A Clinical Study for the Role of Eustachian Tube Function for Successful Mastoidectomy and Middle Ear Surgeries

Hemalatha, P (2015) A Clinical Study for the Role of Eustachian Tube Function for Successful Mastoidectomy and Middle Ear Surgeries. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: The Eustachian tube plays an important role in; 1. Aeration and pressure maintenance, 2. Drainage of the Middle ear thro its mucociliary activity, 3. Protects from reflux of sound and material from the nasopharynx1. The proper functions of the tube like secretory, ciliary, and dilatory actions are essential for optimal conduction of sound through the middle ear cavity. Eustachian tube acts as a pathway of clearance for fluid buildup within the middle ear cavity. Middle ear secretions or infections are removed by two primary mechanisms. The first mechanism involves mucociliary clearance, much similar to the pulmonary system. The ciliated columnar epithelium lines the nasopharyngeal end of the tube, whereas the osseous and superior portion of the tube is lined by the cuboidal epithelium. These ciliated epithelial cells provide a mucociliary elevator to push debris and secretions down the Eustachian tube and into the nasopharynx. The second mechanism of clearance involves muscular pumping. Muscular pumping of the pharyngotympanic tube occurs as the tubal valve progressively closes from the isthmus toward the nasopharyngeal orifice, when the tensor veli palatini muscle relaxes. Both the mechanisms work simultaneously to clear out the secretions and infections from the tympanic cavity to nasopharynx where they can be swallowed or expectorated. AIMS AND OBJECTIVES: 1. To study the ventilatory and mucociliary function of Eustachian tube in all the patients of chronic suppurative otitis media who are all planned for the surgery. 2. To study about the success rate of the tympanoplasty in relation to the Eustachian tube function. MATERIALS AND METHODS: This prospective study was conducted at the department of ENT AND HEAD & NECK SURGERY, THANJAVUR MEDICAL COLLEGE AND HOSPITAL, THANJAVUR, TAMILNADU for a period of two years from august 2012- August, 2014. The study group consists of 60 patients of chronic suppurative otitis media of both Mucosal and Squamous type. The detailed history was taken & clinical features of CSOM are noted. Inclusion Criteria: 1. CSOM- tubotympanic inactive and quiescent stage, 2. CSOM-atticoantral type. Exclusion Criteria: 1. Age less than 15 years. 2. Fungal infections of the ear 3. Any tumour or mass in the nasopharynx causing the Eustachian tube dysfunction. 4. Complete ENT examinations were performed to rule out any Systemic disease which affects the end result of mastoid and middle ear surgeries. The patient (under study) planned for the tympanoplasty was subjected to the following investigations. SUMMARY: The study conducted in our hospital for a period of two years with an objective to find the role of tubal function in the outcome of tympanoplasty. 1. Our study comprises of 60 patients, of which 18 were males and 42 were females. Most of them belong to the lower middle class, living in the rural areas. 2. The unsafe pathology is more common with higher incidence of absent tubal function (73.33%). 3. The mean age of presentation is 20-29 about 46.67% of our study group. 4. The methylene blue dye test and saccharin tests is the simple and cost effective test to assess the mucociliary activity of the tube. 5. Preoperative and preoperative measures to retrieve the tubal function add the success rate in patients of tympanoplasty regardless of disease type. 6. Proper post operative follow up with the Valsalva exercise is mandatory to maintain the patency of tubal patency. 7. Pseudomonas aeruginosa is the most common pathogen isolated from our study group. CONCLUSION: Preoperative evaluation of Eustachian tube function is mandatory for all the patients planned for tympanoplasty. Preoperative and intraoperative corrective measures should be taken in patients with partial and absent tubal function to improve the success rate. Regular postoperative follow up and Valsalva exercises is essential to maintain the patency of Eustachian tube.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Eustachian Tube Function ; Successful Mastoidectomy ; Middle Ear Surgeries ; Clinical Study.
Subjects: MEDICAL > Otolaryngology
Depositing User: Punitha K
Date Deposited: 04 May 2018 17:39
Last Modified: 04 May 2018 17:39
URI: http://repository-tnmgrmu.ac.in/id/eprint/7447

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