Otolaryngologic Clinics of North America最新文献

Obesity alters upper aerodigestive physiology through changes in respiratory mechanics, upper airway stability, reflux burden, esophageal clearance, gastric emptying, and systemic inflammation. These changes may contribute to a myriad of voice, swallowing, and airway pathologies. This article examines the relationship between obesity and upper aerodigestive tract disorders, focusing on voice, swallowing, reflux, airway mechanics, perioperative/postoperative risks, and management relevant to laryngologists and comprehensive otolaryngologists alike.

Obesity is a risk factor for pediatric obstructive sleep apnea. Excess adipose tissue surrounding the pharynx reduces the upper airway's cross-sectional area and increases the likelihood of airway collapse. Evaluation typically includes a comprehensive physical examination and polysomnography, with additional assessments including drug-induced sleep endoscopy select circumstances. Because obstruction often occurs at multiple airway levels, surgical treatment, including adenotonsillectomy, is associated with lower cure rates in children with obesity. Multidisciplinary management that addresses obesity is essential, as weight reduction may improve treatment outcomes.

Innovations in Eustachian tube dysfunction (ETD) management are shifting care from symptom-based approaches toward precision, technology-integrated strategies. Advances in computational modeling, drug delivery systems (including hydrogels and nanoparticles), intranasal surfactants, and drug-eluting devices are expanding medical options. The potential role of biologics in type 2 inflammation and the effects of radiation and GLP-1 receptor agonists on ET function are under investigation. Emerging surgical approaches-such as permanent and biodegradable stents, shims, and injectable fillers-show promise but require validation. Artificial intelligence, robotics, telehealth, and remote monitoring are enhancing diagnosis, treatment precision, and longitudinal care, with significant progress anticipated in the coming decade.

Body weight can have various effects on middle ear health. Pediatric obesity is associated with an increased risk and recurrence of otitis media with effusion. Adult obesity is associated with an increased risk of temporal bone cerebrospinal fluid leak and encephalocele, and weight loss can cause symptoms of patulous Eustachian tube dysfunction. With rising rates of obesity and widespread adoption of glucagon-like peptide 1 receptor agonists, it is increasingly important that patients are appropriately counseled on how weight changes affect the middle ear. In this review, we examine the literature on middle ear diseases and their association with body weight.

Balloon dilation of the Eustachian tube (BDET) is a safe, effective office-based procedure for treating chronic obstructive and barochallenge-induced Eustachian tube dysfunction. Performed under local anesthesia in minutes, it offers a cost-effective alternative to the operating room. Success depends on careful patient selection, thorough preoperative workup, and appropriate anesthetic protocols, including topical and injectable agents to manage pain, vasovagal responses, and barometric pressure changes. Angled endoscopes improve outcomes by ensuring accurate balloon placement. Complications are generally minor and self-limiting, though rare serious events have been reported. With appropriate technique, BDET can reliably improve both objective and subjective patient outcomes.

Chronic obstructive Eustachian tube dysfunction results in persistent negative middle ear pressure, effusion retention, and tympanic membrane retraction. This results in chronic otitis media, which encompasses a spectrum of disease from otitis media with effusion and atelectasis to chronic suppurative otitis media and cholesteatoma. Eustachian tube (ET)-directed interventions add therapeutic value beyond traditional tympanoplasty, which emphasizes disease eradication and hearing mechanism reconstruction or tympanostomy tubes, which act by bypassing the ET. These techniques fail to address the root cause of the problem and are often complicated by recurrent disease.

Otitic barotrauma results from failure to equalize pressure changes across gas-filled ear spaces, most commonly due to Eustachian tube dysfunction. It is highly prevalent among divers and aircrew, with middle ear barotrauma being the most frequent presentation. Symptoms include otalgia, hearing loss, tinnitus, fullness, vertigo, and tympanic membrane injury. Inner ear barotrauma is less common but potentially severe, especially after forceful equalization. Management depends on severity and includes prevention, conservative treatment, otolaryngologic assessment, and, in selected recurrent barochallenge-related cases, balloon dilation of the Eustachian tube.

The history of the Eustachian tube spans ancient Egyptian and Greek texts, Islamic medicine, and Renaissance anatomy. From early misconceptions to Bartolomeo Eustachi's anatomical insights and Valsalva's functional discoveries, understanding evolved. Modern otology owes much to pioneers like Toynbee and Politzer, whose innovations shaped the diagnosis and treatment of Eustachian Tube Dysfunction. Surgical management evolved from risky catheterization procedures to refined surgical techniques. Myringotomy and tympanostomy tubes marked key milestones. Recently, endoscopic advances and balloon dilation have revolutionized treatment. Modern understanding of the spectrum of Eustachian Tube Dysfunction-from obstructive to patulous-continues to shape otologic practice.

Balloon dilation of the Eustachian tube has moved from an experimental concept to a mainstream option for selected adults with chronic obstructive Eustachian tube dysfunction that persists despite optimized medical management. Contemporary practice emphasizes careful phenotyping (obstructive vs patulous vs baro-challenge induced disease), correlation of symptoms with objective middle ear findings, and endoscopic evaluation of the nasopharyngeal orifice before intervention. Randomized trials and subsequent long-term follow-up demonstrate meaningful improvements in patient-reported symptoms and selected objective measures for appropriately chosen patients, with low rates of serious adverse events.