Tokio Sakurai

Evaluation of eustachian tubal functions in patients with otitis media with effusion

Eustachian tubal function in patients with otitis media with effusion (OME) was qualitatively evaluated. Following observation of middle ear pressure, draining function of the Eustachian tube was tested by introduction of specially prepared dye into the middle ear and subsequent inspection of the nasopharyngeal opening of the tube for dye during application of swallowing. Obtained were followings:1. In cases of children, Eustachian tube may be reversibly functioned by equalizing the negative middle ear pressure to the ambient pressure. Draining function was considerably improved in 82.9% of cases. On the contrary, equalization of pressure difference may not provide the improvement of the Eustachian tubal function in cases of adults. Improvement in draining function was achieved only in two cases out of 34. These suggest that tubal dys-function is usually constituted by temporary functional disturbance of tubal opening and closing mechanism caused by persistent middle ear negative pressure in children, whereas Eustachian tube muscles are mainly involved in adults.2. Application of swallowing induced two different types of pressure change in the middle ear;(1) the positive pressure change followed by negative change (observed in 25% of cases), (2) just the negative pressure change (75%). Negative pressure dominant change may be considered to mainly contribute to the development of OME

Pathophysiology Of Otitis Media With Effusion: Clinical Evaluation Through Some Qualitative Methods

In an attempt to elucidate the pathophysiology of otitis media with effusion (OME), systematic clinical investigations were undertaken. The high resolution computed tomography, tympanogram, tubal inflation and our qualitative tubal functioning test were routinely applied to cases of OME, both in children and adults. Through these studies, following was concluded: 1. The primary pathology involved may be obstructive lesion somewhere in the tubotympanic cleft including the epitympanum and the mastoid, which in turn results in negative pressure in the middle ear. 2. This negative middle ear pressure may mainly constitute the Eustachian tube dysfunction, which is considered to play an important role in the pathogenesis of OME. Discussed in detail further will be the importance of correcting the negative middle ear pressure substantially for the treatment of OME, and also the essence of our qualitative tubal functioning test.