Home Ahead of print Instructions Contacts
About us Current issue Submit article Advertise  
Editorial board Archives Subscribe Login   


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2011  |  Volume : 17  |  Issue : 2  |  Page : 80-82

Tympanometric study of eustachian tube function in oral submucous fibrosis


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 Publication20-Dec-2011

Correspondence Address:
Ashish Katarkar
B-10 Doctor's Quarters, C. U. Shah Medical College, Surendranagar, Gujarat 363 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.91043

Rights and Permissions
  Abstract 

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 2019 Nov 21];17:80-2. Available from: http://www.indianjotol.org/text.asp?2011/17/2/80/91043


  Introduction Top


It is generally recognized that submucous fibrosis of the oral cavity is a collagen disease with a great resemblance to morphea or localized scleroderma. [1] Although common in Indians, it has been reported to occur in other nationalities as sporadic cases. [2],[3] 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. [4]

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. [5] Pathological changes in the muscles of soft palate have been described by various workers. [6] 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 Top


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 Top


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)

Click here to view
Table 2: Comparison of ET function between OSMF group and normal group

Click here to view




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 Top


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 [7] 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., [8] showing atrophy and edema of tubal and paratubal muscles. Nasopharyngeal extension of fibrosis involves pharyngeal orifice of eustachian tube and musculature.

Gupta [9] 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 Top


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.

 
  References Top

1.Pindborg JJ, Sirsat SM. Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol 1966;22:764-79.  Back to cited text no. 1
[PUBMED]    
2.Paissat DK. Oral submucous fibrosis. Int J Oral Surg 1981;10:307-12.  Back to cited text no. 2
[PUBMED]    
3.Shian YY, Kwan HW. Submucous fibrosis in Taiwan. Oral Surg Oral Med Oral Pathol 979;47:453-7.  Back to cited text no. 3
    
4.Dhingra PL. Diseases of Ear, Nose and Throat. 3 rd ed. Chapter 43, Section III. India: Elsevier Publication; 2004. p. 266.  Back to cited text no. 4
    
5.Hammer JE 3 rd , Looney PD, Chused TM. Submucous fibrosis. Oral Surg Oral Med Oral Pathol 1974;37:412-21.  Back to cited text no. 5
    
6.Binnie WH, Cawson RA. A new ultrastructural finding in oral submucous fibrosis. Br J Dermatol 1972;86:286-90.  Back to cited text no. 6
[PUBMED]    
7.El Labban, Caniff JP. Ultrastructural finding of muscle degeneration in oral submucous fibrosis. J Oral Pathol 1985;14:709-17.  Back to cited text no. 7
    
8.Gupta SC, Khanna S, Singh M, Singh PA. Histological changes to palatal and paratubal muscles in oral submucous fibrosis. J Laryngol Otol 2000;114:947-50.  Back to cited text no. 8
[PUBMED]    
9.Gupta SC, Singh M, Khanna S, Jain S. Oral submucous fibrosis with possible effect on eustachian tube functions: A tympanometric study. Indian J Otolaryngol Head Neck Surg 2004;56:183-5.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Evaluation of hearing deficit in patients with oral submucous fibrosis
Parvathi Devi,Ipsa Singh,Ravindra Setru,Kuber Tyagi,Dharamveer Singh,Bellona Thiyam
Journal of Oral Science. 2015; 57(2): 109
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed2703    
    Printed120    
    Emailed0    
    PDF Downloaded446    
    Comments [Add]    
    Cited by others 1    

Recommend this journal