Risk Factors and Potential Causes of Eustachian Tube Dysfunction in Adults

This study requires a single visit to the Middle Ear Physiology Laboratory (MEPL) located on the first floor of the Oakland Medical Building (3420 Fifth Avenue in Oakland, Pittsburgh, PA). Adjacent parking attached to that building is available. The total time of the visit should be about 2 hours. If the subject is eligible and signs informed consent to participate in the study, a series of questions regarding past history of ear disease will be asked as well as whether or not a subject has any of several risk factors that makes people more likely to develop otitis media with effusion and other ear diseases. The subject will also complete a short questionnaire that asks questions about whether or not they have symptoms consistent with acid reflux disease. Then, a blood sample (about 2/3 of a tablespoon) will be taken from an arm vein and sent to a laboratory for assay of chemicals associated with allergic diseases. These procedures should take about 30 minutes to complete. Then, the subject's Eustachian tube function will be tested in the ear/ears that have open tympanostomy tubes in the eardrum. For these tests, the subject will be seated comfortably in a chair and a soft rubber tube will be put partway into their ear canal. This tube is attached to a machine that can change the pressure in the ear and measure the pressure at which the Eustachian tube opens and closes, as well as how easily air flows through the Eustachian tube and how easily the subject can open their Eustachian tube during swallowing. These tests only require that the subject not pull the ear plug from their ear and perform certain procedures designed to open their Eustachian tube such as swallowing with an open and pinched nose, blowing against a closed nose and deep breathing. The total time for testing is about 20 minutes per ear. Then, a study doctor will apply topical medicines by spray and cotton balls to the inside of the nose to decrease any swelling and numb the nose (4% Lidocaine and 0.05% Oxymetazoline mixed in 1:1 proportion). After a short break of about 20 minutes to allow time for these medicines to work, the study doctor will choose which side of the subject's nose is most open and will introduce a small video telescope (called an endoscope) into that side of the nose and move it to the back of the nose. This will allow him/her to see the back of the nose and the Eustachian tubes. He/she will focus the endoscope on the Eustachian tubes and will record video images of the back of the nose, the Eustachian tubes at rest and the movements of the Eustachian tubes while the subject swallows, yawns, repeats an "O" sound, repeats a "K" sound and moves their jaw. The subject will be able to see the movements of the Eustachian tube on a monitor while performing these procedures. This procedure should take about 40 minutes to complete. After this test, the study is complete.