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Eustachian Tube Dysfunction
Eustachian tube dysfunction is one of the most common problem seen in patient with sinus infection, allergies and middle ear pathology. Eustachian tube is a narrow tube that connects back of the nose to the middle ear. It is normally closed, but opens up during swallowing, chewing and yawing. ET equalizes air in the middle ear and drains fluid from the middle ear. If ET is not functioning adequately or if there is any blockage it can lead to eustachian tube dysfunction. Patient with this condition can have ear fullness, ear pain, muffled hearing and ringing in the ear.
Methods to assess Eustachian tube function are:
In Valsalva test , initially a regular tympanometry is done to obtain the baseline tympanogram of the patient. Then Valsalva maneuver is performed where patient is asked to close the mouth and the nose , blow hard so that cheeks puffs up and air enters the ears . Later second tympanogram is obtained . If the eustachian tube is normal , during Valsalva maneuver positive pressure will build up in the middle ear resulting shift in the peak pressure in the tympanogram. Then patient is asked to swallow several times and third tympanogram is obtained to determine if pressure has returned to the baseline tympanogram.
Toynbee Test :
Toynbee test is similar to the valsalva test just that Toynbee maneuver is followed. To perform this test the patient is instructed to close the mouth and nose by pinching the nostrils and swallow. It makes the middle ear pressure more negative
Inflation and Deflation test :
It is based on the notion that a large amount of pressure in outer ear will cause slight change in middle ear pressure. First type in this test is to measurement of baseline peak pressure . A positive pressure of +400dapa is pumped into ear canal . This creates a negative pressure in middle ear and then a second tympanogram is taken . The patient is asked to swallow several times and then third tympanogram is done which is expected to show peak pressure more back to baseline value.
Deflation test is similar to inflation test except that -400dapa is pumped into the outer ear which is expected to pull back the eardrum so that middle ear volume becomes slightly large so that there is increase in the peak pressure during second tympanogram.