MIDDLE EAR VENTILATION IN SECRETORY OTITIS MEDIA JORGEN HOLMQUIST, ULF RENVALL,
M.D.
M.D.
GOTEBORG, SWEDEN
SUMMARY - The Eustachian tube function was determined repeatedly in 42 patients during as well as after the course of secretory otitis media. Air pressure equalization technique and impedance audiometry were used. Also the size of the mastoid air cell system was determined. It was found that poor tubal function and a small mastoid air cell system are significant findings in these ears.
Maintenance of equal air pressure over the tympanic membrane is considered one prerequisite for optimal sound transmission from the ear canal to the cochlea. Many factors might be involved in preserving this state of equilibrium, e.g., tympanic membrane mechanics, the amount of gas absorbed through the mucosal lining in the tympanic cavity, the volume of the air filled middle ear cleft, and ventilatory capacity of the Eustachian tube. Information concerning the quantity and quality of these factors in the normal as well as in the pathological ear is essential for our understanding of different middle ear diseases. During the last decade data obtained from normal ears and ears with chronic otitis media concerning middle ear ventilation have been reported.'" Information about these factors in ears with secretory otitis media is more scarce,11-13 and there is need for further analysis of the ventilatory capacity during this disease. In this communication the function of the Eustachian tube and the size of the mastoid air cell system in ears with secretory otitis media will be reported. METHODS AND TECHNIQUES
Eustachian Tube Function. By means of the air pressure equalization technique the Eustachian tube function was determined in 55 ears (42 adult patients) with secretory otitis media. A detailed description of the ma-
terial as well as of the testing technique and the procedure is presented in earlier reports.":" Middle Ear Air Pressure. The air pressure in the middle ear was evaluated by means of impedance audiometry using a Madsen ZO 70 Bridge in 51 ears prior to myringotomy as well as after healing of the tympanic membrane. In a re-examination of 40 of these ears more than ten months after tympanic membrane healing, the middle ear pressure was again determined. A detailed description of the procedure is presented in an earlier report." Middle Ear Air Pressure in Relation to Eustachian Tube Function. It seems clear that the demonstration of a subnormal middle ear air pressure in 60% of the ears after healing of the tympanic membrane also implies inadequate tubal function. One question which must be raised here is whether the normal middle ear air pressure demonstrated in 40% of the ears after secretory otitis media also implies normal Eustachian tube function in these ears. In order to answer this question, 27 ears with normal middle ear air pressure but with histories of Eustachian tube problems were investigated. Size of Mastoid Air Cell System. Besides Eustachian tube function, the volume of air in the middle ear cleft also seems to be an important factor, with regard to middle ear ventilation. In 47 out of the 55 ears with secretory otitis media the mastoid air cell system was measured by planimetry of the lateral x-ray picture." The planimetrically measured size is well correlated to the volume of the middle ear as reported by Flisberg and Zsigmond." The different relations between volume of ears
"Planimetric measurement of the air cell system on roentgen films has been performed by Ebbe Malmcrona, Roentgen Department I, Sahlgrens's Hospital, Coteborg, Sweden. From the Department of Otolaryngology, Sahlgren's Hospital, University of Coteborg, Sweden. Supported by grants from the Swedish Medical Research Council (Project 17 X 3124) and AB Recip, Stockholm, Sweden. 178
MIDDLE EAR VENTILATION " or
'0.
179
tRRS
A
c
8
_"W' On the basis of the results put forward in this report, however, a definitive statement about the etiology can not be made. Further research in this field is necessary in order to give a definite answer to the question of which factor - or factors - is causative in this condition. CONCLUSIONS
It has been shown that dysfunction of the Eustachian tube, reduction of the middle ear air pressure during and after secretory otitis media, as well as reduced size of the middle ear cleft, are characteristic.findings in secretory otitis media. The question as to which of these factors is the most important from an etiological point of view can not be given a definitive answer.
MIDDLE EAR VENTILATION
Ears with secretory otitis media should be looked upon as belonging to a risk group and in order to prevent development of middle ear pathology, regular
181
checks of ears with a history of secretory otitis media must be of great importance.
REFERENCES 1. Miller G: Eustachian tubal function in et al: Mechanics of the Eustachian tube as it normal and diseased ears. Arch Otolaryngol influences susceptibility to and persistence of 81:41, 1965 middle ear effusions in children. Ann Otol 2. Flisberg K: Ventilatory studies on the Rhinol Laryngol 83 (Suppl 11:27), 1974 Eustachian tube. Acta Otolaryngol [Suppl] 14. Holmquist J, Renvall U: Eustachian (Stockh) 219, 1966 tube function in secretory otitis media. Arch 3. Riu R, Flottes L, Bouche J, et al: La Otolaryngol 99:59, 1974 Physiologie de la Trompe d'Eustache. Paris, 15. Renvall U, Holmquist J: Eustachian Librairie Arnette, 1966 tube function in secretory otitis media. Scand 4. Ingelstedt S, Ivarsson A, Jonson B, et Audiol 3:87, 1974 al: Mechanics of the human middle ear. 16. Renvall U: Tympanometry in secreActa Otolaryngol [Suppl] (Stockh) 228, 1967 tory otitis media. Scand Audiol 4, 1975. 5. Siedentop K, Tardy E, Hamilton L, et 17. Flisberg K. Zsigmond M: The size of al: Eustachian tube function. Arch Otolarynmastoid air cell system. Acta Otolaryngol gol 88:386, 1968 (Stockh) 60:23, 1965 6. Holmquist J: The role of the Eustachian tube in myringoplasty. Acta Otolaryn18. Diamant M: Otitis and pneumatization gol (Stockh) 66:289, 1968 of the mastoid bone. Acta Otolaryngol [Suppl] (Stockh) 41, 1940 7. Ekvall L: Eustachian tube function in 19. Diamant M, Rubensohn E, Walander tympanoplasty. Acta Otolaryngol ( Stockh ) A, et al: Otosalpingitis and mastoid pneu263:33, 1970 8. PaIva A, Karja J: Eustachian tube matization. Acta Otolaryngol (Stockh) 49: patency in chronic ears. Acta Otolaryngol 381, 1958 20. Shea J: Autoinflation treatment of ser[Suppl] (Stockh) 263:25, 1970 ous otitis media in children. J Laryngol 84: 9. Elner A, Ingelstedt S, Ivarsson A, et 1254, 1971 al: Indirect determination of the middle ear 21. Holmquist J: Eustachian tube function pressure. Acta Otolaryngol (Stockh) 72:225, in patients with ear drum perforations follow1971 ing chronic otitis media. Acta Otolaryngol 10. Andreassen L: Kronisk slemhinneotit. (Stockh) 68:391, 1969 Malmo Allmanna Sjukhus tryckeri, Malmo, 22. Draper W: Secretory otitis media in Sweden, 1973 children: a study of 540 children. Laryngo11. Silverstein H, Miller GE, Lindeman scope 77:636, 1967 RC, et al: Eustachian tube dysfunction as a 23. Arnold W: Ultrastrukturelle expericause for chronic secretory otitis media in mentella Untersuchungen zur pathogenese des children. Laryngoscope 76:259, 1966 serosen Paukenergusses. Arch Klin Exp Ohren 12. Westergaard 0: Tubal function in pa- Nasen Kehlkopfheilkd 200:91, 1972 tients with chronic secretory otitis media. Acta 24. Proud G, Hiroshi I: Effects of EustaOtolaryngol (Stockh) 263: 23, 1970 chian tube ligation. Ann Otol Rhinol Laryn13. Bluestone C, Beery QC, Andrus WS, gol 79:33, 1970 REPRINTS - [orgen Holmquist, M.D., Dept. of Otolaryngology, Central Hospital, 651 85 Karlstad, Sweden.
M.D.
M.D.
GOTEBORG, SWEDEN
SUMMARY - The Eustachian tube function was determined repeatedly in 42 patients during as well as after the course of secretory otitis media. Air pressure equalization technique and impedance audiometry were used. Also the size of the mastoid air cell system was determined. It was found that poor tubal function and a small mastoid air cell system are significant findings in these ears.
Maintenance of equal air pressure over the tympanic membrane is considered one prerequisite for optimal sound transmission from the ear canal to the cochlea. Many factors might be involved in preserving this state of equilibrium, e.g., tympanic membrane mechanics, the amount of gas absorbed through the mucosal lining in the tympanic cavity, the volume of the air filled middle ear cleft, and ventilatory capacity of the Eustachian tube. Information concerning the quantity and quality of these factors in the normal as well as in the pathological ear is essential for our understanding of different middle ear diseases. During the last decade data obtained from normal ears and ears with chronic otitis media concerning middle ear ventilation have been reported.'" Information about these factors in ears with secretory otitis media is more scarce,11-13 and there is need for further analysis of the ventilatory capacity during this disease. In this communication the function of the Eustachian tube and the size of the mastoid air cell system in ears with secretory otitis media will be reported. METHODS AND TECHNIQUES
Eustachian Tube Function. By means of the air pressure equalization technique the Eustachian tube function was determined in 55 ears (42 adult patients) with secretory otitis media. A detailed description of the ma-
terial as well as of the testing technique and the procedure is presented in earlier reports.":" Middle Ear Air Pressure. The air pressure in the middle ear was evaluated by means of impedance audiometry using a Madsen ZO 70 Bridge in 51 ears prior to myringotomy as well as after healing of the tympanic membrane. In a re-examination of 40 of these ears more than ten months after tympanic membrane healing, the middle ear pressure was again determined. A detailed description of the procedure is presented in an earlier report." Middle Ear Air Pressure in Relation to Eustachian Tube Function. It seems clear that the demonstration of a subnormal middle ear air pressure in 60% of the ears after healing of the tympanic membrane also implies inadequate tubal function. One question which must be raised here is whether the normal middle ear air pressure demonstrated in 40% of the ears after secretory otitis media also implies normal Eustachian tube function in these ears. In order to answer this question, 27 ears with normal middle ear air pressure but with histories of Eustachian tube problems were investigated. Size of Mastoid Air Cell System. Besides Eustachian tube function, the volume of air in the middle ear cleft also seems to be an important factor, with regard to middle ear ventilation. In 47 out of the 55 ears with secretory otitis media the mastoid air cell system was measured by planimetry of the lateral x-ray picture." The planimetrically measured size is well correlated to the volume of the middle ear as reported by Flisberg and Zsigmond." The different relations between volume of ears
"Planimetric measurement of the air cell system on roentgen films has been performed by Ebbe Malmcrona, Roentgen Department I, Sahlgrens's Hospital, Coteborg, Sweden. From the Department of Otolaryngology, Sahlgren's Hospital, University of Coteborg, Sweden. Supported by grants from the Swedish Medical Research Council (Project 17 X 3124) and AB Recip, Stockholm, Sweden. 178
MIDDLE EAR VENTILATION " or
'0.
179
tRRS
A
c
8
_"W' On the basis of the results put forward in this report, however, a definitive statement about the etiology can not be made. Further research in this field is necessary in order to give a definite answer to the question of which factor - or factors - is causative in this condition. CONCLUSIONS
It has been shown that dysfunction of the Eustachian tube, reduction of the middle ear air pressure during and after secretory otitis media, as well as reduced size of the middle ear cleft, are characteristic.findings in secretory otitis media. The question as to which of these factors is the most important from an etiological point of view can not be given a definitive answer.
MIDDLE EAR VENTILATION
Ears with secretory otitis media should be looked upon as belonging to a risk group and in order to prevent development of middle ear pathology, regular
181
checks of ears with a history of secretory otitis media must be of great importance.
REFERENCES 1. Miller G: Eustachian tubal function in et al: Mechanics of the Eustachian tube as it normal and diseased ears. Arch Otolaryngol influences susceptibility to and persistence of 81:41, 1965 middle ear effusions in children. Ann Otol 2. Flisberg K: Ventilatory studies on the Rhinol Laryngol 83 (Suppl 11:27), 1974 Eustachian tube. Acta Otolaryngol [Suppl] 14. Holmquist J, Renvall U: Eustachian (Stockh) 219, 1966 tube function in secretory otitis media. Arch 3. Riu R, Flottes L, Bouche J, et al: La Otolaryngol 99:59, 1974 Physiologie de la Trompe d'Eustache. Paris, 15. Renvall U, Holmquist J: Eustachian Librairie Arnette, 1966 tube function in secretory otitis media. Scand 4. Ingelstedt S, Ivarsson A, Jonson B, et Audiol 3:87, 1974 al: Mechanics of the human middle ear. 16. Renvall U: Tympanometry in secreActa Otolaryngol [Suppl] (Stockh) 228, 1967 tory otitis media. Scand Audiol 4, 1975. 5. Siedentop K, Tardy E, Hamilton L, et 17. Flisberg K. Zsigmond M: The size of al: Eustachian tube function. Arch Otolarynmastoid air cell system. Acta Otolaryngol gol 88:386, 1968 (Stockh) 60:23, 1965 6. Holmquist J: The role of the Eustachian tube in myringoplasty. Acta Otolaryn18. Diamant M: Otitis and pneumatization gol (Stockh) 66:289, 1968 of the mastoid bone. Acta Otolaryngol [Suppl] (Stockh) 41, 1940 7. Ekvall L: Eustachian tube function in 19. Diamant M, Rubensohn E, Walander tympanoplasty. Acta Otolaryngol ( Stockh ) A, et al: Otosalpingitis and mastoid pneu263:33, 1970 8. PaIva A, Karja J: Eustachian tube matization. Acta Otolaryngol (Stockh) 49: patency in chronic ears. Acta Otolaryngol 381, 1958 20. Shea J: Autoinflation treatment of ser[Suppl] (Stockh) 263:25, 1970 ous otitis media in children. J Laryngol 84: 9. Elner A, Ingelstedt S, Ivarsson A, et 1254, 1971 al: Indirect determination of the middle ear 21. Holmquist J: Eustachian tube function pressure. Acta Otolaryngol (Stockh) 72:225, in patients with ear drum perforations follow1971 ing chronic otitis media. Acta Otolaryngol 10. Andreassen L: Kronisk slemhinneotit. (Stockh) 68:391, 1969 Malmo Allmanna Sjukhus tryckeri, Malmo, 22. Draper W: Secretory otitis media in Sweden, 1973 children: a study of 540 children. Laryngo11. Silverstein H, Miller GE, Lindeman scope 77:636, 1967 RC, et al: Eustachian tube dysfunction as a 23. Arnold W: Ultrastrukturelle expericause for chronic secretory otitis media in mentella Untersuchungen zur pathogenese des children. Laryngoscope 76:259, 1966 serosen Paukenergusses. Arch Klin Exp Ohren 12. Westergaard 0: Tubal function in pa- Nasen Kehlkopfheilkd 200:91, 1972 tients with chronic secretory otitis media. Acta 24. Proud G, Hiroshi I: Effects of EustaOtolaryngol (Stockh) 263: 23, 1970 chian tube ligation. Ann Otol Rhinol Laryn13. Bluestone C, Beery QC, Andrus WS, gol 79:33, 1970 REPRINTS - [orgen Holmquist, M.D., Dept. of Otolaryngology, Central Hospital, 651 85 Karlstad, Sweden.
