الفهرس 
Acknowledgement
Middle Ear ContentsOnly 14 pages are availabe for public view
 |  | from | 107 |  |  |
| | | from | 107 | | |
Abstract
The Eustachian tube (ET) has at least three physiologic functions with respect to the middle ear: Middle ear ventilation to equilibrate air pressure in the middle ear with atmospheric pressure, drainage and clearance of secretions produced within the middle ear into the nasopharynx, and protection from nasopharyngeal sound pressure and secretions. Also, it is involved in ensuring air exchange in the middle ear.
Tympanometry and Eustachian tube function (ETF) tests (Valsalva and Toynbee maneuvers) can evaluate the ETF; thus, they have been used widely in clinical and basic research investigations. Patients with tubal dysfunction often complain of a sensation of fullness in ear, which is a result of the functional impairment of the Eustachian tube that results from a ventilatory disturbance. However, despite the sensation of ear fullness, most patients show normal middle ear pressure as measured by tympanometry.
Evaluation of Eustachian tube functions in ears with intact tympanic membrane, can be done using tympanometry, sonotubometry, manometry, inflation deflation tests, and the Valsalva and Toynbee maneuvers.
Nose, paranasal sinuses, and nasopharyngeal diseases can disrupt the functions of the ET. Among the studies that have investigated the effects of nasal obstruction on ET functions, the clinical study by Bonding and Tos,1981 and the experimental study by Buchman et al., 1999 show that middle ear pressure changes when double-sided nasal obstruction occurs was shown to be within the normal range, and contradictory results have been reported regarding ET functions.
The present study was carried out on 59 patients who presented to the otolaryngology outpatient clinic at Assuit University Hospital complaining of different nasal and sino-nasal pathology that required surgery(deviated nasal septum,chronic hypertrophic rhinitis, bilateral nasal polyposis,sinusitis). All patients were operated on according to the cause of the pathology.
Each patient was subjected to full history taking, clinical examination and ETF tests in the form of valsalva together with tympanometry. Eustachian tube function tests in the form of valsalva together with tympanometry had been performed the day before the operation and after a 6-weekperiod that was necessary for wound healing,the patients were examined; again, ear cerumen, if present, was removed. The postoperative middle ear pressure levels were determined using tympanometry. The middle ear pressure values obtained before and after surgery were compared to determine if there was a statistically significant result.
Valsalva maneuver
To evaluate the ability to inflate the middle ear actively, patients were asked to pinch the nose and inflate the cheeks through forced expiration with the mouth closed until a sensation of fullness was achieved in the ears. Patients were then instructed to release the nose and refrain from further swallowing or mandibular movement and an experimental tympanogram was obtained in each ear.
Tympanometry
The tympanograms were classified in the standard manner according to Jerger . A tympanogram with middle ear pressure peak between +50 and −100 daPa was classified as type A. Tympanogram with middle ear pressure peak of −100 daPa or more negative was classified as type C. Tympanogram with a flattened peak of less than 0.3 ml admittance was classified as type B.
The findings of our study demonstrated that in patients with different nasal and sinonasal pathologies that required surgery, patients complaints of nasal obstruction, ear fullness sensation and tinnitus improved after surgical correction, there were significant changes in middle ear pressure values postoperatively in both ears.Also, the results showed that there was an effect of sinonasalsurgery on the type of tympanometry.
When we assessed the changes in ETF postoperatively, there was a significant improvement.
Our findings demonstrated that, there were significant changes in the tympanometric types, compliance values,Eustachian tube but no significant changes in acoustic reflexes before and after sinonasal surgery.
In our study, the relation between the compliance value preoperatively and postoperatively after removal of nasal packing was improved with statistically significant change.
from the above results, it is clear that there are many sinonasal pathologies which may cause Eustachian tube dysfunction, leading to middle ear hypoventilation, and that surgery for nasal improves tubal function and middle ear ventilation at least 6 weeks after the surgical procedure.
Different sinonasal pathologies have definite relationship with ETF.