mystery of yawning
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La parakinésie brachiale oscitante
Yawning: its cycle, its role
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Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
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mise à jour du
21 septembre 2012
Eur Arch Otorhinolaryngol
2012
Eustachian tube function in patients
with inner ear disorders
Park JJ, Luedeke I, Luecke K, Emmerling O, Westhofen M.
Department of Otorhinolaryngology and Head and Neck Surgery
Aachen Universit Germany

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The influence of Eustachian tube (ET) dysfunction on the inner ear fluid pressure and thus on the inner ear function in Meniere's disease has been discussed controversially. So far, most of the studies examining ET function in inner ear disorders indirectly analyzed ET function by tympanometric methods.
 
The present study directly studied ET function in inner ear disorders by sonotubometry. Healthy subjects and patients with Meniere's disease, sudden sensorineural hearing loss, cholesteatoma and chronic suppurative otitis media were examined by sonotubometry.
 
Mean increase of sound pressure intensity (dB) and mean duration of sound pressure increase (s) were analyzed. Highest mean increase of sound pressure intensity was seen in healthy subjects when using >5 dB peaks (11.6 ± 0.7 dB) and >0 dB peaks (9.6 ± 0.6 dB). Comparative analysis including bilateral ears showed decreased ET function in patients with cholesteatoma (p = 0.002) and in patients with Meniere's disease (p = 0.003) when using >0 dB peaks. Examination of each specific ET opening maneuver showed impaired ET function in pathological ears of patients with cholesteatoma and with Meniere's disease, during yawning (p = 0.001; p < 0.001), dry swallowing (p = 0.010; p = 0.049), Toynbee maneuver (p = 0.033; p = 0.032) and drinking (p = 0.044; p = 0.027).
 
Mild ET dysfunction is detected in patients with Meniere's disease by direct sonotubometric assessment of ET function.
 
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Introduction
Eustachian Tube (ET) function is predominately known for ventilation, drainage and protection against ascending infection of the middle ear. An indirect effect of ET function on inner ear function by changing middle ear pressure has been discussed controversially. The possible involvement of ET function in cochleovestibular disorders has been proposed by Tumarkin. Supporting observations were made by other authors, placing a transtympanic ventilation tube in patients with Meniere's disease. Lall reported an improvement of vertigo after tube insertion and Montandon et al. noticed a prevention of vertigo attacks. Contrarily, other studies showed no change of symptoms after ventilation tube placement. Different study results might be due to the diagnostic methods used to assess ET function. Most of the studies examining ET function in patients with cochleovestibular disorders only assessed indirectly ET function by different tympanometric methods in combination with pressure altering methods.
 
Sonotubometry is an acoustic method to measure ventilatory function of ET. The principle of sonotubometry was first described by Politzer. He reported an increasing sound of a tuning fork held in front of the nostril when the subject swallowed. During sonotubometric measurements, ET opening is measured by recording changes of sound pressure level in the external auditory canal; when a sound is applied to the nostril by a microphone while the subject actively performs ET opening maneuvers. Virtanen described the standard procedure for sonotubometry using frequencies between 6 and 8 kHz. Sonotubometry allows to evaluate ET function by assessing actual ET openings.
 
Until now, there have been no investigations examining directly ET function in patients with inner ear disorders. The present study examined ET function in patients with Meniere's disease and with sudden sensorineural hearing loss by using sonotubometry. ET function was compared to healthy persons and to patients with known ET dysfunction such as patients with cholesteatoma and with chronic suppurative otitis media.
 
 
Discussion
During the first analysis, ET function of bilateral ears in patients was compared to bilateral ears in healthy persons. Bilateral ears were involved to assess the overall ET function of patients with cochleovestibular disorders. The comparison showed a significant reduction only in patients with cholesteatoma compared to healthy persons, when peaks>5 dB in sonotubometric recordings were regarded. When considering peaks >0 dB, patients with Meniere's disease also showed reduced sonotubometric amplitudes compared to healthy persons.
 
The separate examination of each ET opening maneuver displayed impaired bilateral ET function during yawning in patients with cholesteatoma and also with Meniere's disease, but not in patients with sudden hearing loss. These observations indicate an overall ET dysfunction of both ears in patients with Meniere's disease. Since malfunction of ET could only be found in analysis for sonotubometric amplitudes>0 dB, ET dysfunction in patients with Meniere's disease can be assumed to be rather mild than severe. Most studies applying sonotubometry defined amplitudes >5 dB as an ET opening. Using sonotubometric peaks >0 dB might not be able to distinguish between actual ET openings from nearly ET openings. Amplitudes >0 dB might also include artifacts caused by pharyngeal muscle activities and nose pollution.
 
In fact, not in every case a definite discrimination between ET opening and artifacts could be made. Still, including peaks >0 dB might detect subtle ET dysfunctions which would be missed when exclusively analyzing peaks >5 dB. Patients with Meniere's disease might have an unknown underlying mild ET dysfunction which is clinically not predominant, but which might effect cochleovestibular function by influencing middle ear and thus indirectly inner ear pressure when present over years. Impaired ET function in patients with Meniere's disease was confirmed by comparing pathological ears only with healthy persons. Maneuver specific analysis showed limited ET opening function not only during yawning, but also during dry swallowing, Toynbee maneuver and drinking when analyzing affected ears.
 
The fact that rather subtle than predominant ET dysfunction was found might explain the findings that only sonotubometric amplitude was reduced but duration of opening was not prolonged significantly in statistical analysis. It should be mentioned that none of the patients with inner ear disorders showed micro-otoscopical signs of middle ear dysventilation. The influence of ET function on inner ear function has been discussed controversially. Abnormal patulous ET was observed in patients with sudden hearing loss and with vestibular symptoms . Although pathologically increased patency of ET could not be confirmed in patients with cochlear dysfunction by further studies, an influence of ET on the inner ear function could not be excluded. Indications of rather decreased patency of ET in patients with sudden hearing loss were found.
 
Patients with aural fullness, which is a common symptom of patients with cochleovestibular defects, showed ET dysfunction. Whereas several authors found pathological negative middle ear pressure in patients with Meniere's disease, others observed no abnormal findings in tympanometry in patients with inner ear disturbances. In these studies, normal tympanometric middle ear pressure was referred as healthy ET function.
 
However, normal tympanometric results of the middle ear does not necessarily reveal mild hypo- or dysfunction of ET. Although tympanometry showed no pathological findings, ET dysfunction was recorded in tubotympanoaero-dynamic graphy (TTAG). One reason data of above-mentioned studies about ET function in patients with Meniere's disease contradict so far might be the predominant usage of tympanometric methods. Almost all investigations examining the role of ET in patients with inner ear disease used indirect methods by either applying tympanometry alone or in combination with whole body pressure chambers.
 
The present study reveals mild ET opening dysfunction in patients with cochleovestibular disorders by direct evaluation of ET function. Mechanisms influencing inner ear pressure by middle ear pressure changes have been described. Adjacent to the cochlear aqueduct, a pouch-like extension of the round window membrane can be found. Depending on the position of the round window membrane, which is modified by middle ear pressure, the entrance of the cochlear aqueduct is opened or closed. Since the cochlear aqueduct plays a key role in inner ear pressure regulation, inner ear pressure can be altered by middle ear pressure changes via the described way. Mild persistent malfunction of ET might lead to intermittent pathologic middle ear pressure not detected in a single tympanometric examination, but influencing inner ear hydrostatic pressure and therefore inner ear function.
 
Subtle ET dysfunction might be more advanced on the affected pathological ear side of patients with inner ear disease. When comparing overall ET function, which means comparing bilateral ears, malfunction was only noticed in patients with concurrent vestibular and cochlear damages, i.e in Meniere's disease, but not in patients with sudden hearing loss. However, analysis of affected ears displayed limited ET function also in patients with isolated cochlear damages. Further investigations comparing ET function of pathological and contralateral ear side in patients with inner ear disorders are needed to examine potential intraindividual differences.
 
Such examinations would be interesting to conduct due to the fact that about 30 % of patients with Meniere's diesease show involvement of bilateral ears. Still, it remains speculative whether ET function influences the pathogenesis of cochleovestibular diseases. But it is conceivable that in addition to intralabyrinthine functional and anatomical abnormalities ET malfunction might contribute to the development of inner ear disorders with the clinical appearance of Meniere's syndrome. Long-term middle ear pressure measurements and if possible inner ear pressure measurements in patients with inner ear disorders and with sonotubometric proven ET dysfunction would be helpful for enhanced understanding of this matter. Additionally, further studies with more advanced sonotubometric techniques need to be performed in patients with Meniere's disease.
 
The present study used a 8 kHz signal for sonotubometry, which is known to have its limits in sensitivity of detection of ET opening. It has been shown that so-called perfect sequences (PSEQ) enhance the sensitivity of sonotubometr. For improved understanding of ET function in Meniere's disease PSEQ should be applied in future investigations.
 

Radiopaque contrast dye in nasopharynx reaches the middle ear during swallowing and/or yawning
Winther B et al
Acta Oto-Laryngologica
2005;125: 625-628 
 
The role of the Eusatchius tube and the tympanal muscles in yawning
Laskiewicz A
Revue de Laryngologie Otologie Rhinologie
Mai-Juin 1953 74° année; n°5-6
 
Yawning with regard to the respiratory organs and the ear
Laskiewicz A
Acta Oto laryngologica (Stockholm)
1953; 43; 2-3; 267-270
 
Remarques sur la signification physiologique du bâillement
Lepp FH
Bull Group Int Rech Sci
Stomtol Odontol
1982; 25; 251-290
 
Evaluation of Eustachian tube function by sonotubometry: results and reliability of 8 kHz signals in normal subjects
Di Martino EF, Thaden R, Antweiler C,et al.
Eur Arch Otorhinolaryngol. 2006
 
Paralysies faciales périphériques d'origine dysbarique
d'Andréa C, Méliet JL, Staikowski F
La Presse Médicale 2008;.37(4 Pt 2):643-7.
 
Park JJ, Luedeke I, Luecke K. et al. Eustachian tube function in patients with inner ear disorders.
Eur Arch Otorhinolaryngol. 2012