HOW WE CORRECT TUBAL DYSFUNCTION
The Eustachian tube has three functions (aerodynamic-ventilation, evacuation, protection), which depend on anatomical structure, heredity, normal innervation (sympatic, parasympatic, vegetative system, which carry out swallowing and secretion), muco-ciliaris system of mucosa, tubal muscles function, nose and paranasales sinusis. In the beginning of the XIX century many methods of treatment have been described, especially in
monographs.2–4,7–14,18–20,25,44,45,49,50,52,54,55,56
Over the last 12 years, depending on the causes (inflammation or anatomical character) leading scientists of the world improved techniques as therapeutic methods2,4,5,6,8, 9,11, 15–19,26,, 29–35, 41–44,51,55,56 and surgical treatment of the Eustachian tube dysfunction (ETD).8,9,15,20,37–40,41,46,47,48,52,55,56
According to Bluestone C., many factors are etiology of Eustachian tube dysfunction (ETD) that is why needing complex methods of treatment its diseases.4,5,6,7,8
Ours experience more 30 years of the treatment ETD with different etiology elaborate two groups methods: therapeutic complex management and chirurgical treatment.
The first applies for all with ETD in spite of causes (especially inflammation and allergy, upper airways diseases):
•Cleaning of the nasale cavity by endonasal irrigation therapy (eliminating therapy,nasal wash, nasal douche): daily endonasal lavage with assistance of a special device – aqua maris rinsingand with isotonic or hyper- tonic sea solution (Aqua Maris, Humer and a.o.) during an extended period (three times daily) to remove secretions, congested nose, dust, allergens, harmful substances, biofilms.
•After nasal douch (5–10minutes) local endonasal spray corticosteroid (mometasone furoate or fluticasone furoat) two times daily during 10–12 days in acute process, and one month in the chronic inflammation and 2–4 month in the allergy.
•Antibiotic therapy (macrolide, amoclave, phtorchinolone III generation), antiinflammation therapy (non- steroid-antiinflammation medicines), antileukotriens (montelukast).30,31
•Immunocorrection (phyto-engineering medicines-sinupret, imupret, immunotherapy).
•Combined reflexotherapy (acupuncture) according to classic methods (acupuncture, auriculopuncture, vi- bropressures, vibroacupuncture, electropuncture).
Innervation ET (based on literature, experimental data) shows a close relationship with ET, middle ear cleft and upper respiratory ways (especially ganglion oticom, pl.tympaniy, chorda tympany, pl.pharyngei, barore-ceptors).1,5,7,9,10,16,17,20,26,32,33,45,49,50,53,54,55
Disorder in balance sympatho-parasympatic systems leads to edema, hyperproduction of the secretion by secretory cells and glands of the mucous membrane of the ET, which leads to disruption of the mucociliary system and consequently to ETD. In addition, disorder of motor innervation MTVP,MLVP and other muscles in the region pharyngeal orifice(n.mandibularis,nn.palatini) disrupts the normal opening act of the ET.
•Therefore, since the 80-ty of last century, we in the most cases of the ETD use periodic sessions of acu puncture in different ways. Combined reflexotherapy (CRT):acupuncture with vibro- or laseropuncture with auriculomicropuncture (for adult), or electropunctrure with vibropressure (for children),treatment consist with 10–15 sessions. Cycles of the reflexotherapy repeated in 3 and 6 months period. Ours experiences have been confirming, that CRT further of rehabilitation of sympato-parasympatic innevation ET and nasal cavitys and activisated mucociliaris transport in the paranasal sinusis and ET, acts swallowing and open pharyngeal orifice of ET.29,30,32,33
•Treatment by hyperbarooxygenisation in the special devices-barocamera, (baroreceptors-stimulation acts swallowing of ET and intratympanic oxygenation ). At the beginning XX century, especially in the 40–50 years airmen trained in special chambers to changes in barometric pressure, and it was proved that this way you can activated open of the ET in healthy persones. A with 70-ty years XX century of clinical practice in the cardiology used in therapeutic séance of the Hyperbarooxygenization (HBO). Since the 80-ty years XX century we use treatment by HBO in acute and chronic sensorineural hearing loss, and also at ETD (late and middle degree dysfunction), but after each seances (warning of barootitis) –otomicroscopic control. As shown by ours experience of HBO- treatment not only restore intratympanic pressure and partial pressure of gases, but reduce swelling of the nasal mucosa and ET.25,37
•Endonasale ultra-sonopuls-aerosoltherapy whith mucolitics and local corticosteroids11,12,13,14,16,17,18,21,30,32,34,35,36,43,44,45,46;
•Special exercises-kinesitherapy for tubal muscles by Riu R. and Jacobs A.3,21,22,23,24,26,27,28,41,51,53, and improve by us (special exercise for ET, pharynx, palate, neck, tongue muscles) and mechanical and vibromassage tubal pharyngeal orifice with special devices.23,24,26–30
The second group individual allocation according from causes:
•Complex antiallergy therapy: immunotherapy, spray azelastine(allergodyl) and local (endonasale) cortico- steroid (mometazone or fluticasone furoat), antihistamine medecines (levoceterizine, dezloratadine).
•Chirurgical treatment (FESS with rhinoseptoplastic and optical adenotomy particular area of tube pharyngeal orifice and fossa rosenmulleri, polipotomy and vasotomy).38,39,40
Materials and results
Functional state of the Eustachian tube had been ivestigating by impedance tympanometry in dynamic (swallowing- test Valsalva,-test Toynbee, – swallowing with drink of water), pneumorhinomanometry, rhinoendos-copie and epipharyngoscopie particulary pharyngeal orifice of the ET (ear salpingoscopie), otomicroscopie (atelectasis of tympan:p.tensa by Sade J.,p.flacida by Tos M.) Grade of ETD determined by C.Bluestone5–8: late(1).middle(2),severe(3);acute or chronic.
During 2006–2011years we had been examining 756 patients with different causes: allergic persistence rhinosinusitis(APRS)-105 (ETD-100%), acute rhinosinusitis(ARS)-156 (ETD-97%), ch. rhinosinusitis(CRS)-215 (ETD-98%), ch.rhinosinusitis with polyps(CRSwP)-150 (ETD-100%), deformation septum nasale(DSN)-110 (ETD-78%), ch.adenoiditis II-IIst.(CAT)-64 (ETD-100%).Atelectasis of Middle Ear has been connecting with ETD. Treatment of EDT we are choiced individually for every cases.
After treatment: we are received improving of the functional state of ET in: APRS group-78%, ARS-88%, CRS-56%, CRSwP-46%, DSN-77%, CAT-98%,but without result of the atelectasis of middle ear.
Conclusion
Improvement of the Eustachian Tube function have been receiving only in 46–98% cases in dependence of duration diseases and etiology.
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Address for correspondence: Prof. Myroslav B.Kruk, Adress: Pekarska Street 69, Department ORL, Lviv National Danylo Halytski medical university, 79010, Lviv, Ukraine. myroskruk@mail.ru
Cholesteatoma and Ear Surgery – An Update, pp. 277–280
Edited by Haruo Takahashi
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