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Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation

Published online by Cambridge University Press:  31 July 2017

O Ilan ,
E-L Marcus ,
Y Cohen ,
T Farkash ,
R Levy ,
A Sasson  and
C Adelman
O Ilan*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Chronic Ventilator-Dependent Unit, Herzog Hospital, Jerusalem, Israel
E-L Marcus
Affiliation:
Chronic Ventilator-Dependent Unit, Herzog Hospital, Jerusalem, Israel
Y Cohen
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
T Farkash
Affiliation:
Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
R Levy
Affiliation:
Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
A Sasson
Affiliation:
Chronic Ventilator-Dependent Unit, Herzog Hospital, Jerusalem, Israel
C Adelman
Affiliation:
Speech and Hearing Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
*
Address for correspondence: Dr O Ilan, Department of Otolaryngology – Head & Neck Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. E-mail: ofir.ilan@mail.huji.ac.il
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Abstract

Objective:

This study aimed to investigate the prevalence of and risk factors for Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation via tracheostomy tube.

Methods:

A total of 40 patients on chronic ventilation were included in a prospective cohort study. Middle-ear status was determined by tympanometry. Tympanograms were categorised as types A, B or C; types B and C were defined as middle-ear pathology.

Results:

In all, 57 ears of 40 patients were examined. Disease was found in at least 1 ear in 26 out of 40 patients. Middle-ear pathology was found in 25 out of 34 patients who were tube fed (via nasogastric tube or percutaneous endoscopic gastrostomy) vs 1 patient out of the 6 fed orally (p = 0.014), and in 23 out of 31 with conscious or cognitive impairment vs 3 out of 9 cognitively intact patients (p = 0.044).

Conclusion:

Middle-ear pathology is common in patients on chronic mechanical ventilation via tracheostomy tube. The highest prevalence was in those with impaired consciousness or cognition, and oral feeding appeared protective.

Keywords

Intubation, gastrointestinalOtitis media with effusionRespirationArtificialTracheostomyEustachian Tube
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 9 , September 2017 , pp. 817 - 822
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Cox, CE, Carson, SS, Holmes, GM, Howard, A, Carey, TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med 2004;32:2219–26Google Scholar
2 Carson, SS, Cox, CE, Holmes, GM, Howard, A, Carey, TS. The changing epidemiology of mechanical ventilation: a population-based study. J Intensive Care Med 2006;21:173–82CrossRefGoogle ScholarPubMed
3 Somefun, AO, Adefuye, SA, Danfulani, MA, Afolabi, S, Okeowo, PA. Adult onset otitis media with effusion in Lagos. Niger Postgrad Med J 2005;12:73–6Google Scholar
4 Mills, R, Hathorn, I. Aetiology and pathology of otitis media with effusion in adult life. J Laryngol Otol 2016;130:418–24Google Scholar
5 Finkelstein, Y, Ophir, D, Talmi, YP, Shabtai, A, Strauss, M, Zohar, Y. Adult-onset otitis media with effusion. Arch Otolaryngol Head Neck Surg 1994;120:517–27Google Scholar
6 Hamill-Ruth, RJ, Ruth, RA. Evaluation of audiologic impairment in critically ill patients: results of a screening protocol. Crit Care Med 2003;31:2271–7Google Scholar
7 Hamill-Ruth, RJ, Ruth, RA, Googer, K, Volles, D, Deivert, M, Turrentine, B. Use of otoacoustic emissions to screen for hearing loss in critically ill patients. Audiology 1998;37:344–52Google Scholar
8 Roth, Y, Sokolov, M, Adler, M, Ezry, T, Harell, M. Otorhinolaryngological problems occurring within the intensive care unit. Intensive Care Med 2003;29:884–9CrossRefGoogle ScholarPubMed
9 Cavaliere, F, Masieri, S, Liberini, L, Proietti, R, Magalini, SI. Tympanometry for middle-ear effusion in unconscious ICU patients. Eur J Anaesthesiol 1992;9:71–5Google ScholarPubMed
10 Lin, CC, Lin, CD, Cheng, YK, Tsai, MH, Chang, CS. Middle ear effusion in intensive care unit patients with prolonged endotracheal intubation. Am J Otolaryngol 2006;27:109–11Google Scholar
11 Lucks, D, Consiglio, A, Stankiewicz, J, O'Keefe, P. Incidence and microbiological etiology of middle ear effusion complicating endotracheal intubation and mechanical ventilation. J Infect Dis 1988;157:368–9Google Scholar
12 Skaansar, K, Christensen, P, Aasmundstad, T. Middle ear effusion in intubated intensive care patients. Acta Anaesthesiol Scand 2009;53:417 Google Scholar
13 Tos, M, Bonding, P. Middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation. Acta Otolaryngol 1977;83:353–9Google Scholar
14 González Pena, M, Figuerola Massana, E, Hernández Gutiérrez, P, Rello Condomines, J. Middle ear effusion in mechanically ventilated patients: effects of the nasogastric tube. Respir Care 2013;58:273–8Google Scholar
15 Chung, HK, Lin, CC, Wang, CY, Lin, CD, Tsai, MH, Chang, CS. Improvement in otitis media with effusion in patients undergoing tracheostomy after prolonged endotracheal intubation. J Otolaryngol Head Neck Surg 2009;38:532–6Google Scholar
16 Jerger, J. Clinical experience with impedance audiometry. Arch Otolaryngol 1970;92:311–24CrossRefGoogle ScholarPubMed
17 Kesser, BW, Woodard, CR, Stowell, NG, Becker, SS. Middle ear effusion in adult ICU patients: a cohort study. Ear Nose Throat J 2013;92:340–6Google Scholar
18 Vento, BA, Durrant, JD, Palmer, CV, Smith, EK. Middle ear effects secondary to nasogastric intubation. Am J Otol 1995;16:820–2Google ScholarPubMed
19 Wake, M, McCullough, DE, Binnington, JD. Effect of nasogastric tubes on Eustachian tube function. J Laryngol Otol 1990;104:17–19 Google Scholar
20 Huyett, P, Raz, Y, Hirsch, BE, McCall, AA. Radiographic mastoid and middle ear effusions in intensive care unit subjects. Respir Care 2017;62:350–6CrossRefGoogle ScholarPubMed