New insights into mechanism of Eustachian tube ventilation based on cine computed tomography images.
New insights into mechanism of Eustachian tube ventilation based on cine computed tomography images.
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DOI：
10.1007/s00405-011-1829-y
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Jiang JJ
中科院分区：
文献类型：
--
作者：
McDonald MH;Hoffman MR;Gentry LR;Jiang JJ
关于咽鼓管（ET）通气的机制存在争议。虽然之前提出了完全打开的机制，但腭帆提肌和翼状内肌的顺序收缩，然后是腭帆张肌和翼外肌的顺序收缩可能会产生短暂的顺序打开机制，从而允许空气团穿过 ET。这可能解释了围绕声管测量报告的混乱，即并非每次吞咽都会导致正常受试者发出声音。我们假设中耳通气时 ET 可能不需要完全打开；相反，离散的空气团可以通过它。五名正常受试者和五名患有疾病的受试者接受了 ET 的低辐射剂量电影计算机断层扫描 (CT) 扫描。通过鼻咽中平行于并包围整个 ET 的 4 cm 区域选择 16 个连续的 2.5 mm 切片位置。在吞咽和其他任务期间，每个切片在 4.8 秒内采集了 12 张图像。分析连续图像。在正常受试者中观察到空气团通过 ET，但在 ET 功能障碍受试者中则没有。还观察到内侧和外侧翼状肌收缩。提出了一种新的瞬时序贯 ET 通气的假设机制。这不是一个明确的结论，因为进行的扫描数量和使用的操作是有限的。随着治疗从通气管置入发展到 ET 操作，提高对 ET 通气的了解可能有助于中耳疾病的治疗。
There is debate concerning the mechanism of Eustachian tube (ET) ventilation. While a mechanism of complete opening has been advocated previously, sequential contraction of the levator veli palatini and medial pterygoid muscles followed by the tensor veli palatini and lateral pterygoid muscles may produce a transient sequential opening mechanism, allowing an air bolus to traverse the ET. This may explain confusion surrounding sonotubometry reports that not every swallow leads to sound passage in normal subjects. We hypothesize that the ET may not need to open completely when ventilating the middle ear; rather, a discrete air bolus can pass through it. Five normal and five disordered subjects underwent low-radiation dose cine computed tomography (CT) scans of the ET. Sixteen contiguous 2.5 mm slice locations were chosen through a 4 cm area in the nasopharynx that were parallel to and encompassed the entire ET. Twelve images were acquired at each slice over 4.8 seconds during swallowing and other tasks. Serial images were analyzed. An air bolus was observed passing through the ET in the normal subjects, but not the subject with ET dysfunction. Medial and lateral pterygoid contractions were also observed. A new hypothetical mechanism of transient sequential ET ventilation is presented. This is not a definitive conclusion, as the number of scans taken and maneuvers used was limited. Improved understanding of ET ventilation may facilitate management of middle ear disease as treatment evolves from ventilatory tube placement to ET manipulation.
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