The Middle Ear Cleft Status in a "Natural" Cohort with Eustachian Tube Dysfunction

Background: The Eustachian tube (ET) has a major role in the middle ear (ME) pressure homeostasis. ET dysfunction is the accepted paradigm for pressure-related ME disorders.

Objective: To study the ME status in patients with severely diminished ET opening abilities, and anticipated to find ME disorders in most of them.

Patients and Methods: ME status was evaluated in unconscious adults, who were hospitalized in a rehabilitation center with severe brain damage, requiring tracheotomy and gastrostomy. These patients were unable to swallow, produce valsalva, yawn, and needed oral suctioning. Examination included fiberoptic nasopharyngoscopy, gag reflex and soft palate assessments, otoscopy and tympanometry.

Results: Nineteen patients (38 ears) were evaluated: 14 males and 5 females, aged 18-93 years (average 59). Duration of gastrostomy and tracheotomy were between 3 months and 18 years. All the patients lacked gag reflex, palatal movements or supraglottic sensation. Eighteen ears (47%) had otitis media with effusion (OME) (versus ~3% in the general population, p=0.00001), none had significant tympanic membrane atelectasis, but 20 (53%) ears were normal. Twenty-two ears (59%) had tympanometry types B/C and 16 (41%) had type A. Cerumen impaction incidence (26 ears, 68%) was significantly higher than in normal adults (10%), mentally retarded (36%) and nursing homes residents (57%).

Conclusions: A dysfunctional ET predisposed ME disorders. Yet, ~50% of the ears were normal, in contrast to the current paradigm. This implies that ME pressure homeostasis is maintained by factors that can compensate for ET dysfunction.

In addition, regular otoscopic clinical observation should be emphasized since treating cerumen impaction and OME may be beneficial for rehabilitation