Objective: The aim of this study is to explore the feasibility and clinical effect of tympanoplasty combined with ventilation tube insertion in otitis media.Method: Retrospective analysis of 35 patients with eustachian tube obstruction or tympanic adhesions for tympanoplasty combined with ventil ation tube insertion in otitis media in EENT Hospital of Fudan University from April 2008 to December 2010. Preoperative routine hearing tests and temporal bone CT examination. Completely remove of lesions at the same time and as much as possible to protect the integrity of the tympanic wall mucosa during operation. Reconstruction of the ossicular chain and simultaneous tympanic membrane hole and placed silicone T-type ventilation tube. All patients were tested for pure tone auditory threshold at 3 months after operation. The patients were followed up for 12 to 44 months.Result:The average hearing level of PTA (0.5,1.0,2.0 kHz) was (31.71±12.25) dBHL. 28 cases (80.0%) had improved to 40 dBHL after operation, 5 cases (14.3%) had hearing enhancement of 10-20 dBHL, and 2 patients (5.7%) had no change in hearing. The number of cases with air bone gap (ABG)(0.5, 1.0, 2.0 kHz) reduced to less than 20 dBHL was 25, 32 and 34 after operation. Ventilation tube self-prolapse in15 cases, 12 cases of artificial removal and 8 cases of inpatient. Twenty seven cases were left perforation of tympanic membrane, of which 22 cases (81.5%) were spontaneously healed and 5 cases(18.5%) were left with small perforations less than 2 mm in diameter. All of them had dry ear after operation, none of them had recurrence after operation, 33 cases (94.3%) had dry ear within 12 weeks, and only 2 cases(5.7%) had dry ear for more than 6 months.Conclusion: Tympanoplasty combined with ventilation tube insertion for the middle ear mucosal dysfunction and eustachian tube mucosal dysfunction of otitis media treatment effect is obvious. It does not extend the dry ear time and cause postoperative recurrence. This operation is feasible, reliable and effective.

Objective: Through analysis of the tympanic membrane perforation rate and hearing improvement rate with chronic suppurative otitis media (CSOM) by myringoplasty,to observe the effect of different preoperative conditions such as middle ear lesion,eustachian tube (ET) function and infection status on the postoperative curative effect.Method:Retrospective analysis of EENT Hospital of Fudan University from January 2012 to November 2016 during the 203 cases (203 ears) with clinical data of myringoplasty: according to intraoperative exploration of the presence of purulent secretions in the tympanic cavity,divided into infection active group and infection quiescence group; according to the preoperative results of the function of ET with acoustic impedance test divided into dysfunction or good group; according to the preoperative temporal bone HRCT suggested that the middle ear (mastoid cells,tympanic antrum and tympanic cavity) with or without soft tissue density,divided into the group with no focal lesion and the group with focal lesion. Review endoscopy and pure tone audiometry after 3 to 6 months. Using SPSS 19.0 statistical software to compare the differences among them of tympanic membrane perforation rate and hearing improvement rate.Result:Single factor analysis: ①The infection quiescence group of tympanic membrane perforation rate was 11.93%(13/109),higher than the infection active group ［8.51%(8/94)］; the infection quiescence group of hearing improvement rate was 75.23%(82/109),below the infection active group ［79.79%(75/94)］,no statistically significant differences of them (P>0.05).②The group with dysfunction of ET of tympanic membrane perforation rate was 14.06%(9/64),significantly higher than the group［4.04%(4/99)］with good function ET,with statistical difference of them (P<0.05); the group with dysfunction of ET of hearing improvement rate was 76.56% (49/64),lower than the group［81.82%(81/99)］with good function of ET,no significant difference of them (P>0.05).③The group with no obvious lesion of tympanic membrane perforation rate was 9.09% (10/110),lower than the group ［11.83%(11/93)］with focal lesion; the group with no obvious lesion of hearing improvement rate was 78.18% (86/110),higher than the group with focal lesion ［76.34%(71/93)］,no significant difference of them (P>0.05).Multivariate analysis: ①There was a significant correlation of postop-erative tympanic membrane perforation rate with preoperative ET functi-on (P<0.05).There was no significant correlation of the postoperative tympanic membrane perforation rate with the infection status and the temporal bone HRCT images in the middle ear lesions (P>0.05).②There was no significant correlation of the postoperative hearing improvement rate with the infection status,the ET function and the temporal bone HRCT images in the middle ear lesions (P>0.05).Conclusion: Dysfunction of ET and localized lesions of the ear were more common in infection active;the accumulation of purulent exudate on the surface of the tympanic mucosa and localized lesions of the middle ear did not affect the healing rate of the tympanic membrane and the hearing improvement rate; ET function is one of the most important factors that affect the healing rate of tympanic membrane after operation,the patients with ET dysfunction are more likely to affect tympanic membrane perforation,but does not affect the hearing improvement rate.

The Eustachian tube is a complex structure connecting the middle ear to the nasopharynx that contributes to the normal function of the middle ear. Eustachian tube dysfunction (ETD) is thought to contribute to the majority of middle ear pathology, although the mechanisms and the degree to which it contributes to middle ear disease is poorly understood. We describe the anatomy and physiology of the Eustachian tube, define ETD, discuss the methods for measuring ETD and describe recent advances in treatment.

Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the long-term outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up ≥12 months). Five additional articles (follow-up, 6-11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET.

Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) remain the 2 most common complications of SCUBA diving, commercial diving, and clinical hyperbaric oxygen treatment (HBO). Reported incidence rates vary between 4.1% to 91%. In 1944, Dr. Teed studied the presence of MEB in US Navy divers during submarine escape training. Tympanic membrane (TM) pressure-related pathology became apparent during the course of those exercises and examinations. Dr. Teed evaluated the trainees with otoscopic visualization following hyperbaric exposures in the submarine escape tower. An increase in atmospheric or hydrostatic pressure effects only the air-containing spaces of the body. The middle ear space is most commonly affected. While most minor TM barotrauma heals rapidly and uneventfully, major trauma, such as a perforation of the TM, may take weeks or months to heal. Major TM barotrauma is likely associated with permanent complications such as hearing loss. This is why prevention and recognition of ETD and MEB remain important when evaluating and treating a pressure-related injury. A complete discussion of inner ear anatomy is outside the scope of this topic, however, its relationship and connection to middle ear anatomy and MEB, as a cause of inner ear barotrauma, will be considered. This paper will focus on the anatomy of the external ear canal, TM, and middle ear space and how increased ambient pressure produces ETD and MEB. Inner ear barotrauma (IEB) and its complications will be discussed as relating to MEB. The outside portion of the ear is called the pinna and composed primarily of ridged cartilage covered by skin, leading to the external auditory meatus, or the opening to the external auditory canal. The external ear canal is composed of two-thirds cartilage laterally and one-third bone medially, the entire circumference covered by skin. The external ear canal extends toward and ends at the TM. Otoscopy directly and easily visualizes the external ear canal and TM. Visualization of the TM may be obstructed if the canal holds impacted cerumen. Cerumen needs to be disimpacted to facilitate visualization of the TM (and to facilitate middle ear equalization). A significant consideration is that all external auditory canals are not anatomically identical and elicit slight variations. This is true when observing the appearance of the superficial landmarks including differences in skin color, vascular formations, vascular prominence, and different cartilaginous and bony configurations and shapes. Some patients may exhibit superficial changes related to prior trauma of the external ear canal and TM. Behind the TM are 3 bony ossicles located in the middle ear space. They are known as the malleus, incus, and the stapes. The umbo is the distal portion of the malleus and connects the bony ossicles to the TM. It is an expected anatomical finding on otoscopy and easily visualized. Other ossicles are visible when favorable anatomical conditions are present, such as a transparent TM. The stapes connects the ossicles to the oval window leading into the inner ear apparatus. These bones are important in the manufacture of sound. Sound waves travel via the external auditory canal to the TM. TM vibrations are then carried through the bony ossicular chain and terminate at the oval window. The last and third bone is known as the stapes, and it abuts the oval window. The stapes moves in and out against the thin membrane of the oval window causing vibration and turbulence of the perilymph fluid producing a wave of motion. The turbulence of the perilymph continues to the scala tympani and on to the round window where sound pressure is dissipated. This dissipation of pressure at the round window becomes an important factor in inner ear barotrauma. Perilymph turbulence arrives at the inner ear apparatus, or cochlea, where it is recognized and interpreted. It is inside the cochlea and Organ of Corti, where sound is transmitted across tiny hair cells in the form of nerve impulses received by the central nervous system via the eighth cranial nerve. The middle ear space is situated directly behind the TM and is covered by mucosa. It is connected to the throat via the Eustachian tube (ET), also referred to as the auditory tube. It is responsible for the drainage of fluid produced in the middle ear space, allowing it to enter the throat. The ET opens and drains just beyond the nasal openings in the posterior nasopharynx. This tube is also responsible for allowing the exchange of air between the external environment and the middle ear space, thereby maintaining an equal pressure between the middle ear space and the external auditory canal. This is known as the equalization of middle ear pressure. Another less described air exchange takes place via the middle ear mucosa and mixed venous circulation. This transmucosal gas exchange is less important during rapid and large changes in ambient pressure occurring during diving and flying or when being treated in a hyperbaric chamber.