Blocked Eustachian Tube
Plastic PPRuNer
"If you know of a reliable and valid tool to distinguish viral from bacterial OM....."
Well there isn't one. A red drum and a child with viral type symptoms is probably viral. Stinky pus and a perf is bacterial. In between it's a best guess.
How reliable and how valid does it have to be for you to accept it? 100% or would a good "based on experience" guess do? Ooops, experience doesn't count!
Anyway, thank God, I at least get wiser as I get older and better at getting my guesses right.
Well there isn't one. A red drum and a child with viral type symptoms is probably viral. Stinky pus and a perf is bacterial. In between it's a best guess.
How reliable and how valid does it have to be for you to accept it? 100% or would a good "based on experience" guess do? Ooops, experience doesn't count!
Anyway, thank God, I at least get wiser as I get older and better at getting my guesses right.
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I'm afraid a guess isn't good enough for my patients. Although to be fair, I'm often "managing risk." (Tree hugging term for guess
)
Funnily enough, as I get older, I'm realising I wasn't as wise as I once thought I was.
)Funnily enough, as I get older, I'm realising I wasn't as wise as I once thought I was.
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I've been reading a number of items on the 'web, citing that Trigeminal Pharyngioplasty was helpful for unblocking ETs. I have also seen reports claiming (possibly from practitioners of TP...) that it is suspected that many people with ET issues are incorrectly diagnosed with allergy / audiological problems and sent to audiologists, when in reality they had a TMD issue...
I wonder what you guys make of that? It would tally with the earlier comments about posture...
Is Trigeminal Pharyngioplasty simply the medical term for Endonasal Therapy?
Try a Google on Dr. Schames - he seems to be the most visible TP practitioner.
I'd love to hear what others think... Personally, and going purely on circumstantial evidence, I tend to think that there could well be some truth in the concept of people being misdiagnosed, when they needed TMD therapy...but what do I know, I'm just an engineer!
I wonder what you guys make of that? It would tally with the earlier comments about posture...
Is Trigeminal Pharyngioplasty simply the medical term for Endonasal Therapy?
Try a Google on Dr. Schames - he seems to be the most visible TP practitioner.
I'd love to hear what others think... Personally, and going purely on circumstantial evidence, I tend to think that there could well be some truth in the concept of people being misdiagnosed, when they needed TMD therapy...but what do I know, I'm just an engineer!
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This is interesting....
I had "Endonasal Therapy" and this looks kind of like the same thing although the 2 practicioners seem to be coming at it from different angles. The guy I saw called it "finger sweep" and said you could remove these "adhesions" by aggressively (and painfully) running a finger across this "Fossa of Rosenmuller" while this other guy seems to achieve the same thing by massaging the muscles. I have just started looking at the links so will read more although it looks very similar if not the same thing.
I had "Endonasal Therapy" and this looks kind of like the same thing although the 2 practicioners seem to be coming at it from different angles. The guy I saw called it "finger sweep" and said you could remove these "adhesions" by aggressively (and painfully) running a finger across this "Fossa of Rosenmuller" while this other guy seems to achieve the same thing by massaging the muscles. I have just started looking at the links so will read more although it looks very similar if not the same thing.
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Just a question for MAC and ginger nut.
Being an engineer and a diver if folk have probs with stuff getting blown back in. How about blowing it out with 1 bar of pressure. ie stick them in a chamber and take them down slowly to 10m let them sit for a bit on 1.6 bar partial o2 and let the free radicals do there stuff then a reasonable sharpish accent?.
I was always amazed at the amount of snot, more than a mouth full, that could be held in ones head that was produced in the last 10m. I never got colds etc when diving 30m plus regularly. My sister who's job it is to research the green slime in sewage farms which eats poo reckoned we where making the bugs burn out with high PP of o2.
Being an engineer and a diver if folk have probs with stuff getting blown back in. How about blowing it out with 1 bar of pressure. ie stick them in a chamber and take them down slowly to 10m let them sit for a bit on 1.6 bar partial o2 and let the free radicals do there stuff then a reasonable sharpish accent?.
I was always amazed at the amount of snot, more than a mouth full, that could be held in ones head that was produced in the last 10m. I never got colds etc when diving 30m plus regularly. My sister who's job it is to research the green slime in sewage farms which eats poo reckoned we where making the bugs burn out with high PP of o2.
Plastic PPRuNer
Interesting thought mad_jock. Hyperbaric oxygen for eustachian tube dysfunction. The volume of air in the middle ear is tiny (<1cc) so I don't know that it would work. Rather an expensive solution and, I suspect, rather painful.
Lets see what our surfing fount_of_all_wisdom says.
Lets see what our surfing fount_of_all_wisdom says.
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I'm a bit confused Jock, I think what your saying is, shall we reduce the outside pressure surrounding the middle ear, (by placing the patient in a decompression chamber), hence promoting expansion of the air in the middle ear, (Boyles law and all that), to try and expulse gunk out of the eustachian tube.
If you are, then I guess the risk is that we blow the delicate drum, instead of forcing out the gunk.
If your talking about hyperbaric oxygen acting as a bacteriacide, it may well kill the bugs, but we tend to find, in OM, other nasties tent to have a habit of taking over what we've killed.
It may be worth an experiment, if you can get Mac to volunteer, I'll gladly operate the chamber. (Only kiddin')
Any cheers all, talking of surfin' I'm off to Watergate in the morning. If anyone fancies a beer, I'm the sturdy one with a red bic and a black dog.
If you are, then I guess the risk is that we blow the delicate drum, instead of forcing out the gunk.
If your talking about hyperbaric oxygen acting as a bacteriacide, it may well kill the bugs, but we tend to find, in OM, other nasties tent to have a habit of taking over what we've killed.
It may be worth an experiment, if you can get Mac to volunteer, I'll gladly operate the chamber.
(Only kiddin')Any cheers all, talking of surfin' I'm off to Watergate in the morning. If anyone fancies a beer, I'm the sturdy one with a red bic and a black dog.
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Remember that at pressure you don't actually need haemoglobin to transport oxygen to the cells so your not relying on just gaesous transport into the ear.
Gingernut you slowly compress the person in the chamber while they breath 100% O2. They then sit there for a bit and then the chamber gets the pressure let off at a comfy rate.
If say you were blown down to 50m you would have a 5 fold increase in the volume of gas in the ear on the way up. Usually just a doubling from 10m to 0 is more than enough for the ears to creak and all the muck to dribble into your throat. We are talking diving masks full to the brim with snot. One bloke even had a lump of lint come out and he had his sinuses scrapped or what ever you do to them 6 years before then.
It was just an ex engineers suggested solution to the problem.
Mac I don't know about exspense I recon a 2 week holiday to the maldives diving 3 times a day should cost less than a course of hyperbaric treament.
Fancy operating at 600meters depth
Gingernut you slowly compress the person in the chamber while they breath 100% O2. They then sit there for a bit and then the chamber gets the pressure let off at a comfy rate.
If say you were blown down to 50m you would have a 5 fold increase in the volume of gas in the ear on the way up. Usually just a doubling from 10m to 0 is more than enough for the ears to creak and all the muck to dribble into your throat. We are talking diving masks full to the brim with snot. One bloke even had a lump of lint come out and he had his sinuses scrapped or what ever you do to them 6 years before then.
It was just an ex engineers suggested solution to the problem.
Mac I don't know about exspense I recon a 2 week holiday to the maldives diving 3 times a day should cost less than a course of hyperbaric treament.
Fancy operating at 600meters depth
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One diagnosis which most GP's and Most ENT's overlook is Patulous Eustation Tube - The symptoms are very, very similiar to Otis Media/ Eu tube disorder- blocked tubes, dulled hearing, difficult to clear gunk etc. (This condition can sometimes be accompanied by acute tinnitinus) Unfortunately there is no foolproof cure at present but there's lots of research going on. The Eustation tube Institute in Geneva is one of two places which can possibly help. The other is in Boston, US.
It would be interesting to see what decompression does as it cannot blow the eardrum as the EU tube remains open with this disorder...
It would be interesting to see what decompression does as it cannot blow the eardrum as the EU tube remains open with this disorder...
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Whilst Googling 'Patulous ET', I came across a link that mentioned having catheters fitted to the ear... I assume this is just another term for grommets?
Has anyone got any comments on Trigeminal Pharyngioplasty? Do you think it appears genuine?
Hyperbaric treatment looks very interesting. How much would it cost to book a chamber for a 30-minute session?
Thanks to all contributors!
Has anyone got any comments on Trigeminal Pharyngioplasty? Do you think it appears genuine?
Hyperbaric treatment looks very interesting. How much would it cost to book a chamber for a 30-minute session?
Thanks to all contributors!
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Depends where you live in the country.
Before you go any further with the try and blow it out option can I suggest you speak to a hyperbaric medic type person in case it really is bloody stupid.
http://www.nationalhyperbariccentre.com
As a suggestion.
If they arn't willing to help with advise they should be able to point you towards a consultant who does know. One of the chamber divers will proberly know someone to speak to or have an old sat divers trick of sorting it out.
but google threw up quite alot of hits in the UK. Seems to be quite the done thing these days.
Before you go any further with the try and blow it out option can I suggest you speak to a hyperbaric medic type person in case it really is bloody stupid.
http://www.nationalhyperbariccentre.com
As a suggestion.
If they arn't willing to help with advise they should be able to point you towards a consultant who does know. One of the chamber divers will proberly know someone to speak to or have an old sat divers trick of sorting it out.
but google threw up quite alot of hits in the UK. Seems to be quite the done thing these days.
Last edited by mad_jock; 2nd May 2008 at 15:30.
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Thanks, Jock.
From the diving sites I've checked, they all say that a diver needs perfect ET function or they shouldn't be diving...
Have a look at This Link
At the bottom of the item, it talks about Laser Eustachian tuboplasty, which appears to be an interesting option. Try Google.
Here's a couple of links I found: http://www.ncbi.nlm.nih.gov/pubmed/12671411
http://www.ncbi.nlm.nih.gov/pubmed/14724483
From the diving sites I've checked, they all say that a diver needs perfect ET function or they shouldn't be diving...
Have a look at This Link
At the bottom of the item, it talks about Laser Eustachian tuboplasty, which appears to be an interesting option. Try Google.
Here's a couple of links I found: http://www.ncbi.nlm.nih.gov/pubmed/12671411
http://www.ncbi.nlm.nih.gov/pubmed/14724483
CONCLUSION: Laser eustachian tuboplasty is a new procedure that has demonstrated early promise in correcting intractable eustachian tube dysfunction with few complications. Further studies will be necessary to reproduce the results and establish the role of laser eustachian tuboplasty in the management of chronic intractable eustachian tube dysfunction
Last edited by WG774; 2nd May 2008 at 15:23.
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Yep I would agree with that but its a bit like you should never fly with a cold.
Your also not meant to drink heavily the night before either. I was part of the drinking research group which proved that it doesn't make a difference. :-)
I would call one of these diving medics you never know you GP might refer you if they say they can help
Your also not meant to drink heavily the night before either. I was part of the drinking research group which proved that it doesn't make a difference. :-)
I would call one of these diving medics you never know you GP might refer you if they say they can help
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I'd love to hear an opinion from a medical pro on this: http://www.biolitec-us.com/filephoto...eustachian.pdf
??????
??????
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WG has uncovered some interesting stuff here....Mac and ginge, you seem to have differing opinions but it would be very helpful for all of us if you could both offer an opinion on this and the Trigeminal Pharyngioplasty ...
My ENT surgeon was VERY dubious when I suggested any surgery of the ET itself....as far as he was concerned such things are rarely successful but I am encouraged by looking at the material that WG has uncovered.
BTW, I have been on Carbocisteine for a few days and it hasn't really done anything. It has definately made me produce more mucous
but the ears are still the same.
I am convinced that my ET issues are muscular. Whenever I swallow (say drinking a glass of water for example) my tubes block up and I go a bit deaf. It takes a bit of ear popping to restore the situation. I can't see why this would happen otherwise???? Anyone??
My ENT surgeon was VERY dubious when I suggested any surgery of the ET itself....as far as he was concerned such things are rarely successful but I am encouraged by looking at the material that WG has uncovered.
BTW, I have been on Carbocisteine for a few days and it hasn't really done anything. It has definately made me produce more mucous
but the ears are still the same.I am convinced that my ET issues are muscular. Whenever I swallow (say drinking a glass of water for example) my tubes block up and I go a bit deaf. It takes a bit of ear popping to restore the situation. I can't see why this would happen otherwise???? Anyone??
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BTW, I have been on Carbocisteine for a few days and it hasn't really done anything. It has definately made me produce more mucous but the ears are still the same.
I am convinced that my ET issues are muscular. Whenever I swallow (say drinking a glass of water for example) my tubes block up and I go a bit deaf. It takes a bit of ear popping to restore the situation. I can't see why this would happen otherwise???? Anyone??
I am convinced that my ET issues are muscular. Whenever I swallow (say drinking a glass of water for example) my tubes block up and I go a bit deaf. It takes a bit of ear popping to restore the situation. I can't see why this would happen otherwise???? Anyone??
Just like you, I have been on Carbocisteine for about 8 days. It has thinned out the mucous, but the ear is still as blocked as ever. What worries me is that my current blockage is on the left, whereas my previous problems have been on the right...
BTW - I'm not totally convinced with Trigeminal Pharyngioplasty. If I could get it done locally and affordably, I'd jump at the chance. The only concern I have - and it may well be somewhat ill-founded - is that those who practice it *seem* - in my mind - to be a tad heavy in terms of marketing it... It might just be my perception / cynicism though.
Of all the treatments I've come across, the one that seems to offer most hope in my layman's eyes is the laser surgery. Look at it this way: many women have been able to conceive by having their fallopian tubes opened with a laser - if the treatment can translate to the ETs...
Ginger? Mac?
Plastic PPRuNer
I can't be a fount of wisdom here because I only deal these days with CSOM and Eustachian tubes as part of the problem in my cleft-palate patients.
What I can say is that middle ear ventilation and eustachian tube dysfunction still isn't too well understood (that doesn't mean, BTW, that it isn't understood at all). Certainly cleft palate patients, where the tensor and levator palati are malinserted have faulty tubal opening and CSOM.
Quite why some folk who seem to be anatomically normal have tubal dysfunction is unclear. Perhaps the muscles just don't "work right". Incidentally, lysing muscle adhesions manually by "Trigeminal Pharyngioplasty" (which sounds like an operation but isn't) sounds odd to me - you don't usually see muscle "adhesions" and when you do, they need more than massage to take down. But if his patients are happy.......
I've no experience of laser surgery here - lots of people have these problems and if laser surgery is effective you can be sure that it will be in mainstream practice. Ask someone with an interest in tubal dysfunction whether it works or is just snake-oil.
I'm old enough to remember Politzerisation, so here are a few references.
http://en.wikipedia.org/wiki/Politzerization
http://journals.cambridge.org/action...ne&aid=1103128
http://www.earpopper.com/
Just remember, for every ill in this world there's a little man with a pendulum or a potion who's the only one who really really understands it......................................
What I can say is that middle ear ventilation and eustachian tube dysfunction still isn't too well understood (that doesn't mean, BTW, that it isn't understood at all). Certainly cleft palate patients, where the tensor and levator palati are malinserted have faulty tubal opening and CSOM.
Quite why some folk who seem to be anatomically normal have tubal dysfunction is unclear. Perhaps the muscles just don't "work right". Incidentally, lysing muscle adhesions manually by "Trigeminal Pharyngioplasty" (which sounds like an operation but isn't) sounds odd to me - you don't usually see muscle "adhesions" and when you do, they need more than massage to take down. But if his patients are happy.......
I've no experience of laser surgery here - lots of people have these problems and if laser surgery is effective you can be sure that it will be in mainstream practice. Ask someone with an interest in tubal dysfunction whether it works or is just snake-oil.
I'm old enough to remember Politzerisation, so here are a few references.
http://en.wikipedia.org/wiki/Politzerization
http://journals.cambridge.org/action...ne&aid=1103128
http://www.earpopper.com/
Just remember, for every ill in this world there's a little man with a pendulum or a potion who's the only one who really really understands it......................................
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You mentioned Catheters in the ET....on doing some more reading it seems this is just shoving a tube up the ET into the middle ear in order to force ventilation.
If you have fluid in the ear then this might be a good technique....it would allow it all to drain out and fingers crossed it might not re-appear. A myringotomy could also help.
If you have patulous ET then you will get a bunch of additional symptoms...the tube is open all the time so you'll be able to hear your own voice loudly in your head when you're talking and will have great sensitivity to sounds so I'm told as there is an open path between the outside air and your middle ear.
My ENT specialist was very dubious about ET surgery....I'm aircrew so I need to make sure my tubes work as well as they can and I'm very reluctant to mess with nature. As I sit and type this, my jaw feels very tight and is aching quite a bit. I'm convinced that is is aTMJ issue for me at least...WG do you have any jaw tension??
If you have fluid in the ear then this might be a good technique....it would allow it all to drain out and fingers crossed it might not re-appear. A myringotomy could also help.
If you have patulous ET then you will get a bunch of additional symptoms...the tube is open all the time so you'll be able to hear your own voice loudly in your head when you're talking and will have great sensitivity to sounds so I'm told as there is an open path between the outside air and your middle ear.
My ENT specialist was very dubious about ET surgery....I'm aircrew so I need to make sure my tubes work as well as they can and I'm very reluctant to mess with nature. As I sit and type this, my jaw feels very tight and is aching quite a bit. I'm convinced that is is aTMJ issue for me at least...WG do you have any jaw tension??
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http://www.headaches.com/home.htm
This guy seems to crop up a lot too in searches....I don't know anything about him though and the website is suspiciously quiet on what the treatment options are (!) but you never know....
This guy seems to crop up a lot too in searches....I don't know anything about him though and the website is suspiciously quiet on what the treatment options are (!) but you never know....