions and Relevance: Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM. Level of Evidence: 4 Laryngoscope, 135:423–428, 2025 [ABSTRACT FROM AUTHOR]

Background/Objectives: The nine-step inflation/deflation tympanometric Eustachian tube function test (commonly referred to as the nine-step test) is a widely utilized method for evaluating Eustachian tube function (ETF). This study aimed to establish normative values for the nine-step test to facilitate the diagnosis of Eustachian tube dysfunction (ETD). Methods: A total of 160 adults, including 70 healthy volunteers and 90 patients with chronic rhinosinusitis (CRS), were recruited for this study. Participants were further categorized into "fair ETF" and "poor ETF" groups based on their scores on the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Eustachian tube function was assessed using both the nine-step test and the ETDQ-7. The diagnostic accuracy of the maximal peak pressure difference (MPD) from the nine-step test was evaluated, using an ETDQ-7 score of ≥14 as the reference standard. Discriminative ability was analyzed using receiver operating characteristic (ROC) curves. Results: An MPD value of ≤4 yielded an area under the ROC curve (AUC) of 0.619, indicating moderate discriminative ability in the Taiwanese population. The median MPD value on the nine-step test was 9.5 (interquartile range [IQR]: 4.5–14.0) in participants with an ETDQ-7 score of <14, compared to a median MPD value of 7.5 (IQR: 2.5–12.0) in those with an ETDQ-7 score of ≥14 (p = 0.033). This finding suggests a potential association between MPD values and ETDQ-7 scores. Conclusions: This study identified an MPD value of 4 as a normative cutoff for screening ETD in a Taiwanese population. However, the diagnostic discriminative power of this parameter was moderate. [ABSTRACT FROM AUTHOR]

Symptoms of patulous Eustachian Tube (PET) were first described by Jago in 1858 and reported by Schwartze in 1864, recognizing PET as a clinical entity. This review summarizes the causes, epidemiology, diagnosis, and treatment of PET, with a particular emphasis on diagnosis and treatment, detailing the diagnostic criteria and silicone plug (Kobayashi plug) surgery proposed or developed in Japan. PET is often linked to weight loss from chronic illnesses, dieting, anorexia nervosa, hemodialysis, and bariatric surgery. It is also associated with pregnancy, oral contraceptive use, nasopharyngeal and muscular atrophy or scarring, and neuromuscular diseases. Interestingly, many PET cases lack an identifiable cause. The prevalence of PET ranges from 0.3 % to 7.0 %, with a higher incidence in females and typically occurring in adolescents and adults. Diagnosis relies on a combination of clinical history, physical examination, ET function test, and imaging. The Japan Otological Society (JOS) proposed standardized diagnostic criteria, where a "definite PET" diagnosis requires all three criteria (aural symptoms, tubal obstruction procedures, and objective findings), while "possible PET" requires two. Treatment includes conservative and surgical interventions. For persistent and severe cases that do not improve with conservative treatments, surgical options are explored. These surgical procedures are classified by the type of intervention, which includes tympanic membrane manipulation (such as tympanostomy tube insertion and mass loading of the tympanic membrane), plug surgery, ET injection, shim surgery, tuboplasty, and ET closure. The Kobayashi plug, a 23 mm long silicone plug, is specifically designed for PET treatment. Indications for its use include "definite PET," a PHI-10 score of 26 or higher, and lack of improvement after six months of conservative treatment. Preoperative evaluations include CT scans to assess ET patency and confirm the bony portion. Surgery, mostly performed under local anesthesia, involves inserting the plug into the ET via a myringotomy, ensuring the correct size and position with endoscopic guidance. In conclusion, PET is a challenging condition with diverse etiologies and symptoms. Effective management requires a comprehensive diagnostic approach and tailored treatment plans, with the Kobayashi plug offering a promising solution for refractory cases. Further research and advancements in diagnostic techniques and therapeutic interventions will continue to enhance the management of PET. [ABSTRACT FROM AUTHOR]

The possibility of biofilms on otitis media with effusion was reviewed. A systematic literature review was conducted using PubMed, Medline, Google, and Google Scholar search engines between 1975 and 2024. Articles dealing with "otitis media with effusion", "children", "treatment", "pathophysiology", "ventilation tube", or "biofilms" were located through a search engine and retrieved through a query. A middle ear effusion, which can be either mucoid or serous and is not purulent, is a hallmark of OME. The eustachian tube disruption, age, and environmental factors have all been linked to OME. Inflammation, infection, effusion, and tissue hyperplasia are common pathways that might lead to OME, suggesting that it is a complex disorder. Whether attached to living or nonliving surfaces, biofilms comprise a collection of microbial cells surrounded by a matrix formed by the cells. This matrix accounts for about 90% of the dry mass of the biofilm. Microbiological biofilms evade both the host immune system and antibiotics. The fact that 70% of OME cultures are sterile has been known for a long time. Numerous data point to the ineffectiveness of antibiotic treatment in OME, suggesting that biofilm is responsible for the disease's chronic nature. The present high rate of further surgery can be reduced by exploring new therapeutic options made possible by comprehending the function of biofilms in the genesis of OME. The most effective way to eliminate biofilms in the middle ear is to provide antibiotics locally. [ABSTRACT FROM AUTHOR]

Objectives: Our objective is to evaluate the prevalence of tympanic membrane (TM) retractions and management of signs of Eustachian tube dysfunction (ETD) in both children and adults following type 1 tympanoplasty or myringoplasty. Furthermore, to identify potential risk factors for developing ETD and TM retractions. Methods: Retrospective cohort study of 423 patients (5–86 years of age) undergoing 452 procedures. We extracted data from electronic patient journals during scheduled consultations to calculate prevalences and relative risks. The project was reported to the Danish Data Protection Authority, and access to electronic patient journals was approved by the Institutional Board of Gødstrup Hospital. Results: At 1 year postoperative follow‐up, the prevalence of TM retractions was 12.7% and ETD manifestations without a concurrent TM retraction was 4.2%. The graft failure rate was 11.0%. Risk factors for developing TM retractions included preoperative myringosclerosis, history of ipsilateral ear surgery, posterior perforations, and use of perichondrium graft. Conversely, previous contralateral ear surgery and temporal fascia graft use were associated with decreased risk. ETD manifestations were significantly increased in cases of preoperative bilateral perforation, history of ipsilateral ventilation tube, and traumatic TM perforation. Conclusions: TM retractions accounted for 12.7%, ETD manifestations without a concurrent TM retraction 4.2%, and graft failure 11.0%. The dynamic nature of these complications necessitates diligent follow‐up strategies. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]

Background: Many materials such as fascia, cartilage have been used for the reconstruction of the ear drum. Cartilage retains its rigidity and resists retraction, resorption and reperforation, even in cases with eustachian tube dysfunction. The hearing gain and uptake rate of cartilage is comparable to that of temporalis fascia. Objective: To compare hearing outcome amd graft uptake rate between temporalis fascia graft & cartilage graft. Methodology: A Quazi experimental study was conducted between January 2019-April 2020 in 52 patients who underwent Type 1 Tympanoplasty. 26 patients underwent Cartilage tympanoplasty & 26 underwent tympanoplasty with Temporalis fascia as graft. All patients underwent pure tone audiogram before surgery & 3 months after tympanoplasty and we compared the graft uptake and hearing outcome in both groups. Result: In Group A out of 26 patients who underwent temporalis fascia as graft, 2 patients had residual perforation. In group B out of 26 patients who underwent cartilage Tympanolasty 1 patient had residual perforation. In Group A 11 patients had hearing gain more than 10db. In Group B 12 patients had hearing gain more than 10 db. Conclusion: Temporalis fascia & cartilage perichondrium are equally good as graft material & we should select the graft material according to the cases. [ABSTRACT FROM AUTHOR]

Eustachian tube is complex and inaccessible structure. It connects nasopharynx to middle ear. It is composed of cartilaginous and bony segments. Eustachian tube helps in pressure regulation, protection and clearance of the middle ear. Dysfunctions of Eustachian tube are either due to anatomical obstruction or functional failure. Whether variation of length, width of bony canal, isthmus, length of the cartilaginous canal and angulation of the Eustachian tube to horizontal plane affects overall pressure regulation, protection and mucociliary clearance leads to the spread of the infection to the middle ear are highlighted. A comparative prospective study design of 20 adults of both gender of normal ear computerized tomography done for some other cause and 20 adults of both gender with chronic otitis media (tubo-tympanic pathology). After obtaining consent, clinical examination, all patients had got computerized tomography study of the temporal bone and were evaluated to study the variation of length, width of bony canal, isthmus, length of the cartilaginous canal and angulation of the Eustachian tube to horizontal plane. In our series cartilaginous Eustachian tube length is 26.72 mm in normal ear and 26.17 mm in diseased ear. Long and reduced diameter of bony segment is the anatomical cause in the tubotympanic pathology along with inflammation and loss of ciliary moment. Normal ear bony width is 2.36 mm; isthmus 1.18 mm are comparatively more than diseased ear (bony width 2.13 & isthumus1.04). Whereas bony length of normal ear is 11.21 mm and diseased ear is 11.62 mm. Decreased Eustachian tube pretympanic diameter and Reid –plane ET angle can be used to predict Eustachian tube dysfunction. Angle to horizontal plane in our series in normal ear 44.670 whereas in diseased ear 45.10. The Eustachian tube plays an important role in the development of the tubotympanic pathology of the ear. Pre-existing Eustachian tube anatomical variation appears to be risk factor in developing tubotympanic pathology. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate Eustachian tube function in patients with Behçet's disease (BD). Patients and methods: Forty-six patients (22 males, 24 females; mean age: 42.1±11.3 years; range, 19 to 64 years) with BD and 46 (21 males, 25 females; mean age: 38.5±14.8 years; range, 19 to 63 years) age- and sex-matched audiologically healthy individuals were enrolled in this cross-sectional, case-control study between June 2023 and August 2023. Demographic and clinical characteristics of participants were recorded from electronic health records. All participants completed the Eustachian tube function test and the Eustachian tube dysfunction questionnaire 7 (ETDQ-7). Binary logistic regression analysis was employed to identify the factors that predict Eustachian tube dysfunction in patients with BD. Additionally, the association between disease duration and ETDQ-7 scores was evaluated using Spearman's rank correlation. Results: The median ETDQ-7 scores were significantly higher in patients with BD than in controls (10 (7-32) vs. 7 (7-9); p<0.001). The number of ears with Eustachian tube dysfunction was also significantly higher in the BD group than in the controls (n=22, 47.8% vs. n=7, 15.2%; p=0.007). Regression analysis did not reveal statistically significant factors that predicted Eustachian tube dysfunction. Moreover, no statistically significant correlation was observed between Eustachian tube dysfunction and disease duration (R=-0.067; p=0.525). Conclusion: This study showed that Eustachian tube dysfunction is more prevalent in patients with BD than in the healthy controls. However, clinical and demographic variables were not found to be associated with Eustachian tube dysfunction. [ABSTRACT FROM AUTHOR]

Objectives. Balloon dilation of the Eustachian tube (BDET) is widely recognized as a minimally invasive treatment for obstructive Eustachian tube dysfunction (ETD). We employed a Delphi consensus methodology to develop recommendations for the clinical management of BDET in cases of obstructive ETD. Methods. A Delphi panel consisting of 26 expert physicians specializing in otology participated in two rounds of anonymous, iterative questionnaires. Consensus was defined as agreement from ≥70% of the panelists on a recommendation, while disagreement was defined as

We present the imaging findings of a 44-year-old female patient who was diagnosed with nasopharyngeal carcinoma (NPC) extending from the nasopharynx to the external auditory canal (EAC) through the Eustachian tube (ET). The patient presented with a left neck submandibular lump on initial presentation that showed NPC upon fine needle aspiration, leading to chemoradiotherapy. Despite treatment, the patient experienced multiple relapses and later presented with aural symptoms, including left ear pain, foul-smelling drainage, and trismus on recurrence, and was subsequently diagnosed through biopsy. CT, MRI, and PET-CT scans revealed an extensive infiltrative nasopharyngeal mass extending into the left ET, involving the EAC. This rare case highlights the importance of considering the extension of NPC into the EAC as a potential etiology in patients who present with aural symptoms.

Malignant nasopharyngeal tumors account for approximately 4% of ENT malignant tumor pathology and 1% of all cancers. The diagnosis of nasopharyngeal tumors is often late, the reason being the location in a silent anatomical region in terms of symptomatology and accessibility. Thus, approximately 70% of newly diagnosed patients with nasopharyngeal carcinoma unfortunately present with the condition in an advanced local stage. The early signs and symptoms are varied (nasal obstruction, hearing loss, otalgia, headache) and are usually ignored by the patient and even by the doctor in the initial stage of nasopharyngeal tumor evolution. Approximately 5% of patients have systemic metastases at presentation, the most common location being bone. Latent Epstein-Barr virus infection appears to be involved in the pathogenesis of nasopharyngeal carcinoma. There is no exact evidence of how often a nasopharynx tumor’s first sign is unilateral hearing loss. Thus, further work is required to determine that exactly to help patients get diagnosed faster and therefore improving their therapeutical options. This study aims to explore which symptoms are most common as the first indication of NPC, as well as how these symptoms compare to each other in terms of frequency and likelihood of occurrence.

Background/objectives: Eustachian tube dysfunction (ETD) presents complex diagnostic challenges in otolaryngology, compounded by concurrent chronic nasal disease. Patient-reported outcome measures (PROMs) often assess ETD severity due to its elusive diagnosis. Tubomanometry (TMM) emerges as a promising diagnostic tool, yet its application alongside chronic nasal disease remains unclear. Our study aims to elucidate TMM's role in ETD diagnosis within the context of chronic nasal diseases, integrating subjective assessments, clinical examination, and TMM results. Methods: A prospective observational study was conducted with patients suffering from ETD and chronic nasal disease allocated in three different groups according to their nasal pathology. Clinical examination, PROMs in the form of ETDQ-7, and NOSE questionnaires as well as TMM were performed. Results of the above subjective and objective measurements were analysed and correlated statistically to determine the value of TMM in chronic nasal disease patients. Results: All recruited patients suffered from ETD and chronic nasal disease, with similarly affected ETDQ-7 scores across all groups, while NOSE scores differed significantly based on the underground nasal pathology. TMM values confirm the presence of ETD in all three groups, confirming the role of TMM within this cohort. Interestingly, TMM values can still confirm the presence of ETD in patients with chronic nasal disease but cannot discriminate among chronic nasal pathology patients, making TMM a diagnostic tool with uniformity among the chronic nasal pathologies. Conclusions: ETD in individuals with chronic nasal disease presents distinct complexities, requiring a tailored diagnostic approach. In this context, a thorough clinical assessment, integrating ETDQ-7 and NOSE questionnaires, supplemented by TMM where accessible, is crucial to confirm diagnosis. This study confirms that TMM can diagnose ETD in all nasal pathology patients without being influenced by the nature of the disease. This research endeavours to refine diagnostic strategies, enriching clinical decision-making, and enhancing ETD management in patients suffering with chronic nasal diseases. [ABSTRACT FROM AUTHOR]

Background: Facial nerve baroparesis is a peripheral facial nerve injury resulting from barotrauma during activities such as diving, aviation, and mountain climbing. This condition occurs when increased pressure in the middle ear affects the facial nerve, leading to facial palsy. Despite being documented in otolaryngology literature, facial nerve baroparesis remains underreported and often misunderstood. Enhanced awareness and education about this condition are essential for effectively managing affected patients, helping to mitigate unnecessary panic and procedures during episodes. Case presentation: We present two cases of facial nerve baroparesis that occurred during flights. The first case involves a 25-year-old Arab male with no significant medical history who experienced a transient, one-time episode of right-sided facial nerve baroparesis during a flight from Kuwait to Syria; he reported nasal congestion and a sore throat prior to the flight, with the episode lasting approximately 30 min before resolving spontaneously. The second case is a 30-year-old Arab female with a history of chronic allergic rhinitis, who has experienced recurrent episodes of left-sided facial nerve baroparesis for the past 2 years, occurring during nearly every flight; each episode lasted around 5 min, caused severe facial pain, and also resolved spontaneously. Both patients exhibited varying degrees of Eustachian tube dysfunction. Treatment for the recurrent case included maneuvers to alleviate ear pressure and the use of nasal decongestants, which improved symptoms and decreased the frequency of episodes. Conclusion: Facial nerve baroparesis is frequently underestimated due to its temporary nature, yet it remains a significant cause of facial nerve palsy, especially after changes in pressure. Although the underlying mechanisms are not completely understood, dysfunction of the Eustachian tube is believed to be a contributing factor. Identifying the characteristic features of baroparesis—such as rapid onset, brief duration, and bilateral involvement of facial muscles—is essential for effective management. This highlights the necessity of educating healthcare professionals and flight personnel about this condition to prevent unnecessary treatments. For recurrent cases, management strategies should focus on alleviating Eustachian tube dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Acute otitis media is a common disease in children under the age of 5 years due to their primitive ear anatomy. One of its consequences is otitis media with effusion (OME), which is a condition wherein serous secretion accumulates in the middle ear due to Eustachian tube dysfunction. OME results in conductive hearing loss, impacting children's learning and development. This review aimed to identify discrepancies in clinical practice guidelines (CPGs) for managing OME in children across Asian and Western countries, focusing on updates to these guidelines. Methods: A comparative review involving critical appraisal using the Appraisal of Guidelines for Research and Evaluation II tool was conducted. CPGs for managing ear effusion in children in Western and Asian countries published in the PubMed, Cochrane Library, Scopus and Science Direct databases were reviewed. Four CPGs from Western countries (Scotland, England, the United States of America and France) and three CPGs from Asian countries (Japan, Korea and Malaysia) were selected. Results: There was a mild discrepancy regarding conducting surgery after 3 months, particularly myringotomy and adenoidectomy with or without grommets, between the Scottish CPG and other CPGs. Conclusion: Asian CPGs for the management of OME share many similarities with Western CPGs. However, Asian CPGs tend to be stronger in most domains and levels of evidence. Japanese and American CPGs are up to date as of 2022 and 2016, respectively, while other CPGs are outdated for about 10 years. [ABSTRACT FROM AUTHOR]

Background: The transesophageal echocardiogram (TEE) is the standard imaging modality for confirming the presence or absence of patent foramen ovale. PFO is a flap valve depending on the pressure change between the left and right atrium, which can help determine whether to open. 3D‐TEE was shown to optimize the visualization of PFO. There is a causal association between PFO and unexplained stroke. It seems that 3D‐TEE can present a high‐risk PFO morphological feature, which seems to show more than just being easier to open. Methods: In total, 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c‐TCD, TTE, and c‐TEE were included in this study. TEE confirmed the PFO. The right‐to‐left shunt (RLS) grade of PFO at rest and abdominal compression Valsalva maneuver was detected by c‐TEE. Results: The long diameter of FO (1.74 ± 0.3 vs. 1.60 ± 0.4, p = 0.039), the short diameter of FO (1.12 ± 0.3 vs. 1.00 ± 0.3, p = 0.036), perimeter of FO (4.62 ± 0.7 vs. 4.22 ± 1.0, p = 0.026), and area (1.80 ± 0.8 vs. 1.35 ± 0.8, p = 0.05) of the FO were significantly larger in the larger RLS group. In group of CS, a larger proportion of Eustachian valve or a Chiari's network (14.3% vs. 3.5%, p = 0.036), a larger proportion of in the left funnelform (55.1% vs. 16.3%, p < 0.001), a longer length of the PFO tunnel (13.4 ± 4.4 vs. 7.8 ± 2.5, p < 0.001), a lower IVC‐PFO angle (16.4 ± 3.4 vs. 20.3 ± 7.7, p = 0.001), a higher proportion of LA multiple exits of the tunnel (46.9% vs. 14.3%, p < 0.001). Multivariate regression analysis showed that male gender (HR: 4.026, 95% CI: 0.883–18.361, p = 0.072), age (HR: 1.076, 95% CI: 1.002–1.155, p = 0.045), the left funnelform (HR: 7.299, 95% CI: 1.585–33.618, p = 0.011), a longer length of the PFO tunnel (HR: 1.843, 95% CI: 1.404–2.418, p < 0.001) and multiple exits of the tunnel of LA (HR: 8.544, 95% CI: 1.595–45.754, p = 0.012) increased the risk of cerebral infarction. The cut‐off value calculated by ROC for the diagnosis of high‐risk PFO was that the length of the PFO tunnel was 12 mm and the left funnelform combined with multiple exits of the left atrial (sensitivity was 92%, specificity was 90%). The area under the curve of the combined index versus PoPE score (0.932 vs. 0.736) relative to the RoPE score was statistically significant. Conclusions: TEE has shown outstanding advantages in displaying the specific morphological characteristics of PFO. The left funnelform, a longer length of the PFO tunnel, and multiple exits of the tunnel of LA are associated with an increasing risk of CS in anatomical PFO respect. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the internal carotid artery (ICA) and jugular bulb (JB) structures in terms of lateral temporal bone resection using 3D computed tomography (CT). Methods: We retrospectively investigated 80 ears of 40 patients using 3D reconstruction data from normal temporal bone CT. Ten critical points (P) in the temporal bone were marked in the 3D object with reference to the axial, coronal, and sagittal images of the CT scans. An imaginary plane of the facial nerve (PLf) course was also reconstructed in relation to the three points of the chorda-facial junction, P5 (second genu), and P3 (cochleariform) process. Results: The distances (mean ± SD; mm) from points P3 to P1 (the highest level of the JB) and P2 (the posterior wall of the ascending petrous IAC at the level of the Eustachian tube) were 12.03 ± 2.56 and 9.79 ± 1.78, respectively. The distances from point P4 (chorda-facial junction) to P1 and P2 were 10.98 ± 2.70 and 17.66 ± 2.26, respectively. The angles (mean ± SD; degree) between the PLf to the line from Pa (point of the anterior bony canal) to P3 and P4 were 17.80 ± 10.05º and 8.93 ± 5.37º, respectively. The angles between the PLf to the line from P3 to P1 and P2 were − 36.35 ± 13.28º and − 24.78 ± 13.91º, respectively. The angles between the PLf to the line from P4 to P1 and P2 respectively were − 40.35 ± 15.37º and − 13.34 ± 7.63º. Conclusions: Understanding the anatomical relationships of P1 and P2 at P3 and P4 can be helpful in preventing iatrogenic trauma of the ICA and JB. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of combining Eustachian tube balloon dilatation with triamcinolone acetonide on inflammatory response and immune function in secretory otitis media patients. Methods: Seventy-six (76) patients diagnosed with acute secretory otitis media in the Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China were randomly assigned to study group (SG) and control group (CG). Patients in CG received 40 mg triamcinolone acetonide injections in the tympanic membrane weekly for 4 weeks, while SG patients were administered Eustachian tube balloon dilatation in addition to triamcinolone acetonide injection. Pre- and posttreatment assessments in the two evaluated groups included the proportion of T lymphocytes, serum inflammatory molecules and Eustachian Tube Score (ETS). Results: The study group exhibited a significantly higher efficacy (92.1 %) than the control group (68.4 %; p < 0.05). In addition, the study group exhibited higher CD8+, CD4+, CD4+/CD8+ ratio and T cells proportion after treatment (p < 0.05). Furthermore, the concentration of serum inflammatory cytokines (PCT, IL-2, IL-4, TNF-α) in SG was significantly lower than that in CG (p < 0.05). Also, the ETS score in CG was lower (3.53 ± 2.40) compared to SG (5.25 ± 2.02) after treatment (p < 0.05). Conclusion: The combination of triamcinolone acetonide and Eustachian tube balloon dilation demonstrates enhanced efficacy in alleviating symptoms, diminishing inflammatory responses and reestablishing immune balance in the treatment of acute secretory otitis media, underscoring its significant promise. Longer follow-up and larger sample size prospective studies are, however, warranted. [ABSTRACT FROM AUTHOR]

Objective: Eustachian tube dysfunction is prevalent in both paediatric and adult populations. Current clinical guidelines recommend observation over topical intranasal corticosteroids for Eustachian tube dysfunction management, which remains controversial. This study aimed to systematically review randomised, controlled trials assessing topical intranasal corticosteroid efficacy in Eustachian tube dysfunction, and analyse effect through tympanometric normalisation. Methods: PubMed, EMBASE, Web of Science and Cochrane Library databases were searched. All randomised, controlled trials assessing intranasal corticosteroids in adult or paediatric Eustachian tube dysfunction patients were included. A meta-analysis of proportions was used to evaluate tympanogram normalisation. Results: Of 330 results, eight randomised, controlled trials met inclusion criteria and underwent qualitative data synthesis and risk-of-bias analysis. Meta-analysis of tympanometry data from four eligible trials (n = 512 ears) revealed no significant difference in tympanometric normalisation between intranasal corticosteroids and control (odds ratio 1.21, 95% confidence interval 0.65–2.24). Conclusion: Study results do not strongly support intranasal corticosteroids for Eustachian tube dysfunction. Data were limited, emphasising the need for larger, higher quality, randomised, controlled trials. [ABSTRACT FROM AUTHOR]

Background: Patients with aspirin-exacerbated respiratory disease (AERD) frequently experience symptoms consistent with eustachian tube dysfunction (ETD), which can substantially impair patient quality of life. Methods: We analyzed a cohort of 98 adult patients with AERD who participated in a longitudinal, survey-based study. Results: By assessing data over 1 year, we established that, in patients with AERD, the ear/facial subdomain of the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire could predict performance on the 7-item Eustachian Tube Dysfunction Questionnaire, a validated instrument for the diagnosis of ETD. We then performed a re-analysis of data from a prospective, open-label study of 22 adult patients with AERD treated with dupilumab for 3 months. We found that treatment with dupilumab was associated with a significant decrease in the SNOT-22 ear/facial subdomain score, which reflects a substantial reduction in otologic symptoms and ETD within 1 month of initiating dupilumab and was sustained for 3 months afterward. Conclusion: Our findings provide evidence that dupilumab significantly improved ETD and otologic symptoms in AERD, evidenced by changes in the SNOT-22 ear/facial subdomain score. The presence of ETD and otologic symptoms should be considered when determining the optimal therapeutic course for patients with AERD. [ABSTRACT FROM AUTHOR]

(1) Background: Eustachian tube dysfunction (ETD) is a frequently observed clinical manifestation of chronic rhinosinusitis (CRS). This systematic review aimed to evaluate the function of the Eustachian tube following endoscopic sinus surgery (ESS) in adult CRS patients with confirmed preoperative ETD symptoms. (2) Methods: A systematic search of PubMed, Cochrane, Embase, and MEDLINE electronic databases was conducted. The review was performed following the PRISMA guidelines. Studies investigating concurrent ETD in CRS patients who underwent ESS were retrieved. The changes in ETD outcomes were measured by the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7). We employed a random-effects model to conduct the meta-analysis (3) Results: We included seven observational studies that involved a total of 436 CRS patients with concurrent ETD. The pooled results revealed a statistically significant reduction (Standardized mean difference = −1.24; 95% CI = −1.64 to −0.84) in ETDQ-7 scores among the CRS with ETD patient cohort at the 3-month postoperative follow-up. (4) Conclusions: ESS serves as an effective intervention for improving E-tube function in adult CRS patients with concurrent ETD. Future prospective randomized controlled trials that incorporate various outcome predictors should be conducted to explore potential clinical factors for greater ETD improvement and normalization after ESS. [ABSTRACT FROM AUTHOR]

Objective: To determine whether balloon dilation of Eustachian tube (BDET) improves postoperative audiology and quality of life scores in children with chronic Eustachian tube dysfunction. Study Design: Retrospective study. Setting: Tertiary care pediatric center. Methods: Eligible participants were patients 8 years or older, with a history of 2 prior tubes placement. Group 1—patients completed pre‐and post‐Eustachian Tube Dysfunction Quality of Life Survey (ETDQ‐7) survey scores, Group 2—patients had available pre‐ and postdilation tympanogram data (TD), and Group 3—patients had both ETDQ‐7 survey and TD. The average time for the first and subsequent follow‐ups was 3.8 and 12.9 months, respectively. Results: A total of 43 patients (85 ears) underwent BDET. The mean age was 13.3 years (8‐18 years). Twenty‐four patients were male (55.8%) and over 80% were Caucasian. The average mean ETDQ‐7 score before and after dilation was 3.9 and 2.5, respectively. Ninety‐three percent experienced improvement of their postoperative ETDQ‐7 scores and 53% had normal postdilation ETDQ‐7 score (P <.0001). Thirty‐seven ears in Group 2 (60.7%) had improvement in postdilation TD. A greater proportion of ears showed improvement of 62.3% with a 95% confidence interval (CI) [50.1%‐74.5%] compared to 37.7% without improvement, 95% CI [25.5%‐49.87%]. Ears with type A or B TD were more likely to show improvement than ears with type C, perforated, or with tubes (P <.0001). Eighteen out of 30 ears in Group 3 (60%) experienced an improvement in both ETDQ‐7 and tympanogram. Conclusion: BDET is a safe, efficacious alternative to tubes in selected pediatric patients. [ABSTRACT FROM AUTHOR]

Objectives: Eustachian tube dysfunction (ETD) is a common disease associated with chronic otitis media. A standard diagnostic tool for ETD in patients with tympanic membrane perforation is still lacking. We developed and validated a new diagnostic model for ETD in patients with tympanic membrane perforation. Methods: A prospective study was conducted in patients who had tympanic membrane perforation from February to August 2023. We collected clinical characteristics and examination results including otoscopy, nasal endoscopy, tubomanometry, and 5-item Eustachian Tube Score (ETS-5). Univariate and multivariate logistic regression analysis was performed to determine the independent diagnostic factors. Based on this, the nomogram model was constructed. The discrimination and calibration of the nomogram were evaluated using the area under the curve (AUC), the C-index, the calibration curve, and the decision curve analysis (DCA). Results: A total of 40 participants were enrolled in the study. ETS-5 score and Eustachian tube opening mucosa inflammation in the nasopharynx were significant predictors in identifying ETD. Based on the above independent predictors, a diagnostic nomogram was successfully established. The sensitivity and specificity of the diagnostic model were 80.0% and 90.0%, respectively. The AUC and the C-index of the diagnostic model were both 0.901, which suggested that the model had a good discrimination power. The calibration curve indicated a good calibration degree of the model. DCA showed that the proposed model was useful for clinical practice. Conclusion: The nomogram model is effective and reliable in identifying ETD in patients with tympanic membrane perforation. [ABSTRACT FROM AUTHOR]

Background: Disorders affecting the temporomandibular joint (TMJ), related structures, and the masticatory muscles are called temporomandibular disorders (TMD). The two most typical symptoms are mouth opening restriction and pain. Costen noted the connection between TMD and tinnitus in 1934. These conditions are brought about by the shared structures that connect the TMJ and the auditory apparatus (bones and muscles) through a shared innervation source and specific ligaments. Wright addresses Costen ideas, which suggest that otological symptoms of TMD could be caused by auriculotemporal nerve damage, Eustachian tube restriction, or other factors causing an incorrect intratympanic pressure adjustment. Methods: Cross-sectional observation was regulated at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. The following are the inclusion criteria: patients with a TMD diagnosis and those older than 16 years old. The following conditions are excluded: neurological or oncological disorders, ear infection, and a history of face trauma. Results: The total number was 196 patients, 63.8% females and 36.2% males. A total of 76.5% had bilateral joint pain, and 21.9% had unilateral joint pain. While 70.4% had bilateral muscle pain, 18.9% had unilateral muscle pain. A total of 91.8% had mild tinnitus, while 8.2% had moderate tinnitus. Conclusion: In this study, 8.2% of patients complaining of tinnitus had severe tinnitus, while 91.8% had mild tinnitus. [ABSTRACT FROM AUTHOR]

Unmet needs in the treatment of chronic otitis media and Eustachian tube dysfunction (ETD) triggered the development of stents for the Eustachian tube (ET). In this study, for the first time, stents were placed in an artificially blocked ET to evaluate stent function. Eight adult female sheep were injected with stabilized hyaluronic acid (HA) on both sides to induce ETD. Subsequently, a tapered nitinol ET stent was inserted on one side, and animals were examined bilaterally by endoscopy, tympanometry, cone beam computed tomography, and final histology. Seven of the stents were placed in the desired cartilaginous portion of the ET. At the end of the study, one stented side appeared slightly open; all other ET orifices were closed. Tympanometry revealed re-ventilation of the middle ear in four out of seven correctly stented animals within 3 to 6 weeks after stent insertion. The major amount of HA was found at the pharyngeal orifice of the ET anterior to the stent. Thus, the stent position did not completely align with the HA position. While a functional analysis will require refinement of the experimental setup, this study provides first promising results for stent insertion in a sheep model of ETD. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the efficacy and safety of ballon dilation of the eustachian tube (BDET) in adult population suffering from Eustachian tube dysfunction (ETD). Methods: Following PRISMA criteria, a systematic review was conducted by searching PubMed, Cochrane, and Embase databases from January 2015 to March 2024. The primary outcomes included Eustachian Tube Score (ETS), tympanometry, and Valsalva maneuver. The quality of studies was assessed using the Quality in Prognostic Studies (QUIPS) instrument. Results: Overall, 11 studies were incorporated into the systematic review: two RCTs, three prospective investigations, and six retrospective studies. The balloon dilation in all investigations was performed using either Spiggle & Theis or Acclarent catheters for balloon dilation. There was heterogeneity across studies examining the effect of BDET on persistent ETD in terms of patient selection, period of follow-up, administration of conservative or surgical therapies, and use of assessment methods. Overall, the treatment yielded alleviation of symptoms, which either exhibited stability over time or demonstrated further improvement after an average duration of follow-up. Moreover, the incidence of complications was categorized as low and resolving spontaneously. The majority of the studies exhibited a high risk of bias related to confounding variables, and consequently, the overall risk of bias across most studies was considered high. Conclusion: The findings suggest BDET holds promise for ETD treatment, reducing symptom severity with minimal complications. Nonetheless, there is a need for improved studies that adhere to established indications, methodologies, and outcomes to establish a more robust body of evidence. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the validity and reliability of tubomanometry (TMM) in diagnosing obstructive Eustachian tube dysfunction (OETD) before balloon Eustachian tuboplasty (BET). Methods: A prospective cohort study was conducted, involving 25 patients with sinonasal pathology, 75 patients with middle ear disease, and 25 healthy subjects, totaling 250 ears. All participants underwent comprehensive physical examinations, including TMM, nasal videoendoscopy, otoendoscopy, Valsalva maneuver (VM), tympanometry, and audiometry. Additionally, various scales such as ETDQ-7 and ETS-7 were employed. Tympanometry served as the gold standard for assessing OETD, and comparisons were made among the measures across the three groups. Results: Among the 125 participants, 44.8% (n = 56) were female, and 55.2% (n = 69) were male, with ages ranging from 19 to 93 years (M = 48.5; SD = 15.6). In our study, VM demonstrated high sensitivity (86.3%) when tympanometry was considered the gold standard. Conversely, TMM, ETDQ-7, and ETS-7 exhibited high specificity, with ETDQ-7 showing the highest specificity (87.4%). Regarding TMM, all R values in patients within the middle ear disease group were pathological (R > 1). Conclusion: TMM has exhibited notable specificity as a diagnostic tool compared to tympanogram and VM. Nonetheless, the combination of TMM and ETDQ-7 has enabled us to conduct a diagnostic assessment with high sensitivity and specificity for chronic OETD diagnosis. [ABSTRACT FROM AUTHOR]