Study of Corelation betweenEustachian Tube Functions and Result of Myringoplasty

HEM.ANT CHQPRA, Reader.SOMNATH GUPTA Ex prof & HeadMANISH MUNJIAL Ex Registrar

Dayanand Medical College & Hospital, Ludhiana 141001

In the present study of 34 cases of dry central perforations, 26 cases of adhesive otitis media and 2cases of adhesive otitis media with postero superior inpouching, the eustachian tube function was

assessed pre-operatively in a qualitative &

quantitative manner to evaluate there dependability in predicting the outcome of Myringoplasty. Amongst

other tests valsalva & forced response tests gave the

most reliable results.

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T The long term results of myringoplasty in patients

with secondary pars tensa perforations and atelectatic

middle ears are not so good because afterinitian success later a state of 'high negative pressure'

(H NP) is developed leading to a retraction of the

postero-superior or attic portions of the drum with

consequent development of adhesive otitis media andits sequelet• 9 •

Hence it would be a logical conclusion that an"Eustachian tube with adequate patency, uncompromised

tubal dynamics and an intact mucosal anatomy, is an

integral part of a normally functioning stable middle

ear and adesirable goal foroptimum results in tympanoplasticsurgery ". A thorough, qualitative as well as quantitativedetermination of the eustachian tube function is therefore

partinent in cases where surgical therapy is to be

contemplated.

Eustachian Tube Function Test Battery (E.T.B.)

The following test battery was employed to estimate

the status of the eustachian tube, in the pre & postoperative periods, in a qualitative and quantitative

manner.

i) The Valsalva's Maneuver.

ii) The Politzerization Method.

iii) The Pressure-Swallow Equalization Test: It is

a 'Physiological'test of ventilation based on

the principle of aspiration, initially used by

Miller, 1965; Bortnick, 1966. We utilized the

pump-manometer section of an old Danplex

ZA-27 Impedance bridge. The system comprised

of an manual air pump and manometer capable

of reading ± 400 mm of H2O.

iv) The Response Test.

DISCUSSION

In the present study an attempt has been made

to evaluate the influence of the pre-operative eustachian.tube status on the outcome of surgery.

When the results of the surgery are corelated with

the pre-operative functional status of the eustachian

tube, it is seen that 74% of Valsalva+ve cases,86.9%

of Politzer +ve cases, 86.6% of Forced Response Test

(opening pressur < 300 mm H2O) cases, 78.2% of

Negative Pressure Equalization Test cases (Residual

Pressure 0 to - 50 mm H2O) and 73% of Positive

Pressure Equalization Test cases (Residual Pressure

O to + 50 mm H2O) for the same test subject hadsuccessful outcome.

Amongst the Quantitative tests the Forced Response

Test was the most reliable since

Table 1

Grouping of Patients No. of

Cases

Group I Para Tensa Dry CentralPerforations without

adhesive otitis media 34

Group IIA Adhesive otitis mediawith or without pars

tensa perforations. 26

Group IIB Adhesive otitis media with

postero-superior inpouching. 2

TOTAL 62

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Study of Corelation between Eustachian Tube Functions and Result of Myringoplasty — H. Chopra et at

Table II Table III

Corelation between Valsalvatest and Corelation between Politzer Test andPost-operative results Post operative results

PreOperativeMiddle Ear

Post Operative Results.

Valsalva + ve Valsalva - veGroups. status status

Group I N : 31 N : 3ID : 83.8% ID : 33.3%

F.M : 84% F.M.: 100%R.M. : 15.3% R.M.:

Group IIA N : 18 N : 8ID : 94.4% ID : 50%

F.M.:88.2% F.M.:50%A.M.: 11.7% R.M.:50%

Group 118 N : 2

ID : 50%

F.M.: 100%

R.M.: -

ID : Intact F.M.: Fully mobile R. M. : Restricted

Drum mobility.

Pre Post Operative Results.Operative

Valsalva + ve Valsalva - veMiddle EarGroups. status atatus

Group I N : 31

Group I N : 33 N : 1ID : 72.8% ID : 100%

F.M.:91.6% F.M. :100%R.M. : 8.3% R.M.: -

Group IIA N : 23 N : 3ID : 73.9% ID : 66.7%

F.M. :100% F.M. :100%A.M.: - R.M.: -

Group IIB N : 2 N : 0ID: 50%

F.M.: 100%R.M.: -

ID : Intact F.M. : Fully mobility R.M : Restricted mobility.

Table IV

Corelation between Pre-Op. Negative Pressure equalisation Test and Post operative results

Pre-Operative Post Operative Resultsfiddle ear groups Residual Middle Ear Pressure (SWA) - mm H2O

0 to - 50 Normal - 50 to - 100 Mild. - 100 to -200 Moderate > 200 Poor

Group I N: 13 N: 13 N: 4 N: 4ID: 100% ID: 75% ID: 25% ID: 100%

F.M.:80% F.M. :80% F.M. :100% F.M. :100%A.M.: 20% R.M. : 20% R.M : - R.M.: -

Group IIA N: 8 N: 8 N : 5 N: 5ID: 100% ID: 75% ID: 60% 10 : 80%

F.M.: 87% F.M.: 100% F.M.: 100% F.M. : 100%R.M.: 13% R.M.: - R.M.: - R.M.: -

Group IIB N : 2ID: 50%

F.M.: 100%R.M.: -

ID : Intact Drum F.M. : Fully mobility R.M. : Restricted mobility.

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cases with opening pressures recorded: (i) below 300,(ii) between 300 to 400, and (iii) above 400 mm H2Ogave descending results of success respectively (86.6%,66.6% and 60%). In the positive pressure equalizationtest, high residual pressure tended to predict failureof surgery and low residual pressure the reverse ofit.

In the Negative Pressure Equalization Test,high residual negative pressure tended to predicta lower chances of success. Thus we canponclu ability to equalibrate a negativep r , t a successful result. Butin^l q'bylt tbi U sa' s not necessarily meanallure. yr c0

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The results obtained in pre-operative normalyfunction cases in the present series are similar to thosereported by Miller and Bilodeau (1967) 88%, Holmquist(1968) 75%, Palva and Karja (1970) 77%, Senguptaand Kacker (1971) 91 %.

The Results obtained in pre-operative Hypo orPoor function cases, in the present series are similarto those reported by Ekvall (1970) 100%, Palva andKarja (1970) 83%, Sharp (1970) 83%, Mackinnon (1970)82%, Sengupta and Kacker (1971) 78%.

The result obtained in the Negative PressureEqualization Test are similar to those reported byPalva & Karja (1970), Ekvall (1970), Mackinnon (1970),Sidentop (1972) and Holmquist (1970).

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Study of Corelation between Eustachian Tube Functions and Result of Myringoplasty - H. Chopra et al.

Table VCorelation between Pre-operative Positive Pressure Equalisation Test and Post Operative Results

Pre-OperativeMiddle ear groups

Post Operative ResultsResidual Middle Ear Pressure (SWA) - mm H2O

0 to - 50 Normal - 50 to - 100 Mild. - 100 to -200 Moderate > 200 Poor

N: 19 N: 11 N: 3 N : 1Group IID: 79% ID : 63.7% ID :100% ID : 0%

F.M. : 93.3% F.M.: 85.7% F.M. : 100%R.M. : 6.6% R.M.: 14.2% R.M. . -

Group IIA N : 13 N: 6 N: 7

ID: 92.3% ID : 83.3% ID : 57%F.M. : 83.3% F.M.: 100% F.M.: 100%R.M. : 16.6% R.M. - R.M.: -

Group IIB N: 2ID: 50%

F.M. : 100%R.M. : -

ID : Intact Drum F.M.: Fully mobility R.M. : Restricted mobility.

Table VICorelation between pre-Op. Forced Response Test and Post-Op. Result

Middle ear groupsPre-Operative Post Operative Results

Residual Middle Ear Pressure (SWA) - mm H2O

(A) (B) (C)>300 mm H2O 300 to 400 mm H2O > 400 mm H2O

Group I N: 20 N : 12 N : 2

ID : 80% ID : 66.6% ID : 50%F.M. : 87.5% F.M.: 100% F.M.: 100%R.M.: 12.5% R.M.: - R.M.: -

Group IIA N: 14 N : 9 N : 3

ID : 92.8% ID : 66.6% ID : 66.6%F.M. : 84.6% F.M.: 100% F.M. : 100%R.M. 15.3% R.M.: - R.M. : -

Group fIB N : 2ID : 50%

F.M. : 100%

R.M. -

Table VII

Achievement of Results in different groups of Patient

Group 1. N : 34 P.M.E. : (25) 67.6%

1. M.E. : (11) 32.3%

Group IIA N : 26 P.M.E. : (19) 73%

I. M.E. : (7) 27%

Group IIS N : 2 P. M.E : (1) 50%

I. M.E : (1) 50%

REFERENCE

1. Bluestone, C. D.; Paraoise, J. L. and Beery. O.C. (1972) : Physiology of the Eustachian Tube in Pathogenesis and Managementof middleear effusions. Laryngoscope St. Louis, 82, 1654.

2. Bortnick E. (1966): A simple apparatus for eustachian tubal function. Arch. Otolaryn 82 : 51.

3. Cantekin, E.; and Douglas, G.(1979) : Eustachian tube function related to the results of tympanoplasty in children. The Laryngoscope 89.

4. Ekvall, L (1970): Eustachian tube function in tympanoplasty. Ada. Oto-lar. Suppl. 263 : 33.

5. Hilmquist. J. (1968): The role of eustachian tube in myringoplasty. Acta. Oto-Laryng. 66 : 289.

6. Mackinnon, D. N. (1970): Pre operative eustachian tube function and tympanoplasty. Acta. Otolaryngol 69.

7. Miller, Jr. G. F. (1965): Eustachian tube function in normal and diseased ears. Arch. of Otolaryng. 81 : 42-48.

8. Sengupta, R. P. and Kacker, S. K. (1974): Study of the eustachian tube function with particular reference to long term follow up in Myringoplasty.

Ind. Journal Otolaryngol.

9. Zechne, G. (1983): Adhesive otitis media. J Laryngo Oto. Suppi. 8 : 56-61.

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