|Year : 2011 | Volume
| Issue : 2 | Page : 80-82
Tympanometric study of eustachian tube function in oral submucous fibrosis
Maulik Shah1, Ashish Katarkar1, Pankaj Shah1, Noorain Alam2, Datt Modh1
1 Department of ENT, C. U. Shah Medical College and Hospital, Surendranagar, Gujarat, India
2 Departments of Audiology and Speech Therapy, C. U. Shah Medical College and Hospital, Surendranagar, Gujarat, India
|Date of Web Publication||20-Dec-2011|
B-10 Doctor's Quarters, C. U. Shah Medical College, Surendranagar, Gujarat 363 001
Source of Support: None, Conflict of Interest: None
Background: Oral submucous fibrosis (OSMF) is a premalignant condition. Incidence of OSMF in India is 0.5%, mainly found in southern states and also in Saurashtra region. The pathological changes can involve mucosa, submucosa and the underlying muscles. The changes of tubal and paratubal muscles can affect the eustachian tube function. So, this study was carried out with an aim to determine the effect of OSMF on the eustachian tube function. Materials and Methods: 54 ears of 27 patients with OSMF and 50 ears of 25 normal persons were screened by eustachian tube function test (ETFT) after thorough history taking and clinical examination. Results: Out of the 54 ears in the OSMF group, type A curve was obtained in 42 (77.8%) ears, type B curve in none and type C curve was found in 12 (22.2%) ears, as compared to the normal group in which type A curve was obtained in 46 (92%) ears, type B curve in 2 (4%) ears, type C curve was found in 2 (4%) ears. On testing compliance of the middle ear, no change was observed at -200 daPa in 15 (27.8%) ears in the OSMF group and 5 (10%) ears in the normal group. Conclusion: The data observed were statistically analyzed by chi-square test, which suggested significant association between OSMF and eustachian tube function. Therefore, it can be concluded that eustachian tube function may be affected in OSMF and vice versa. So, while treating OSMF, hearing disability due to eustachian dysfunction has to be kept in mind and vice versa because treatment of hearing disability without taking care of OSMF will not be successful.
Keywords: Eustachian tube function test, Oral submucous fibrosis, Tympanometry
|How to cite this article:|
Shah M, Katarkar A, Shah P, Alam N, Modh D. Tympanometric study of eustachian tube function in oral submucous fibrosis. Indian J Otol 2011;17:80-2
|How to cite this URL:|
Shah M, Katarkar A, Shah P, Alam N, Modh D. Tympanometric study of eustachian tube function in oral submucous fibrosis. Indian J Otol [serial online] 2011 [cited 2020 Feb 25];17:80-2. Available from: http://www.indianjotol.org/text.asp?2011/17/2/80/91043
| Introduction|| |
It is generally recognized that submucous fibrosis of the oral cavity is a collagen disease with a great resemblance to morphea or localized scleroderma.  Although common in Indians, it has been reported to occur in other nationalities as sporadic cases. , Incidence varies from 0.2 to 0.5% in India, with a higher percentage being found in the southern areas as well as in Saurashtra region.
Oral submucous fibrosis (OSMF) is a precancerous condition. Although OSMF is occasionally preceded by and/or associated with vesicle formation, it is always associated with a juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of oral mucosa, trismus and inability to eat. The exact etiology is still obscure, but many factors such as chewing betel nut, tobaccoand pan masala, smoking and consuming chillies have been thought to be contributory. 
The disease is characterized by progressive fibrosis involving the mucus membrane of the mouth, mainly the buccal mucosa, soft palate, lip mucosa, and anterior pillars. It rarely affects the membrane lining of the pharyngeal box or vocal cords, but is capable of involving the Eustachian tube More Details.  Pathological changes in the muscles of soft palate have been described by various workers.  Involvement of these muscles subsequently may affect the function of eustachian tube.
This study was carried out to determine the effect of OSMF on eustachian tube function by using eustachian tube function test (ETFT).
| Materials and Methods|| |
The present study was carried out in the Department of ENT and HNS, C. U. Shah Medical College, Surendranagar, from September 2010 to February 2011, on 27 OSMF patients, aged 18 years and above and belonging to both sexes (males 24, females 3). Detailed history taking and clinical examination was done for each patient in the OPD of Department of ENT and HNS after taking permission from the Institutional Human Ethics Committee of our college.
The following clinical parameters were recorded. The mouth opening was recorded using a graduated vernier gauge to measure the distance between the upper and lower central incisor edges at maximal unaided mouth opening, taking the mean of three readings. The scores were assigned to the patients as follows: 41 mm and above was considered as normal mouth opening (0), 37-40 mm (1), 33-36 mm (2), 29-32 mm (3), 25-28 mm (4), 21-24 mm (5), 17-20 mm (6), 13-16 mm (7), 9-12 mm (8), 5-8 mm (9) and 0-4 mm (10).
The color of oral mucosa was assessed in natural light and scored as normal pink (0), red or deep pink (1), pale white (2) and blanched white (3).
The fibrous bands were palpated and scored as follows: No fibrous bands (0), one or two solitary fibrous bands (1), bands felt nearly in the entire surface (2), adherent fibrous band producing binding and rigidity of mucosa (3).
The patients were enquired about burning sensation while taking spicy food, pan, tobacco, hot beverages, etc. and scored as no burning sensation (0), mild (l), moderate (2) and severe (3).
Audiological assessment was done in the Department of Audiology and Speech therapy by using Madsen Orbiter 922 audiometer and eustachian tube function was determined by using Madsen Zodiac 901.
Procedure of impedence audiometer
The patient's ability to equalize the pressure difference between the surroundings and the middle ear is called the "tube function." If the patient's tympanic membrane is intact, this measurement is performed in AUTOTYMP mode. The audiometer can automatically give the patient a constant over/under pressure of 200 daPa in the auditory canal. The patient must swallow 8-10 times so that the over/under pressure that the tight tympanic membrane has caused in the middle ear is equalized. The examiner records the compliance graph, and if the eastachian tube functions correctly, the middle ear pressure must now have moved in the opposite direction of the static pressure. Thus, the shifted compliance peaks show that eustachian tube functions are good. If there is no shifting of compliance peaks, then it is poorly functioning.
By charting the compliance of tympano-ossicular system against various pressure changes, diferent types of tympanograms were obtained.
| Results|| |
In the present study, hospital-based prevalence of OSMF was found to be 0.5% of all the outdoor ENT patients; most of the cases were in 2 nd and 3 rd decades of life. The rise in the percentage was because of increase in consumption of "pan masala" among adolescents and young adults.
The patients with OSMF presented with difficulty in opening mouth, repeated ulcerations of oral mucosa, intolerence to chillies and spices, burning sensations in mouth and inability to protrude tongue.
On pure tone audiometry (PTA), hearing was found to be normal in 36 ears, mild sensorineural hearing loss was found in12 ears and moderate mixed hearing loss was present in 6 ears.
Tympanometry was done in all cases. Out of the 54 ears examined, normal tympanogram type A curve was recorded in 42 (77.8%) ears. Abnormal tympanograms included type B in none and type C in 12 (22.2%) ears [Table 1] and [Graph 1]. Out of 54 ears, eustachian tube function test (ETFT) revealed no shift in compliance peaks in 15 (27.8%) ears with −200 daPa pressure changes after swallowing [Table 2] and [Graph 2].
|Table 1: Comparison of tympanograph between OSMF group (n=54 ears) and normal group (n=50 ears)|
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A similar study was also done in 50 ears of 25 normal identical individuals as a control group to establish the validity of data in the disease group. In 46 (92%) ears, normal type A tympanogram curve was obtained. Out of four abnormal tympanograms, 2 (4%) ears showed type B and 2 (4%) ears had type C curve. Out of 50 ears, ETFT revealed no shift in compliance peaks in 5 (10%) ears with −200 daPa pressure changes after swallowing.
| Discussion|| |
OSMF is predominantly a disease of the oral cavity and oropharynx. A variety of histopathologic changes in the oral mucosa have been described by various workers. However, only few authors have reported muscle degeneration in their study. They took punch biopsies from the buccal mucosa and reported changes in the buccal mucosal layer. El Labban  and Caniff compared ultrastructural changes in the muscle fibers of normal and OSMF patients, which showed severe degenerative changes in a high proportion of muscle fibers in OSMF patients.
The principal and accessory muscles attached to eustachian tube, which is a dynamic organ and its ventilatory function and patency may be impaired if these muscles are involved.
Histopathologic changes have been described in palatal muscles on incisional biopsies of OSMF patients by Gupta et al.,  showing atrophy and edema of tubal and paratubal muscles. Nasopharyngeal extension of fibrosis involves pharyngeal orifice of eustachian tube and musculature.
Gupta  compared the eustachian tube function of 53 patients of OSMF with that of 20 normal persons and found statistically significant difference between both groups and concluded that eustachian tube function may be affected in OSMF.
| Conclusion|| |
In our study, tympanometry revealed an abnormal tympanogram in 12 (22.2%) ears in cases of OSMF and ETFT revealed no shift in compliance peaks in 15 (27.8%) ears with −200 daPa pressure changes after swallowing. Comparison between the disease group and control group showed statistically significant difference between normal and OSMF patients. Statistical analysis of data was done by chi-square test, which was suggestive of a significant association between normal and OSMF patients' eustachian tube function. So, while treating OSMF, hearing disability due to eustachian dysfunction has to be kept in mind and vice versa because treatment of hearing disability without taking care of OSMF will not be successful.
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[Table 1], [Table 2]