I query the whole basis of the question, since I do not think primary E tube function exists, apart from very rare cases of tumour blockage. If there is excessive fluid in the middle ear for whatever reason, or impaired drainage of it, or reduced middle ear pressure, then the E tube can become secondarily blocked off, which will increase the original problem.
Dear Dr. Saafan:
A number of tests of the ventilatory function of the Eustachian tube have been designed, including the video-teleotoscopy with Valsalva maneuver, tubomanometry, sonotubometry, nine-step inflation–deflation test and pressure chamber tests. At the current time, the equipment these tests require is not widely available, and their accuracy and validity is unclear, but they can be useful research tools. all these tests are still subject of study and innvestigacion.
Particularly I use the video-teleotoscopy with Valsalva maneuver, which I consider a very simple office test, using the same endoscope for evaluation of the nasal cavities test. Obviously the results of this test are subjective and not reveal quantitative values of pressure
Dear Dr Saafan,
The tubomanometer is a little expensive but portable device and consists of a manometer with nasal and ear probes, the former delivering a bolus of air into the nasal cavity and the latter detecting TM displacement due to change in ME pressure, which is interpreted as an ET opening. The machine’s resident software generates pressure curves and outputs values for numeric descriptors of the nasal and ME pressure curves such as the R-value.
We have a lot of experience with tubomanometry (TMM) at the Middle Ear Physiology Lab, and all I can say is that it is a work in progress. The machine is not difficulty to use and the test is not difficult to perform but the person needs to be able to follow instructions and collaborate swallowing at specific times - the youngest age we've tested so far is 5yo. Since its release about 14 years ago as a reliable Eustachian tube function test, very little was done to measure sensitivity, specificity or improve the test protocol. Recently it became very popular because it started to be used as a test to assess the outcome of the Balloon dilation of the Eustachian tube. We have many critics to TMM and several ongoing studies are underway to address our concerns but maybe, if well used, it could become an interesting test in the future.
Thanks professor Miriam, for your detailed informations, is the TMM device availabe commerically to get it or still inn expeimental phase?
Hi - The tubomanometer has been commercially available for a while. La Diffusion Technique Francaise went out of business and apparently the company currently manufacturing the machine is Spiggle & Theis from Germany.
The role of tubomanometry (TMM) is to measure the reactivity of a system which we call the "isobaric system of the middle ear" (ISME). This system contains two effectors: the Eustachian tube and the mastoïd per-mucous gaseous exchanges. The role of these effectors is to maintain permanently the equality of pressure between the endotympanic gas and the atmospheric pressure. By measuring, in case of chronic otitis media (COM), a dysfunction of the Eustachian tube, we highlight the concomitant dysfunction of gaseous exchanges, the origin of which holds two factors: the modifications of the mastoïd mucous membrane herself, and also an acquired infringement of the neurological part of the ISME. This last infringement can be corrected by a specific treatment.
The indications of the TMM, outside the evaluation of the stage of the COM, is the positive diagnosis of the PET, the positive diagnosis of the presence of a scar tissue (or of a process with effect of mass) symptomatic at the level of the rhinopharynx, the positive diagnosis of a velar dysfunction whatever is the origin, the screening of the subjects at risk of barotrauma, in particular to the flight crew.
The TMM is made by:
"La Diffusion Technique Française" - DTF - 19, rue de la Presse - CS60132 - F-42003 SAINT-ETIENNE CEDEX 1
Person in charge: Monsieur Gilles CHANTREL ([email protected]).
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