Tube ventilation disorder
| Classification according to ICD-10 | |
|---|---|
| H-68.1 | Closure of the tuba auditiva |
| ICD-10 online (WHO version 2019) | |
The tube ventilation disorder (obstructive tube dysfunction) is a limited or missing air pressure equalization between the middle ear and nasopharynx. The disease can occur acutely (acute middle ear catarrh ) or in chronic form.
The Tuba auditiva ( Eustachi tube ) - also called the ear trumpet - connects the middle ear with the nasopharynx. It consists of a longer cartilaginous part on the side of the nasopharynx and a short bony part towards the eardrum . It opens and closes with every swallowing process (often accompanied by a cracking noise) and thus balances the pressure. If this does not succeed, a feeling of pressure or dull hearing persists.
The tube ventilation disorder arises from several, sometimes complementary factors. An initially existing swelling of the mucous membrane can grow into a mucous membrane overgrowth. This can lead to a narrowing or even a blockage of the tube duct. The causes can be chronic inflammation or an allergy. Changes in the mucous membrane such as nasal polyps can also lead to an inadequate exchange of air and secretions between the middle ear and nasopharynx.
Symptoms
Symptoms of tube ventilation disorder can be a decrease in hearing, dizziness , ringing in the ears or even ear pain . The symptoms are particularly pronounced with rapid pressure differences (take-off and landing when flying, diving, driving through tunnels).
If left untreated, the consequences can be a chronic otitis media have (chronic otitis media) or even a complete hearing loss by destroying the middle ear structures. The incidence of tube ventilation disorder is approximately 1% of the adult population. This disease can be diagnosed through various clinical ENT examinations such as a hearing test, CT examinations or tube manometry, in which the patency of the tubes is measured under increased air pressure.
Diagnosis
In addition to the patient's own and third-party medical history, the diagnosis of a tube ventilation disorder also includes an ear microscopic examination. Fluid accumulations in the middle ear or adhesive processes in the eardrum can be detected. For further diagnostics, the nasopharynx is examined in order to be able to determine possible infections or pathological changes, such as a change in the nasal septum. In adults with a persistent, unilateral tympanic effusion, a diagnosis of the nasopharynx and the tubal region should be performed to exclude the tumor.
The functional diagnostic tests include the Weber and Rinne tuning fork tests and tone audiometry . In addition, a tympanometry and a tube manometry (TMM) according to Estève can be carried out, since these examinations are objective measurement methods in audiology.
therapy
Conservative therapy consists of strengthening the muscular tube opening with Valsalva maneuvers , nasal rinsing and decongestant nasal sprays to improve the patency of the tube and the middle ear.
In the case of an advanced course of the disease (chronic otitis media), paracentesis of the eardrum is carried out, optionally with or without the insertion of a ventilation tube . The aim is to ventilate the middle ear again and give the secretion a drainage facility. If there is a large accumulation of fluid, it is suctioned off.
In addition to conservative drug therapy, there is another possibility of treating obstructive tube ventilation disorder. This treatment method is mainly carried out in patients with a protracted and chronic middle ear disease (seromucotympanum) who have not experienced any clinical improvement due to drug therapy or paracentesis. With the help of a balloon catheter, the nasopharyngeal tube ostium is catheterized under endoscopic view and dilated for a period of 2 minutes and a pressure of 10 bar. For a long time there was no control group in the studies, as many placebo were carried out in a controlled manner. The new study results show a significant treatment success when both therapy options are carried out in combination.
Complications (possible consequences due to illness)
- Delayed speech development in children (due to prolonged hearing loss)
- Acute purulent otitis media
- toxic inner ear hearing loss
- Changes in the structure of the eardrum in the sense of a glassy ( hyaline ) degeneration
- Scarring or calcification of the lining of the middle ear
- Formation of atrophic retraction pockets of the eardrum with the risk of a later developing cholesteatoma
Individual evidence
- ↑ H.-G. Boenninghaus et al .: Ear, Nose and Throat Medicine . 12th edition. Springer Verlag, 2005, ISBN 3-540-21969-2 , pp. 74-77 .
- ↑ H.-G. Boenninghaus et al .: Ear, Nose and Throat Medicine . 12th edition. Springer Verlag, 2004, ISBN 3-540-21969-2 , pp. 76-78 .
- ↑ German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery: Guideline Seromukotympanum . Ed .: AWMF online The portal of scientific medicine Class: S1.
- ^ S. Schröder: New therapy for chronic obstructive tube ventilation disorders . 2012, p. 7th ff .
- ^ G. Browning et al .: The prevalence of middle ear disease in the adult British population . 4th edition. No. 17 , 1992, pp. 317-321 .
- ↑ German Society for Ear, Nose and Throat Medicine: Guideline Seromukotympanon . Ed .: AWMF online The portal of scientific medicine Class: S1. April 2011, p. 4 .
- ↑ German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery: Guideline Seromukotympanon. (PDF) In: AWMF online. 2011, accessed December 22, 2017 .
- ↑ J. Lautermann et al .: Guideline Seromukotympanon. (PDF) https://www.awmf.org/ , 2018, accessed on January 15, 2019 (d).
- ^ Dennis Poe: Balloon Dilation of the Eustachian Tube for Dilatory Dysfunction: A Randomized Controlled Trial. (PDF) In: The Laryngoscope. 2017, accessed January 15, 2018 .
- ↑ Ted A. Meyer: A Randomized Controlled Trial of Balloon Dilation as a Treatment for Persistent Eustachian Tube Dysfunction With 1-Year Follow-Up. In: Otology & Neurotology. 2018, PMC 6075883 (free full text)
