Eustachian Tube Function in 6-Year-Old Children with and without a History of Middle Ear Disease
Ellen M Mandel1, Margaretha L Casselbrant2, Beverly C Richert3
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA mandele@pitt.edu.
Insights
Children with a history of recurrent acute otitis media have impaired eustachian tube opening efficiency, even after their middle ear disease resolves. This suggests lasting eustachian tube dysfunction in these children.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Auditory Physiology
Background:
- Recurrent acute otitis media (RAOM) is common in children.
- The eustachian tube's role in middle ear disease is critical.
- Long-term effects of RAOM on eustachian tube function are not fully understood.
Purpose of the Study:
- To investigate eustachian tube opening efficiency in 6-year-old children with a history of RAOM.
- To compare eustachian tube function between children with and without a history of RAOM.
Main Methods:
- A cross-sectional study was conducted at a tertiary care pediatric hospital.
- Eustachian tube function was assessed in 44 healthy 6-year-olds using a pressure chamber protocol.
- Fractional gradient equilibrated (FGE) was calculated to measure opening efficiency.
Main Results:
- Children with a history of RAOM showed significantly lower mean FGE (0.16) compared to controls (0.32).
- Preswallow middle ear pressures were similar between groups.
- FGE was not dependent on preswallow pressure.
Conclusions:
- Children with a history of RAOM exhibit persistent eustachian tube opening inefficiency.
- This inefficiency remains even after the resolution of active middle ear disease.
- Findings suggest a lasting impact of RAOM on eustachian tube function.
Objective:
To test the hypothesis that eustachian tube opening efficiency, measured as the fractional gradient equilibrated (FGE), is lower in 6-year-old children with no middle ear disease but a well-documented history of recurrent acute otitis media, as compared with children with a negative disease history (control).
Study Design:
Cross-sectional study.
Setting:
Tertiary care pediatric hospital.
Subjects And Methods:
Bilateral eustachian tube function was evaluated in 44 healthy 6-year-old children (19 boys, 29 white). None had middle ear disease at the time of testing, but 23 had a history of recurrent acute otitis media. Twenty-one had no significant past otitis media. Eustachian tube function was measured with a pressure chamber protocol that established negative middle ear gauge pressures (referenced to the chamber pressure) and recorded that pressure before and after a swallow. FGE was calculated as the change in middle ear gauge pressure with swallowing divided by the preswallow pressure. Between-group comparisons of the preswallow pressures and FGEs were made with a 2-tailed Student's t test.
Results:
FGE was independent of the preswallow middle ear gauge pressure. For the 39 and 44 evaluable ears in the control and recurrent acute otitis media groups, the mean preswallow pressures were -194 daPa (95% confidence interval [95% CI] = -211 to -177) versus -203 (95% CI = -216 to -190; P > .40), and FGEs were 0.32 (95% CI = 0.21-0.43) vs 0.16 (95% CI = 0.08-0.24; P = .016), respectively.
Conclusion:
In children with past recurrent acute otitis media, residual eustachian tube opening inefficiency is maintained after they have "outgrown" their middle ear disease.
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