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This book, written by international experts, is a detailed guide to the Eustachian tube, with emphasis on those aspects of most relevance to the practitioner. The opening chapters document the clinical anatomy and provide essential information on physiology, with explanation of the new model of tubal mechanics. Diagnosis and therapy for the patulous Eustachian tube are then discussed, placing special emphasis on a novel conservative treatment regimen that has proven to be a breakthrough for patients with this clinical syndrome. A further extensive chapter examines overall function of the Eustachian tube, primarily from the middle ear surgeon’s viewpoint. Tuboplasty procedures, including laser tuboplasty, and tympanoplasty are described, and the implications of different middle ear pathologies for surgical treatment are explained. The previously unpublished treatment methods that are described in this book will be invaluable in ensuring the best possible clinical outcomes.
Acute and chronic ear disease continues to be one of the leading diseases of childhood. Understanding eustachian tube function and management remains one of the most important aspects in controlling inflammatory ear disease. Chronic ear disease requires elaborate surgical interventions designed to bypass eustachian tube dysfunction and/or poor mastoid aeration, since surgical management of the eustachian tube has been elusive. Our understanding of the ear and hearing continues to expand at record pace, as auditory neuroscientists discover the fundamental molecular structure and function of the auditory system. The cochlear implant has revolutionized the treatment of deafness. In contrast, the complexity of eustachian tube pathophysiology is only just beginning to be appreciated. This book provides a detailed analysis of contemporary knowledge on the morphology, physiology, and gas exchange function of the eustachian tube, middle ear, and mastoid. Newer diagnostic tests, such as sono tubometry, tubomanometry, and endoscopic video-analysis, are also described. Finally, a selection of innovative surgical management strategies for eustachian tube dysfunction is presented. The clinical impact of these diagnostic tools and surgical management options still requires the test of time, as well as investigation by others. This text provides the trainee, clinician, and researcher with the opportunity to acquire state-of-the-art information in a single volume. I am certain that this is just the beginning of our knowledge of ways in which to improve the management of one of the long-standing chronic conditions that result in hearing loss and more serious sequellae.
For the middle ear to maintain its most important function, sound con duction, its pressure always needs to be kept around atmospheric level. The eustachian tube has long been believed to be the only organ playing the important role of pressure regulation of the middle ear. However, several phenomena that cannot be explained solely by reference to eustachian tube function have gradually emerged. For instance, otitis media with effusion cannot always be produced experimentally by selectively eliminating the ventilatory function of the eustachian tube by excising the tensor veli pala tini muscle and the hamulus pterygoideus. Also, most cases of otitis media with effusion (OME) in children can heal in spite of persistently poor tubal function even in the convalescent stage. In recent decades, gas exchange in the middle ear, particularly through the mastoid mucosa, has gradually come to light as another ventilation or pressure-regulation system for the middle ear. Although numbers of studies have revealed important information about the physiology and patho physiology of this function, there have been only a few studies related to gas exchange that directly contributed to the field of clinical otology by clarifying the pathogenesis of otitis media or to improving its treatment. One of the biggest reasons for the paucity of studies appears to be lack of an appropriate clinical method for assessing the gas exchange function.
As one of today's leading researchers of middle ear disorders, Dr. Bluestone offers a unique perspective on the diagnosis and management of common middle ear problems.The Eustachian Tubeis the first book to comprehensively cover these disorders in both adults and children. The Eustachian Tubebegins with an overview of middle ear anatomy, and the epidemiology of middle ear disorders. Then it discusses current tests of eustachian tube function, as well as the physiology and pathophysiology of the eustachian tube. Dr. Bluestone also draws on his extensive clinical experience to describe the latest surgical and nonsurgical methods of middle ear treatment. Throughout, photographs and drawings illustrate anatomy and pathophysiology.