Related Experiment Video
Updated: Jul 7, 2026

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual
Published on: January 11, 2018
[Examination of the Eustachian tube activity with perfect sequences]
E Di Martino1, V Nath, A Telle
1Klinik für Hals-Nasen-Ohrenheilkunde und Plastische Kopf- und Halschirurgie, DIAKO, Ev. Diakonie-Krankenhaus Bremen, Gröpelinger Heerstrasse 406-408, Bremen. e.dimartino@diako-bremen.de
Introduction:
Sonotubometry allows an assessment of the Eustachian tube (ET) function under physiological conditions. The application of conventional sinus signals is not reliable enough for routine clinical use. The aim of this study was to investigate ET activity with so-called perfect sequences (PSEQ).
Patients And Methods:
PSEQs generated by a custom-made device were applied in 25 healthy subjects. ET opening was induced by Toynbee manoeuvre, yawning, dry and water swallowing. All sonotubograms were qualitatively analysed according to their shape, and quantitatively according to increase of sound intensity, frequency of opening and opening duration. The sonotubometry results were combined with the patients' perception of tone variation.
Results:
A number of 400 measurements were performed. In 92.75 % measurements the patients reported ET openings. These were confirmed by 81.5 % valid sonotubograms. The swallowing manoeuvres dry/water swallowing and Toynbee yielded with 94 %/90 % and 93 % valid measurements favourable results. Yawning was associated with 49 % valid measurements. Sound level increase was also significantly different in these manoeuvres when compared to yawning (p < 0.0001). Nasal decongestion had no influence on the results (p > 0.05).
Conclusions:
PSEQs allow an evaluation of ET function. The chosen manoeuvres trigger in healthy subjects objective ET openings with a high reliability. The application of PSEQs can detect ET activity with a high sensitivity and good specificity. By further technical refinements specificity may also be enhanced in future studies.
Related Concept Videos
Anatomy of the Ear
Physical Assessment of the Respiratory Tract IV: Auscultation
Breath Sounds
Breath sounds are categorized into vesicular, bronchovesicular, and bronchial.
Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
Assessing Body Temperature - Tympanic membrane
Step 1: Begin by practicing good hand hygiene to prevent the transmission of microorganisms.
Step 2: Turn on the thermometer and wait until the ready sign appears on the screen to ensure accurate measurement.
Step 3: Slide the probe cover in place to prevent cross-contamination.
Step 4: Instruct the patient to tilt their head to the side for comfort and check for cerumen...
The Auditory Ossicles
The aptly named stapes look very much like a stirrup. The three ossicles are unique to mammals, and each plays a role in...
Equilibrium and Balance