| Background:Otitis media is an inflammation of the middle ear without reference to aetiology or pathogenesis.Otitis media can be classified into acute or chronic,suppurative or non-suppurative.The onset of Otitis Media is associated with various risk factors,of these risk factors Eustachian Tube Dysfunction(ETD)is the most important.Tubomanometry was first introduced by Esteve et al in Europe in 2003;it is a relatively simple,non-invasive,objective test,which can be used to evaluate Eustachian tube function.In the last decade,a number of studies have been done to determine the validity and reliability of this tool as an instrument for the evaluation of Eustachian Tube function.These studies have been primarily done in subjects with normal Eustachian tube or in patients undergoing balloon dilation of the Eustachian tube,not much work has been done using this tool in patients with Otitis Media.Objective:To use Tubomanometry to determine if Eustachian tube dysfunction is present in patients with Otitis media(OME,CSOM,Cholesteatoma).Method:In this study we evaluated a total of 216 ears: 75 ears from 60 CSOM patients(20 males,40 females),40 ears from 27 OME patients(16 males,11 females),31 ears from 26 Cholesteatoma patients(12males,14 females)and a control group comprising of 70 ears from 35 healthy volunteers(13 males,22 females).We used Otoscopy or Oto-endoscopy,Pure tone audiometry,Tympanometry,TMM,Subjective Valsalva and ETDQ-7 to assess all subjectsResults:Restricted opening of the Eustachian tube was seen in all patient groups at all pressures(30,40 and50mbar).In the control group,the rate of restricted opening at 30 mbar was 10%,2.86% at 40 mbar and 1.43% at 50 mbar.In the CSOM group,it was 69.33%,60%,and 41.33%.In the OME group,it was 84.09% at 30 mbar,77.28% at 40 mbar,and 70.55 %.It was 54.84 %,45.16% and 41.94% in the Cholesteatoma group.On pairwise comparison of the different pressures within the control group a significant difference in restricted ET opening was observed between 30 and 50 mbar P=0.007.On pairwise comparison of the different pressures within the control group,a significant difference in restricted ET opening was found only between 30 and 50 mbar P=0.007.In the CSOM group,a significant difference in restricted ET opening was seen between 30 and 50 mbar P=0.001 and 40 and50 mbar P= 0.034.On comparison of the pressures within the OME and Cholesteatoma groups,no significant difference of restricted opening existed between the different pressures P= 0.324 and P=0.571 respectively.Comparison of Otitis media groups(CSOM,OME,Cholesteatoma)to the controls yield P <0.05 at all pressures.On comparison of the CSOM and OME groups,a significant difference in restricted opening was seen only at 50 mbar P=0.016.In the OME group,there were,31 type B tympanogram and 12 type C.The rate of restricted opening in the type B group was 87.10 %,80.64%and 74.19 % at 30,40 and 50 mbar.In the type C group,it was 75% at 30 mbar,58% at 40 and50 mbar.Comparison of the three pressures between the types of tympanogram showed no significant difference P >0.05.The ETDQ-7 score of the subjects in the CSOM group was analysed.The scores ranged from 7-48 with a mean ± Standard deviation of 19.7867 ± 11.12587.There were 52 ears with pathological results and 23 ears with normal results.Comparison of the TMM results with ETDQ-7showed no significant difference at 30 and 40 mbar P =1.000 and 0.232.Conclusion:In our study,the TMM results supported our hypothesis that ETD exists in patients with CSOM and OME and Cholesteatoma.The persistent level of restricted ET opening,even with increased pressure seen in the Cholesteatoma and OME group raises the question of possible impaired results due to the presence of effusion or mass within the middle ear cavity resulting in obstruction or dampening of the transmission of the pressure resulting in a falsely elevated number of absent or prolonged R values.TMM can be of value in patients with Tympanic membrane perforated as if clearly was able to identify ETD in these patients with the results showing a clear association with pressure.The use of multiple pressured should be compulsory when using TMM since there is a decrease in ET opening with an increase in pressure... |
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