Niels van Heerbeek

Eustachian tube function in children after insertion of ventilation tubes.

This study was performed to assess the effect of the insertion of ventilation tubes and the subsequent aeration of the middle ear on eustachian tube (ET) function in children. Manometric ET function tests were performed repeatedly for 3 months after the placement of ventilation tubes in 83 children with otitis media with effusion (OME). Opening and closing pressures (passive tubal function) and active tubal function were measured. Analysis of the results showed a significant increase in opening pressure over time, whereas the closing pressure did not change. The active tubal function did not change and remained at the same poor level. Therefore, the opening pressure and closing pressure and, especially, the poor active tubal function, were more likely to be a causal factor of OME than a result. Certain children may have poor intrinsic ET function that makes them more susceptible to OME.

Reliability of manometric eustachian tube function tests in children

Objective To assess the reliability of manometric eustachian tube function tests in children with ventilation tubes in situ. Study Design Repeated manometric eustachian tube function tests during one session. Setting The study took place at a secondary referral hospital and a tertiary referral hospital. Patients Ninety-nine children with ventilation tubes in situ because of persistent otitis media with effusion. Main Outcome Measures Opening pressure (Po), closing pressure (Pc), and tubal function group. Results Analysis of Po and Pc showed a decrease with repeated measurement (p = 0.0001 and p = 0.001, respectively). The effect of repeated measurement on Po was more pronounced than the effect on Pc. The results of the first and second pressure equilibration tests showed 99% agreement. Conclusions: This study showed good reproducibility of the categorized results of the pressure equilibration test, whereas the results of the forced-response test seemed to be less reproducible and showed a downward shift with repeated measurement. A single measurement using wet swallowing and starting pressures of 100 and −100 daPa and the mean of the first three measurements of the Po and Pc are sufficient to determine tubal function. Further studies are needed to determine the discriminative power of these tests in children with different degrees of middle ear disease.

No effect of a nasal decongestant on eustachian tube function in children with ventilation tubes

Objective The aim of the study was to assess the effect of a topical decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion.

Left-right differences in Eustachian tube function in children with ventilation tubes.

OBJECTIVE To study the intraindividual variation in Eustachian tube (ET) function in children with ventilation tubes. METHODS The forced response test, the pressure equilibration test and the sniff test were performed on both ears of 148 children. The results of both ears were compared. RESULTS No systematic differences were found between the left and the right ears. However, the intraindividual variation was very pronounced. The variation in passive ET function within children was of similar magnitude as the variation in passive ET function between children. Twenty-eight percent of the children had different active ET function in both ears and 15% had an opposite result in each ear with respect to the sniff test. CONCLUSIONS This study shows that ET function is much more a characteristic of the individual ear than of the individual child. These findings also question the validity of trials on ET function or middle ear disease that use the opposite ear as a control (split level design).

Sonotubometry in Children With Otitis Media With Effusion Before and After Insertion of Ventilation Tubes

OBJECTIVES To test the outcome of sonotubometric measurement in children with otitis media with effusion (OME) before and after insertion of ventilation tubes. DESIGN Eustachian tube ventilatory function was tested in children with OME. To test validity, sonotubometric testing took place before insertion of ventilation tubes (ie, glue ear) and 1 week and 3 months after grommet insertion (ie, aerated middle ear cavity). One set of measurements consisted of 10 acts of swallowing. The outcomes of the tests were compared with those in otologically healthy controls. SETTINGS All testing took place during an outpatient clinic otorhinolaryngologic consultation in a city hospital. PATIENTS Thiry-three children with OME and 61 otologically healthy children (controls). INTERVENTIONS Surgical grommet insertion. MAIN OUTCOME MEASURES Sonotubometric measurements before and after insertion of ventilation tubes. RESULTS Fewer incidences of the opening of the eustachian tube were recorded in the measurements before insertion of ventilation tubes compared with after insertion. The number of incidences of opening recorded after insertion of ventilation tubes did not significantly differ from measurements in healthy controls. CONCLUSIONS Sonotubometric testing in children with OME reveals a low incidence of eustachian tube opening. Shortly after insertion of ventilation tubes, sonotubometry revealed no difference in eustachian tube ventilatory function compared with measurements in healthy controls. The low incidence of eustachian tube opening before grommet insertion may be attributable to decreased opening or dampening of the sound transmission by the middle ear fluid.

Effect of exogenous surfactant on ventilatory and clearance function of the rat's eustachian tube.

Hypothesis and Background The Eustachian tube has three important functions with respect to the middle ear: ventilation, clearance, and protection. Surfactants are assumed to be important to maintain these functions. The administration of exogenous surfactant may therefore be effective to improve the function of the Eustachian tube. This randomized, double-blind, placebo-controlled study was designed to investigate the effect of exogenous surfactant on the function of the Eustachian tube in rats. Materials and Methods Exogenous surfactant was administered into the middle ear of 10 otologically healthy rats, and 10 other rats received placebo. The effect on the opening and closing pressure (passive ventilatory function) and the dye clearance time (clearance function) of the rats Eustachian tube was measured. Results A significant decrease in the opening pressure was seen after the administration of surfactant. Both surfactant and placebo caused an increase in the closing pressure. A serious disturbance of the dye clearance time was induced in 13 rats, and the test failed in 1 rat. In the remaining 6 rats, no significant differences in the dye clearance time were observed between the two groups. Conclusions Exogenous surfactant decreased the closing forces of the Eustachian tube even in otologically healthy rats. No significant effect on the mucociliary clearance was observed, but this may have resulted from the small number of rats. Additional randomized, double-blind, placebo-controlled trials should be conducted to determine the clinical relevance of these changes and to further assess the effect of surfactant on the function of the Eustachian tube.