带有正常耳道的儿童和成人的耳压力开闭功能_中文版

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Acta Otolaryngol Downloaded from informahealthcare.com by Kainan University on 04/04/15

Acta Otolaryngol 95:55-62,1983

PRESSURE OPENING AND CLOSING FUNCTIONS OF THE EUSTACHIAN TUBE IN

CHILDREN AND ADULTS WITH NORMALEARS

Anita Bylander,Orjan Tjernström and Alf Ivarsson

From the Department of Otolaryngology,University of Lund,Malmö General Hospital,Malmö,Sweden

(Received December 2,1981)

Abstract.Eustachian tube function was studied with the

impedance technique and a pressure chamber in 58 chil-

dren,aged 3-12 years,and 61 adults,aged 17-73 years,

all otologically healthy.The pressure opening and closing

functions were measured,i.e.the relative overpressure in

the middle ear required to force open the tube,and the

residual overpressure in the middle ear after pressure

opening,respectively.These passive"functions of the

tube,assumed to reflect the closing factors,did not differ

significantly between normal children and adults.The

muscular opening function,i.e."active"pressure equili-

bration capacity,on the other hand,was significantly

poorer in children than in adults and poorer in younger

children than in older ones.The results can be used as a

reference material in investigations of the Eustachian tube

in children with middle ear disease.

For personal use only.

In the last few decades interest has focused

mainly on the muscular opening function of

the Eustachian tube,but recent reports have

stressed the importance of investigation of the

pressure opening and closing functions of the

tube as well(Bluestone et al.,1972,1974;Can-

tekin et al.,1976;Ekvall &Magnusson,1977;

Ingelstedt,1978;Magnusson,1980).

Bluestone et al.(1972,1974)and Cantekin et

al.(1976)have tried to elucidate the nature of

tubal dysfunction in children with middle ear

effusions or recurrent otitis media.They often

found poor muscular opening function in asso-

ciation with low opening pressures and sug-

gested that functional obstruction of the tube,

i.e.too distensible or compliant a tube,rather

than mechanical obstruction,might be a cau-

sative factor of middle ear disease in children.

Ekvall &Magnusson(1977)and Magnusson

(1980)reported impaired closing ability of the

tube in chronic adhesive otitis media and re-

traction cholesteatoma.They proposed that

these patients with “closing failure”,i.e.low

closing pressures of the tube,might get nega-

tive middle ear pressures due to habitual sniff-

ing,which also in children might be an impor-

tant factor for the retraction of the eardrum.

Before any conclusions can be drawn re-

garding the role of tubal dysfunction as an

etiological factor in middle ear disease,it is

obvious that knowledge must be acquired of

tubal function in otologically healthy children

and adults.It also seems important to investi-

gate the pressure opening and closing func-

tions as well as the muscular opening function

of the tube.

Such an investigation requires a method,al-

lowing the study of the above-mentioned vari-

ables of tubal pressure equilibration functions,

in subjects with intact eardrums without dis-

turbing the normal physiology of the middle

ear.The impedance method in combination

with a pressure chamber meets these require-

ments and has proved to be suitable also in the

examination of small children(Bylander et al.,

1981).

The aims of this study were:1)to investigate

the "passive"pressure opening and closing

functions as well as the "active"muscular

opening function in otologically healthy chil-

dren of different ages;2)to compare the re-

sults with those of normal adults tested with

the same method;and 3)to compare the re-

sults of the "passive"functions with those of

the "active"muscular opening function in

these children and adults.

Acta Otolaryngol 95

由凯南大学于2015年4月4日发布于informahealthcare.com

耳鼻喉学学报95：55-62,1983

带有正常耳道的儿童和成人的耳压力开闭功能

Anita Bylander，Orjan Tjernstrom和Alf Ivarsson

瑞典隆德大学耳鼻喉科，马尔默综合医院，马尔默

（1981年12月2日收到）

摘要。本研究采用阻抗技术结合压力舱法，对58名3-12岁

儿童和61名17-73岁成人（所有受试者均耳科健

康）的咽鼓管功能进行研究。测量中耳压力开启与

闭合功能，即引导咽鼓管开启所需的中耳相对过压

值，以及压力开启后中耳残留的过压值。这些被动“功能”

（推测反映闭合机制）在正常儿童与成人之间无显著差异。

然而，肌肉开启功能（function，i.e.“主动”压力平衡能

力）在儿童中明显逊于成人，且低龄儿童表现更差。本研究

结果可作为儿童中耳疾病患者咽鼓管功能评估的参考依据。

仅供个人使用。

下载的耳鼻喉科病例

近几十年来，研究焦点主要集中在咽鼓管

的肌肉开闭功能，但最新研究强调了探究

其压力开闭机制的重要性（Bluestone等，

1972,1974；Cantekin 等，1976；Ekvall 与

Magnusson，1977；Ingelstedt，1978；

Magnusson，1980）。

布鲁斯通等人（1972、1974）与坎特金团队

（1976）曾针对中耳积液或反复发作的中耳

炎患儿，深入探究输卵管功能障碍的本质。

研究发现，患儿普遍存在肌肉张力不足导致

的开启功能障碍，伴随较低的开启压力。研

究者提出，相较于机械性阻塞，输卵管功能

障碍（即管壁过度扩张或顺应性增强）可能

是引发儿童中耳疾病的潜在病因。埃克瓦尔

与马格努松（1977）以及马格努松（1980）

的研究则揭示，慢性粘连性中耳炎患儿的输

卵管闭合功能存在明显缺陷。

牵拉性胆脂瘤。研究者指出，这些患者因耳

道闭合压力（failure“，i.e.low）闭合时，可

能因习惯性吸气导致中耳压力下降，这种情

况在儿童中尤为常见，可能是鼓膜回缩的重

要诱因。

在探讨输卵管功能障碍作为中耳疾病病因

因素的作用前，必须先明确耳科健康儿童和

成人的输卵管功能状况。同时，研究输卵管

的压开闭功能及肌肉开闭机制也具有重要价

值。

此类研究需要采用特定方法，以在不干扰

中耳正常生理功能的前提下，对鼓膜完整受

试者的输卵管压力平衡功能相关变量进行检

测。阻抗法结合压力舱技术不仅符合上述要

求，且经证实适用于婴幼儿检查（Byland-

er等，1981）。

本研究旨在：1)探究不同年龄段耳科健康

儿童的“被动”压力开闭功能及“主动”肌

肉开闭功能；2)将实验结果与采用相同方法

测试的正常成年人进行对比；3)比较这些儿

童与成人中“被动”功能与“主动”肌肉开

闭功能的差异。

耳鼻喉学学报

Acta Otolaryngol Downloaded from informahealthcare.com by Kainan University on 04/04/15

For personal use only.

56 A.Bylander et al.

MATERIAL AND METHODS

The material consisted of 58 otologically

healthy children,aged 3-12 years(mean 7.0

years)and 61 adults,aged 17-73 years(mean

29.8 years).The criteria for acceptance as oto-

logically healthy were:no history of recurrent

otitis media;no history of middle ear effusion

or impairment of hearing;no history of ob-

structing adenoid or allergy;no symptoms or

signs of upper respiratory tract infection when

tested;normal otoscopic or otomicroscopic

findings including examination with Siegle's

pneumatic otoscope;pure tone hearing thresh-

old within 0-20 dB(ISO standard 1964);and

V-shaped tympanograms indicating air-filled

middle ears.

Equipment

An electroacoustic impedance bridge,model

ZO 70(Madsen Electronics,Copenhagen,

Denmark),with a probe frequency of 220 Hz

was used for the recordings.A pressure cham-

ber was used to induce static relative over-and

underpressures in the middle ear for testing

muscular opening function and to induce dy-

namic relative pressure changes in the middle

ear for testing pressure opening and closing

functions.The pressure range of the chamber

was±7kPa and the mean rate of pressure

change from ambient pressure to -7kPa was

0.37 kPa/s.During changes in chamber pres-

sure an open communication between the ear

canal and the chamber was established by a

valve.The recordings were made on a multi-

channel ink jet recorder(Mingograph 81,Sie-

mens Elema,Stockholm,Sweden)with a chart

speed of 10 mm/s.For further details of the

equipment,see Bylander et al.(1981).

ment.Only the left ear of each subject was

tested.All recordings of the tests were per-

formed by one and the same examiner.Three

variables of Eustachian tube function were

studied,viz.muscular opening function,pres-

sure opening function,and pressure closing

function.

Muscular opening function was assessed

from the subject's ability to equilibrate a static

relative overpressure as well as a relative un-

derpressure of 1kPa in the middle ear,induced

by changing the chamber pressure.The "ac-

tive"pressure equilibration performed by the

subject was standardized in the following way:

if the middle ear pressure was not equilibrated

completely by deglutition,wet (juice)and dry,

alternately,10 times within 3 min.,the subject

was instructed to open the mouth,yawn,move

the mandible laterally and swallow repeatedly,

for up to 10-20 min.This is called "the meth-

od of free choice”,as described by Bylander

et al.(1981).The subjects were divided into

four tubal function groups according to Elner

et al.(1971).Group Iequilibrated both positive

and negative pressures of 1 kPa to less than0.1

kPa residual pressure.Group I equilibrated

partially positive and negative pressures (re-

sidual pressures 0.1-0.9 kPa).Group Ⅲ

equilibrated positive pressures of 1 kPa com-

pletely or partially but not any applied nega-

tive pressures.Group IV equilibrated neither

positive nor negative pressures of 1 kPa.Mus-

cular opening function was assumed to be

good in groups I and II as air passed in both

directions in the tube,but to be poor in groups

II and IV as no equilibration of negative pres-

sure was recorded during the test period.The

muscular opening function test has been de-

scribed in detail elsewhere(Bylander et al.,

1981).

Performance

Informed consent of the children's parents

was obtained before the tests.The subject was

seated comfortably in the pressure chamber

and instructions were given for the different

tests.The small children needed an assistant in

the chamber for instructions and entertain-

Pressure opening function was assessed

during decreasing pressure in the chamber by

measuring the change in chamber pressure re-

quired to induce a relative overpressure in the

middle ear necessary to open the tube(Fig.1)

This pressure change is called the pressure

opening level (Pol).First the neutral position

Acta Otolaryngol 95

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标签： #耳道 #耳压力 #中英文

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ActaOtolaryngolDownloadedfrominformahealthcare.combyKainanUniversityon04/04/15ActaOtolaryngol95:55-62,1983PRESSUREOPENINGANDCLOSINGFUNCTIONSOFTHEEUSTACHIANTUBEINCHILDRENANDADULTSWITHNORMALEARSAnitaBylander,OrjanTjernströmandAlfIvarssonFromtheDepartmentofOtolaryngology,UniversityofLund,MalmöGeneralHo...

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