Yoko Hori

Three-dimensional computed tomography imaging in the sitting position for the diagnosis of patulous eustachian tube.

Objective: Computed tomography (CT) in the sitting position was useful for detecting patulous Eustachian tube (ET). Study Design: Retrospective. Setting: Tertiary referral center. Patients: Eighty-seven patients divided into two groups. The patulous ET group consisted of 111 ears of 67 patients with patulous ET. The control group consisted of 30 ears of 20 patients without symptoms characteristic of patulous ET or abnormal findings in ET function tests. Main Outcome Measures: CT was performed under the resting condition and during Valsalva maneuver (Valsalva condition). The multiplanar reconstruction technique was used to reconstruct 1-mm-thick gapless images parallel to and perpendicular to the ET long axis. The open tubal distance (OTD) and average ET-gram were examined. Results: The OTD was significantly longer in the patulous ET group than in the control group under both resting and Valsalva conditions (both p < 0.001). The OTD was also significantly longer under the Valsalva condition than under the resting condition in both groups (p < 0.01 in the patulous ET group, p < 0.001 in the control group). The average ET-gram showed an occlusive zone in the cartilaginous portion medial to the isthmus under both the resting and Valsalva conditions in the control group (n = 30). However, the occlusive zone could not be observed under either the resting or Valsalva conditions in the patulous ET group (n = 111). Completely patent (open) ET was observed with continuous hyperlucency from the pharyngeal to the tympanic orifices in 88 of 111 patients in the patulous ET group, but in none of the control group, indicative of 100% specificity. Conclusion: Computed tomography in the sitting position employing Valsalva maneuver is useful for the diagnosis of patulous ET.

Audiometry with nasally presented masking noise: novel diagnostic method for patulous eustachian tube.

Objective: Nasal-noise masking audiometry was developed to assess the acoustic transfer function from the nasopharyngeal cavity to the middle ear via patulous eustachian tube (ET). Study Design: Prospective. Setting: Tertiary referral center. Patients: Twenty-seven ears of 18 patients with patulous ET and 20 ears of 10 healthy subjects with no history of ear disease or complaints of aural symptoms. Main Outcome Measures: Audiometric measurement was conducted with and without masking noise presented in the nasal cavity. Results: The masking effect of nasally presented noise caused elevation of the threshold for the tone presented in the external auditory canal. This threshold elevation was significantly greater, particularly in the lower-frequency region, in ears with patulous ET and was decreased to the normal range after obstructive treatment of the patulous ET. Conclusion: Nasal-noise masking audiometry is a simple and effective way to identify patulous ET.

Bimodal audio-visual training enhances auditory adaptation process

Effects of auditory training with bimodal audio–visual stimuli on monomodal aural speech intelligibility were examined in individuals with normal hearing using highly degraded noise-vocoded speech sound. Visual cue simultaneously presented with auditory stimuli during the training session significantly improved auditory speech intelligibility not only for words used in the training session, but also untrained words, when compared with the auditory training using only auditory stimuli. Visual information is generally considered to complement insufficient speech information conveyed by the auditory system during audio–visual speech perception. However, the present results showed another beneficial effect of audio–visual training that the visual cue enhances the auditory adaptation process to the degraded new speech sound, which is different from those given during bimodal training.

Three-Dimensional Computed Tomography Imaging of the Eustachian Tube Lumen in Patients with Patulous Eustachian Tube

Background: The eustachian tube (ET) has a complicated anatomy, which is related to middle ear pathology. The anatomy of the ET has been well investigated in cadavers, but may not accurately reflect that in living subjects. Three-dimensional (3D) computed tomography (CT) was used to examine the ET in patients with patulous ET. Method: The subjects were 35 patients (17 males, aged 59 ± 16 years, and 18 females, aged 44 ± 15 years) with patulous ET which could be continuously traced from the pharyngeal orifice to the tympanic orifice (53 ears). CT was performed in the sitting position at rest, followed by 3D reconstruction. The course of the ET from the middle ear to the pharynx was visualized in 3D surface images. Morphological measurements of the curvature angle (angle C) and the inclination angle (angle I) were determined from 3D coordinates on the CT images. Results: The full length of the ET could be visualized in most patients suffering from patulous ET in the sitting position. Angle C was 21.7 ± 5.8° in the patients aged <40 years (n = 20), which is significantly larger than 16.7 ± 6.8° in the patients aged >59 years (n = 18; Student’s t test, p < 0.05). Angle I was 26.5 ± 4.2° in the patients aged <40 years (n = 20), also significantly larger than 21.6 ± 5.8° in the patients aged >59 years (n = 18; Student’s t test, p < 0.05). Conclusion: CT in the sitting position is a potential diagnostic tool of the ET and middle ear pathology.

Magnetic resonance imaging of the eustachian tube cartilage.

Conclusion. No useful examination was available for morphological assessment of the eustachian tube cartilage (ETC) in living subjects, but evaluation of magnetic resonance (MR) imaging enables useful assessment of the eustachian tube (ET) and ETC during preoperative examination before ET surgery. Objectives. The objective of this study was to investigate the usefulness of MR imaging for analysis and assessment of the ETC. Subjects and methods. Analysis of MR images. Results. The ETC could be demonstrated by oblique parasagittal MR imaging in most subjects, but was poorly defined in others, particularly in aged subjects. The ETC appeared as a hook-shaped structure with wide variability.

Involvement of pterygoid venous plexus in patulous eustachian tube symptoms.

Conclusions. The pterygoid venous plexus (PVP) is an important factor in the mechanism of eustachian tube (ET) closure under conditions that can cause increased venous pressure in the head, such as during neck compression and postural change from the sitting/standing to the recumbent position. Objectives. The symptoms of patulous ET are usually improved by neck compression or postural change (from sitting/standing to recumbent position). Venous congestion around the ET and/or gravitational change may be involved in the changing degree of symptoms, but its mechanism is not understood. This study investigated whether the PVP is involved. Materials and methods. The dimensions of soft tissues surrounding ET were measured on magnetic resonance images before and after neck compression. Results. The lateral pterygoid muscle became enlarged after neck compression. Simultaneously, the volume of venous plexus observed between the medial pterygoid muscle and tensor veli palatini muscle was increased. Such enlargement was probably due to blood pooling in the PVP, resulting in protrusion of the ET anterior wall to the luminal side, and decreased ET patency.

The effects of mastoid aeration on autophony in patients with patulous eustachian tube

The effect of the mastoid pneumatization on sound transmission from the nasopharyngeal cavity to the inner ear, which is one of the important factors to indicate the severity of the patulous eustachian tube (ET), are investigated in patients with patulous ET. Twenty ears of 13 subjects with patulous ET were retrospectively analyzed. Sound transmission from the nasopharyngeal cavity to the inner ear was evaluated by observing the masking effects of noise presented in the nasopharyngeal cavity on the auditory threshold (nasal noise masking audiometry). The relationship between this masking effect and mastoid pneumatization were examined among the patients with similar conditions of ET patency. The masking effect of nasally presented noise was greater with less developed mastoid pneumatization. The present results indicate that the symptoms associated with patulous ET may be more distressful in patients with poorly developed mastoid cavity than in those with well-aerated mastoid under similar conditions of ET patency.

Objective assessment of autophony in patients with patulous Eustachian tube

The objective of the present study is to evaluate the Eustachian tube (ET) acoustic patency during phonation. The sound level in the EAC during phonation of the “A” and ”N” sounds was measured by microphones in the bilateral EACs of nine normal subjects and 31 patients with patulous ET. The measured sound pressure differences between the right and left ears were correlated with the differences in severity of autophony between the bilateral ears assessed by a visual analogue scale (VAS). The patulous condition was often remarkable when the “N” sound was phonated. In some patients with patulous ET, the patulous condition was indicated only by the present method, and not by conventional ET function tests such as tubo-tympano-aerodynamic-graphy or sonotubometry.

Patulous Eustachian tube associated with hemodialysis

The objective of the present study is to demonstrate that hemodialysis (HD) is a possible causal factor for patulous Eustachian tube (ET). We present a representative case report and results of a mass examination in the HD unit. The present patient (a 55-year-old woman) reported aural fullness and autophony were often experienced after HD. The findings of eardrum and ET function tests revealed that her patulous ET condition was observed soon after HD and then disappeared until the next HD. A survey in the HD unit was carried out to identify patients who noticed patulous symptoms after HD. Patients underwent further examination, including detailed interview, otoscopy, and ET function tests with sonotubometry and tubo-tympano aerodynamic-graphy just before and soon after HD. The survey at the HD unit found 13 of 147 HD patients (8.8%) had HD-related patulous ET. Aural symptoms occurring after HD are frequently caused by patulous ET.

Effects of hearing level on habitual sniffing in patients with cholesteatoma.

Conclusions. Quality of hearing is one of the key conditions promoting habitual sniffing associated with closing failure of the Eustachian tube and sniffing may stop with deterioration of hearing due to progression of the disease. Objective: To examine habitual sniffing associated with closing failure of the Eustachian tube and hearing level in patients with cholesteatoma. Patients and methods. A total of 171 patients with middle ear cholesteatoma treated in Tohoku University Hospital (106 sides in 101 patients, 63 males and 38 females, mean age 43.3 years), and Sendai Ear Surgi Center (70 sides in 70 patients, 37 males and 33 females, mean age 42.7 years) were included. The patients were divided into two groups based on the presence or absence of habitual sniffing, and pre- and postoperative hearing was compared between the two groups. Results. Habitual sniffing was not found in patients with air conduction hearing level worse than 60 dB or air–bone gap larger than 40 dB. Habitual sniffing disappeared in all patients with expanded air–bone gaps in lower frequency regions after surgery.