HOW WE CORRECT TUBAL DYSFUNCTION

Myroslav B. Kruk, Myroslav M. Kruk

Department ORL, Lviv National Danylo Halytski Medical University, Lviv, Ukraine

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.24,714,1820,25,44,45,49,50,52,54,55,56

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, 1519,26,, 2935, 4144,51,55,56 and surgical treatment of the Eustachian tube dysfunction (ETD).8,9,15,20,3740,41,46,47,48,52,55,56

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.23,24,2630

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.Bluestone58: 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.

References

1.Amano H. The adrenergic innervation of the Eustachian tube. Pract Otol Kyoto 77(10):1965–1979, 1984

2.Belforte G. Chirurgia e fisioterapia dell`ostio tubaricofaringe. In: Coppo E, Belforte G (eds.), La tuba di Eustachio, pp. 141–147. XIX Congresso Nazionale Otologi Ospedalieri Italiani, San Remo, 2–5 Giugno 1966. Italy: Cirie, Tipografia cav. Capella, 1966

3.Berger M, Pinson L, Dufour A. Le massage tubaire. Ses heureux resultats. Rev Laryngol 85(3–4):236–239, 1964

4.Bluestone CD, Cantekin EI, Berry QC. Effect of inflammation on the ventilatory function of the Eustachian tube. Laryngoscope 87:493–507, 1977

5.Bluestone CD. Eustachian tube function: physiology, pathophysiology and role of allergy in pathogenesis of otitis media. J Allergy Clin Immunol 72(3):242–251, 1983.

6.Bluestone CD. Eustachian tube structure and function – Update 1996. In: Passàli D (ed.), Pediatric Otorhinolaryngology: An update, pp. 201–216. Proceedings of the 4th international Conference on Pediatric ENT, Siena, Italy, October 2–5, 1996. The Hague: Kugler Publications, 1996

7.Bluestone CD. Eustachian Tube Function and Dysfunction. In: Rosenfeld R, Bluestone CD (eds.), Evidence-Based Otitis Media, pp.137–156. Hamilton-London-Saint Louis: B.C. Decker Inc., 1999

8.Bluestone CD, Klein JO. Otitis media and Eustachian tube dysfunction. In: Bluestone CD, Stool SE, et al. (eds.) Pediatric oto-laryngology, pp.474–685. 4th ed. Philadelphia: W.B. Saunders, 2003

9.Boboshko MY, Lopotko A. Tuba auditiva Eustachii, pp. 208–220, 232–273. St. Petersburg: Spec Lit., 2003

10.Cantekin EI, Doyle WJ, Bluestone CD. Effect of levator veli palatine muscle excision on Eustachian tube function. Arch Oto-laryngol 109(5): 281–284, 1983

11.Chobaut JC, Bebear JP. Traitement médicamenteux du dysfunctionnement tubaire. In: Martin C, Magnan J, Bebear JP (eds.), La trompe auditive (la trompe d’Eustache), pp.255–257. Société Française d’Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale. Paris: Arnette-Blackwell, 1996

12.Chobaut JC, Bebear JP. Rééducation de la trompe auditive. In: Martin C, Magnan J, Bebear JP (eds.), La trompe auditive (la trompe d’Eustache), pp. 259–263. Société Française d’Oto-rhino-laryngology et de pathologie cervico-faciale. Paris: Arnette-Blackwell, 1996

13.Darrouzet JM,Estève D,Casse B,Fraysse B,Bebear JP.Crénotérapie et trompe auditiva.In: MartinC,Magnan J,Bebear JP (eds.),La trompe auditiva (la trompe d’Eustache) pp.283–289. Société Française d’Oto-rhino-laryngology et de patologie cervico-faciale. Paris: Arnette-Blackwell,1996

14.Dubrenil C, Martin C, Esteve D. Aeroliseur manosonique automatique (AMSA) et la patologie tubaire. In: Martin C, Magnan J, Bebear JP (eds.), La trompe auditive (la trompe d’Eustache), pp.275–281. Société Française d’Oto-rhino-laryngology et de pathologie cervico-faciale. Paris: Arnette-Blackwell, 1996

15.Dutheillet de Lamothe M. Le traitememt des affection du bourelet tubaire sous le controle de la salpingoscope. Ann Oto-Laryng (Paris)11(7):1008–1009, 1933

16.Estève D. Re-adaptation of the baroreceptors of the fibrocartilaginous Eustachian tube and middle ear cleft by the mean of the Kinétube®. In: Ars B (ed.), Fibrocartilaginous Eustachian tube. Middle ear cleft, pp.203–217. The Hague: Kugler Publications, 2003

17.Estève D. Rehabilitative management of the imbalance of pressure variations in the middle ear cleft. In: Ars B (ed.), Chronic Otitis Media. Pathogenesis-Oriented Therapeutic Management, pp. 341–349. Amsterdam: Kugler Publications, 2008

18.Gavrylenko IU. Clinico-laboratory study of treatment tactics of children with auditory tube inflammation, p. 11 (Ukr). Thesis, 2011

19.Holmquist J. Medical treatment of ears with Eustachian tube dysfunction. In: Münker G, Arnold W (eds.), Physiology and Patho-physiology of Eustachian Tube and Middle Ear, International Symposium, Freiburg (Breisgau) 1977, pp. 201–205. Germany, Stuttgart: Georg Thieme Verlag, 1980

20.Honjo I. Eustachian Tube and Middle ear Diseases, pp.65–89. Tokyo-Berlin-Heidelberg-New York-London-Paris: Springer Verlag, 1988.

21.Hory F, Kawauchi H, Mogi G. Effect of S-Carboxymethylcisteine on the clearance of middle ear effusion: en experimental study. Ann Otol Rhinol Laryngol 103:567–575, 1994

22.Jacobs A. La kinesitherapie de la trompe d’Eustache. Thèse Med Nancy, pp. 1–146, 1981

23.Kruk MB. Mechanical vibromassage of pharyngeal orifice of tuba auditiva and nasophasrynx. Journal of the Ear, Nose and Throat Diseases (Ukr) 1:94–95, 1973.

24.Kruk MB, Kulyk AF, Ivach FI. Apparat for vibromassage in ENT-Practices. Med technic (Rus) 4:43–44, 1974

25.Kruk MB, Nikonenko FN, Myskiv FE. Hyperbarooxygenation therapy in the tubal disorder in the complex treatment sensoneural ear problems. In: VI Congress ORL of Ukraine,12–14 september 1983 in Lviv, abstracts, pp.132–134. Kyiv, 1983

26.Kruk MB. Functional state of the tuba auditiva in the nonpurulent chronic otitis media and UPR diseases, pp. 1–44. (Experimental and clinical investigation, diagnostic and treatment)(Rus). Thesis. Moscow, 1987

27.Kruk MB. Complex exercises for muscles of tuba auditiva. In: Shushko J, Rosenfeld L (eds.), Diagnostic and treatment tubal dysfunction (Ukr), pp.13–17. Kyiv, 1986

28.Kruk MB. Kinesitherapie and massage pharyngeal orifice of tuba auditiva in tubal dysfunction. In: VII science-clinical conference otorhinolaryngology of Moldavian Republic (Rus), pp.66–67. Kiszenev, 1985

29.Kruk MB, Chyz O. Complex treatment of secretory otitis media. In: Ribari O, Hirschberg A (eds.), 3rd European congress of the European Federation of Oto-rhino-laryngological Society EUFOS. Budapest (Hungary), pp. 45–46. Italy: Moduzzieditore, International Proceeding Division, 1996

30.Kruk MB. Update methods prevention of middle ear diseases. In: Otology 2000 Achievements and Perspective XXII Annual meeting of the Politzer Society, abstracts, A-16–1, p. 37. Zürich, Switzerland, 1999

31.Kruk MB. New macrolide in complex treatment of secretory otitis media. In: 4th European Congress of Oto-Rhino-Laryngology and Neck Surgery (EUFOS 2000), May 13–18, 2000, abstracts, IIC, p. 158. Berlin, Germany, 2000

32.Kruk MB, Moskalyk OE. Diagnosis and treatment of allergic rhinitis. In: 2nd World Congress of Otorhinolaryngology, Allergy, Endoscopy and Laser Surgery, abstracts, pp. 20–23. Greece, Athens, 2001

33.Kruk MB, Kruk MM. Reflexotherapy in complex treatment of the allergic rhinitis. In: 1st Congress of Allergologists of Ukraine (Ukr) 2002, pp. 82–83. Kyiv, 2002

34.Kruk MB, Puszkariova WM. Rhinofluimucil in the treatment of acute rhinitis and sinusitis. Journal of Ear, Nose and Throat Diseases (Ukr) 5;c:120–122, 2004

35.Kruk MB, Olaszyn VV, Kruk MM. Mucoactive medicine and nonsteroid treatment of the atelectatic middle ear. Journal of Ear, Nose and Throat Diseases (Ukr) 5;c:173–174, 2005

36.Kruk MB, Olaszyn VV, Geron RM. Mucoactive therapy in chronic rhinosinusitis. Journal of Ear, Nose and Throat Diseases (Ukr) 3;c:152–143, 2007

37.Kruk MB, Kovtuszenko SV, Kruk MM, Olaszyn VV, Geron RM. Our experiences of 25th years applied hyperbarooxygenisation (GBO) in the barocamera in the complex treatment of ear diseases. Journal of Ear, Nose and Throat Diseases (Ukr) 3;c:62–63, 2007

38.Kruk MB, Chuszak IM, Olaszyn VV, Radovenczyk PP. Experiences in FESS. In: The 44th Congress of the Polish Society of Otorhinolaryngologists – Head and Neck Surgeons, June 9–12, 2010, Warsaw, Poland. Abstracts, pp. 25–26. Warsaw, 2010

39.Kruk MB, Olaszyn VV. Importance of rhinoseptoplstik in the functional state of the ear. In: Otologia 2011. International congress of the pediatric ENT of Poland, June 9–11, 2011, Mikolajki. Abstracts, p. 30, 2011

40.Kruk MB, Czuszak IM, Kruk MM, Olaszyn VV, et al. Importance of optical adenotomy with special-szeiver in the restoration of functional state of the ET. Journal of Ear, Nose and Throat Diseases (Ukr) 3;c:127–128, 2012

41.Martin H, Martin Ch, Magnan J. Adenoidectomie. Massage tubaire. In: La trompe auditiva (la trompe d’Eustache), pp. 293–294. Paris: Arnette Blackwell S.A., 1996

42.Lajko A, Gavrylenko IU, Bredun A, et al. Salpingootitis treatment in children. Journal of Ear, Nose and Throat Diseases 5.c:49, 2007

43.Lajko A, Gavrylenko I, Otitis treatment in children in aggregate with acute rhinosinusitis. Journal of Ear, Nose and Throat Diseases (Ukr) 3.c:73, 2008

44.Lajko AA, Melnikov OF, Gavrylenko IU. Pharmacotherapy of the inflammation of the tuba auditiva in children. Journal of Ear, Nose and Throat Diseases (Ukr) 5.c:73, 2010

45.Lajko AA, Zabolotnyj DI, Melnikov OF, et al. Inflammation of tuba auditiva in children (Ukr), pp. 116–133. Kiev: Logos, 2009

46.Lajko A, Melnikov O, Gavrylenko J. Pharmacotherapy inflammation of the tuba auditiva in children. Journal of Ear, Nose and Throat Diseases (Ukr) 5c:67–68, 2010

47.Poe DS, Grimmer JF, Metson RB. Laser Eustachian Tuboplasty: two-year re-sults. Laryngoscope 117:231–237, 2007

48.Poe DS, Gopen Q. Medical and surgical management of Eustachian tube dysfunction: mucosal disorders. In: Ars B (Ed.), Chronic Otitis Media. Pathogenesis-Oriented Therapeutic Management, pp. 329–340. The Hague/Amsterdam: Kugler Publications, 2008

49.Riu R, Flottes L, Bouche J Le, Den, et al. La physiologie de la trompe d’Eustache. Application clinique et therapeutiques, pp. 446–485. Paris: Librairie Arnette, 1966

50.Sadé J, Secretory Otitis Media and its Sequelae, pp. 212–275. New York-Edinburgh-London: Churchill Livingstone, 1979

51.Szuszko Y, Rudenko A. Treatment chronic otitis with perforation and tubal dysfunction by manual massage of pharyngeal orifice. Journal ENT diseases (Ukr) 5:54–57, 1976

52.Takahashi H, Fujita A, Honjo I. Effect of adenoidectomy on otitis media with effusion, tubal dysfunction and sinusitis. Am J Otolaryngol 10:208–213, 1989

53.Terracoll J, Corone A, Guerrier J. La trompe d’Eustache, pp. 102–112, 144–146, 169–214. Paris: Masson et Cie, Libraires de l’Academie de Medecine, 1949

54.Yamashita T, Kitajira M, Tomoda K, et al. Cholinergic Innervation in the Eustachian Tube of guinea pigs. Pract Otol Kyoto 74(5):873–879, 1981

55.Zollner F. Anatomie, Physiologie,Pathologie und Klinik Ohrtrompete. Berlin: Springer-Verlag, 1942

56.Zollner F. Therapy of the Eustachian tube. Arch Otolaryngol 78(3):394–399, 1963


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

2013 © Kugler Publications, Amsterdam, The Netherlands