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Eustachian tube evaluation in aviators

  • Otology
  • Published:
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Abstract

The aim of the study is to evaluate the Eustachian tube functionality in a group of aviators to underline a subclinical dysfunction and the related risk of ear fullness or barotitis. Hypobaric chamber allows to simulate the pressure variation of the flight. This prospective study enrolled 42 aviation pilots, members of the Italian Air Force, to whom were evaluated Eustachian tube functionality by Tubomanometry, patients subjective assessments concerning feasibility of Valsalva’s and Toynbee’s clinical symptoms, tympanometry, and objective Valsalva before and after exposure to hypobaric chamber. The new Eustachian tube score (ETS-7) was also calculated for each pilot before and after exposure to hypobaric chamber. Results of our examination showed that: before chamber exposition, in 92.8 % of pilots, an ETS-7 of eight or more was found bilaterally. In three (7.2 %) cases, a unilateral ETS-7 ≤ 7 was found and two of those had a positive history. After undergoing the hypobaric chamber session, the evaluation of ETS-7 showed only 19 % of pilots with an ETD score ≤7, in particular three bilateral and five unilateral cases. Three of those pilots were clinically positive: two airmen reported persistent fullness, while the other one had a barotitis. Therefore, the combined use of TMM and ETS-7 before and after hypobaric chamber exposure appears to be a reliable method for assessing the functional capacity of the Eustachian tube in aviators, the stressful effect of flight on it, to exclude subjects at increased risk of ear pain, fullness, or barotrauma.

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References

  1. Magliulo G, Ciniglio Appiani M, Porcaro M, Iannella G (2012) Pneumolabyrinth following eustachian tube insufflation. Otolaryngol Head Neck Surg 147:980–981

    Article  PubMed  Google Scholar 

  2. Hussein AA, Adams AS, Turner JH (2015) Surgical management of Patulous eustachian tube: a systematic review. Laryngoscope 125:2193–2198

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sudhoff H, Schröder S, Reineke U et al (2013) Therapy of chronic obstructive eustachian tube dysfunction: evolution of applied therapies. HNO 61:477–482

    Article  CAS  PubMed  Google Scholar 

  4. Gürtler N, Husner A, Flurin H (2015) Balloon dilation of the Eustachian tube: early outcome analysis. Otol Neurotol 36:437–443

    Article  PubMed  Google Scholar 

  5. Swarts JD, Alper CM, Luntz M et al (2013) Panel 2: Eustachian tube, middle ear, and mastoid–anatomy, physiology, pathophysiology, and pathogenesis. Otolaryngol Head Neck Surg 148:E26–E36

    Article  PubMed  Google Scholar 

  6. Magliulo G, Iannella G, Granata G, Ciofalo A, Pasquariello B, Angeletti D, La Marra F, Quinti I (2016) Otologic evaluation of patients with primary antibody deficiency. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-016-3956-y

  7. Ockermann T, Reineke U, Upile T, Ebmeyer J, Sudhoff HH (2010) Balloon dilation eustachian tuboplasty: a feasibility study. Otol Neurotol 31:1100–1103

    Article  PubMed  Google Scholar 

  8. Ockermann T, Reineke U, Upile T, Ebmeyer J, Sudhoff HH (2010) Balloon dilatation eustachian tuboplasty: a clinical study. Laryngoscope 120:1411–1416

    Article  PubMed  Google Scholar 

  9. Schröder S, Lehmann M, Sauzet O, Ebmeyer J, Sudhoff H (2015) A novel diagnostic tool for chronic obstructive eustachian tube dysfunction—the eustachian tube score. Laryngoscope 125:703–708

    Article  PubMed  Google Scholar 

  10. Schilder AGM, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, Norman G, Pennings RJ, Poe D, Silvola JT, Sudhoff H, Lund VJ (2015) Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol 40:407–411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Henry JL (2008) When the envelope pushes back: a combat aviator experiences barotrauma after descending with an ear block. Mil Med 173:403–405

    Article  PubMed  Google Scholar 

  12. Kanick SC, Doyle WJ (1985) Barotrauma during air travel: predictions of a mathematical model. J Appl Physiol 2005(98):1592–1602

    Google Scholar 

  13. Jumah MD, Schlachta M, Hoelzl M, Werner A, Sedlmaier B (2010) Pressure regulating ear plug testing in a pressure chamber. Aviat Space Environ Med 81:560–565

    Article  PubMed  Google Scholar 

  14. Landolfi A, Torchia F, Autore A et al (2009) Acute otitic barotrauma during hypobaric chamber training: prevalence and prevention. Aviat Space Environ Med 80:1059–1062

    Article  PubMed  Google Scholar 

  15. Morgagni F, Autore A, Landolfi A et al (2012) Predictors of ear barotrauma in aircrews exposed to simulated high altitude. Aviat Space Environ Med 83:594–597

    Article  PubMed  Google Scholar 

  16. Morgagni F, Autore A, Landolfi A, Torchia F, Ciniglio Appiani G (2010) Altitude chamber related adverse effects among 1241 airmen. Aviat Space Environ Med 81:873–877

    Article  PubMed  Google Scholar 

  17. Devine JA, Forte VA Jr, Rock PB, Cymerman A (1990) The use of tympanometry to detect aerotitis media in hypobaric chamber operations. Aviat Space Environ Med 61:251–255

    CAS  PubMed  Google Scholar 

  18. Ashton DH, Watson LA (1990) The use of tympanometry in predicting otitic barotrauma. Aviat Space Environ Med 61:56–61

    CAS  PubMed  Google Scholar 

  19. Schröder S, Lehmann M, Korbmacher D et al (2015) Evaluation of tubomanometry as a routine diagnostic tool for chronic obstructive Eustachian tube dysfunction. Clin Otolaryngol 40:691–697

    Article  PubMed  Google Scholar 

  20. Jenckel F, Kappo N, Gliese A et al (2015) Endonasal dilatation of the Eustachian tube (EET) in children: feasibility and the role of tubomanometry (Estève) in outcomes measurement. Eur Arch Otorhinolaryngol 272:3677–3683

    Article  PubMed  Google Scholar 

  21. Di Martino EF (2013) Eustachian tube function tests: an update. HNO 61:467–476

    Article  PubMed  Google Scholar 

  22. Smith ME (2015) Tysome JR1Tests of Eustachian tube function: a review. Clin Otolaryngol 40:300–311

    Article  CAS  PubMed  Google Scholar 

  23. Klokker M, Vesterhauge S, Jansen EC (2005) Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude. Aviat Space Environ Med 76:1079–1082

    PubMed  Google Scholar 

  24. Teed RW (1944) Factors producing obstruction of the auditory tube in submarine personnel. US Nav Med Bull 42:293–306

    Google Scholar 

  25. Holmstrom FMG (1971) Hypoxia. In: Randel HW (ed) Aerospace Medicine. Williams & Wilkins, Baltimore, pp 56–85

    Google Scholar 

  26. Esteve D (2003) Tubomanometry and pathology. In: Ars B (ed) Fibrocartilaginous eustachian tube—Middle Ear Cleft. Kugler, The Hague, pp 184–192

    Google Scholar 

  27. Esteve D, Dubreuil C, Della Vedova C, Normand B, Martin C (2001) Tympanometric evaluation of the opening of the Eustachian tube in normal subjects and cases with chronic otitis media. J Fr ORL 50:223–231

    Google Scholar 

  28. Van Balen FA, Aarts AM, De Melker RA (1999) Tympanometry by general practitioners: reliable? Int J Pediatr Otorhinolaryngol 48:117–123

    Article  PubMed  Google Scholar 

  29. Magliulo G, Celebrini A, Cuiuli G, Parotto D (2004) Osteopetrosis of temporal bone with blockage of the eustachian tube. A case report. An Otorrinolaringol Ibero Am 31:51–58

    CAS  PubMed  Google Scholar 

  30. Stangerup SE, Tjernström O, Klokker M, Harcourt J, Stokholm J (1998) Point prevalence of barotitis in children and adults after flight, and effect of autoinflation. Aviat Space Environ Med 69:45–49

    CAS  PubMed  Google Scholar 

  31. Brown TP (1994) Middle ear symptoms while flying. Ways to prevent a severe outcome. Postgrad Med 96:135–137

    CAS  PubMed  Google Scholar 

  32. Smallman DP, Hu Z, Rohrbeck P (2014) U.S. Armed Forces air crew: incident illness and injury diagnosis during the 12 months prior to retirement 2003–2012. MSMR 21:8–12

    PubMed  Google Scholar 

  33. Guyot JP (1996) Should a pilot suffering from Ménière’s disease be grounded or lifted off to the moon? ORL J Otorhinolaryngol Relat Spec 58:304–305

    Article  CAS  PubMed  Google Scholar 

  34. Pons Y, Raynal M, Hunkemöller I, Lepage P, Kossowski M (2010) Vestibular schwannoma and fitness to fly. Aviat Space Environ Med 81:961–964

    Article  PubMed  Google Scholar 

  35. EASA: Part-MED/AMC/GM. In: http://easa.europa.eu/regulations. Accessed 1 Oct 2012

  36. Air Force Waiver Guide, 1 Mar 2016

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Authors and Affiliations

  1. ‘Organi di Senso’ Department, ‘Sapienza’ University of Rome, Viale del Policlinico, 151, 00161, Rome, Italy

    Giannicola Iannella, Benedetta Pasquariello, Alessandra Manno, Diletta Angeletti & Giuseppe Magliulo

  2. Aerospace Medicine Department, Experimental Flight Centre, Italian Air Force Logistic Command, Aeroporto di Pratica di Mare, Pomezia, Italy

    Marco Lucertini

  3. Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy

    Massimo Re

  4. Via Gregorio VII n. 80, 00165, Rome, Italy

    Giuseppe Magliulo

Authors
  1. Giannicola Iannella
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  2. Marco Lucertini
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  3. Benedetta Pasquariello
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  4. Alessandra Manno
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  5. Diletta Angeletti
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  6. Massimo Re
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  7. Giuseppe Magliulo
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Correspondence to Giuseppe Magliulo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Iannella, G., Lucertini, M., Pasquariello, B. et al. Eustachian tube evaluation in aviators. Eur Arch Otorhinolaryngol 274, 101–108 (2017). https://doi.org/10.1007/s00405-016-4198-8

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  • DOI: https://doi.org/10.1007/s00405-016-4198-8

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