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Children's Hospital researchers study dysfunctions in the tiny tube that causes so many ear problems for children
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Research technician Jenna El-Wagaa administers a test to 5-year-old Peter Strobl inside a pressure chamber. -
Peter Strobl inside a pressure chamber.
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By Pohla Smith
Five-year-old Peter Strobl of the South Side has felt the sensation of being 2 feet under water, as well as being as high as the top the U.S. Steel Tower -- all while sitting in the same spot.
He's experienced these feelings in the submarine-like ENT Pressure Chamber -- and to him it's all a grand adventure.
For researchers in the Pediatric Otolaryngology Department of Children's Hospital of Pittsburgh of UPMC, using the $450,000 pressure chamber is a way of studying dysfunctions in the Eustachian tube -- the tiny tube that originates in the middle air that often causes so many problems for young children, especially recurrent ear infections.
The researchers have been testing children between the ages of 3 and 7 as well as adults, some with healthy Eustachian tubes like Peter's, others with dysfunctional Eustachian tubes, since 2009. They have tested more than 100 adults; their goal is to test 200 children twice a year.
"We have seven or eight studies going," said William J. Doyle, the research team's principal investigator who has a Ph.D. in physical anthropology. "We want to identify what is the problem that causes the dysfunction and then work on treatment. There is no treatment except putting tubes in the ears."
"We're trying to find out why we're putting tubes in," added Charles D. Bluestone, a pediatric otolaryngologist. "We're bypassing the problem."
The Eustachian tube, which drains in the throat, has three functions: to keep the same air pressure in the middle ear as is in the outer environment; to prevent secretions from the nose from getting in the ear and causing an infection and to clear secretions from the ear into the throat.
Surgeons often insert tubes in the eardrums of children who get frequent ear infections or have fluid in their ears all the time. Sometimes with an ear infection, the Eustachian tube remains swollen and can't open, and fluid that built up behind the eardrum during the infection is trapped and causes hearing loss because it prevents the eardrum from vibrating normally. When tubes are inserted in the eardrum, air can get into the middle ear, allowing the fluid to drain out that way, bypassing the problem of the swollen Eustachian tube. Over time, the air also helps to decrease the swelling in the Eustachian tube, allowing it to function normally again.
But the Eustachian tube's major function is maintaining pressure in the middle ear equal to that outside the body. In a normal ear, it opens and closes when you swallow. If you change elevation, particularly when you descend from a higher elevation -- by elevator, by airplane or by a car traveling down a mountain -- you may hear your ears crack or pop. Or you may feel pressure in your ears that you relieve by swallowing or by holding your nose while you blow. That's your Eustachian tubes doing their work.
But some people can't even force their Eustachian tubes to pop.
Thirty percent of people have problems with their Eustachian tubes when their flight descends, Mr. Doyle said. The researchers are using their pressure chamber to try to find out why, and, if they do, "perhaps we can treat them ahead of time."
Similarly, the researchers are trying to find out why some scuba divers have trouble getting their Eustachian tubes to open when they dive and others don't. Again, they hope to be able to diagnose ahead of time who's going to have trouble getting their Eustachian tubes to equalize pressure and treat them ahead of time, Mr. Doyle said.
The team also wants to diagnose kids and adults who have no problems in normal atmospheric pressure but block up when they have a cold and test them to see if they're the ones who can't open their Eustachian tubes when they are under pressure in the chamber, he said.
During recent tests on his normal ear tube, Peter happily accompanies research technician Jenna El-Wagaa into the National Institutes of Health-funded chamber, which sits within an office painted to look like it's under water in the Oakland Medical Building on Fifth Avenue. Senior research technician Julie Banks seals the door.
Ms. Banks changes the atmospheric pressure within the chamber, and Peter feels like he is 2 feet under water. Ms. El-Wagaa asks him to swallow to see if his Eustachian tubes can open adjusting for the pressure change. She records the pressure in the middle ears before and after she uses sound in his nose while listening at his ears with microphones to see whether the tubes opened.
Ms. Banks changes the atmospheric pressure back to street level, and Ms. El-Wagaa asks Peter to swallow again, records the pressure and puts the sound in his nose. Ms. Banks then increases the pressure to an elevation of about 500 feet (Ms. El-Wagaa tells Peter they're going to the top of the U.S. Steel Tower), and Peter and Ms. El-Wagaa go through the swallowing and testing again.
Ms. Banks once more returns the atmospheric pressure to street level for more swallowing and testing before she increases the elevation to 2,200 feet (Ms. El-Wagaa tells Peter they're going up a mountain in Uniontown). This time Peter is asked to not swallow, but the microphones are in his ears as the researchers try to find out if and when his Eustachian tubes opened without him swallowing.
Among other studies under way, one involves three groups of children. One group comprises kids without ear disease who can open their Eustachian tubes; another group is children who had multiple infections but recovered between them and shouldn't be able to open their Eustachian tubes and the third group has kids with a particular type of ear disease and the researchers don't know if the subjects will be able to open their Eustachian tubes.
The purpose of this study is to identify characteristics of the kids that predict which of them will continue to have middle ear disease and require treatment. Again, the researchers are hoping to identify problems unique to those children so they will have an insight into how to treat or, they hope, cure them.
Researchers are still looking for study subjects. To volunteer, call 412-692-3595.
He's experienced these feelings in the submarine-like ENT Pressure Chamber -- and to him it's all a grand adventure.
For researchers in the Pediatric Otolaryngology Department of Children's Hospital of Pittsburgh of UPMC, using the $450,000 pressure chamber is a way of studying dysfunctions in the Eustachian tube -- the tiny tube that originates in the middle ear that often causes so many problems for young children, especially recurrent ear infections.
The researchers have been testing children between the ages of 3 and 7, as well as adults, some with healthy Eustachian tubes like Peter's, others with dysfunctional Eustachian tubes, since 2009. They have tested more than 100 adults; their goal is to test 200 children twice a year.
"We have seven or eight studies going," said William J. Doyle, the research team's principal investigator who has a Ph.D. in physical anthropology. "We want to identify what is the problem that causes the dysfunction and then work on treatment. There is no treatment except putting tubes in the ears."
"We're trying to find out why we're putting tubes in," added Charles D. Bluestone, a pediatric otolaryngologist. "We're bypassing the problem."
The Eustachian tube, which drains in the throat, has three functions: to keep the same air pressure in the middle ear as is in the outer environment; to prevent secretions from the nose from getting in the ear and causing an infection; and to clear secretions from the ear into the throat.
Surgeons often insert tubes in the eardrums of children who get frequent ear infections or have fluid in their ears all the time. Sometimes with an ear infection, the Eustachian tube remains swollen and can't open, and fluid that built up behind the eardrum during the infection is trapped and causes hearing loss because it prevents the eardrum from vibrating normally. When tubes are inserted in the eardrum, air can get into the middle ear, allowing the fluid to drain out that way, bypassing the problem of the swollen Eustachian tube. Over time, the air also helps to decrease the swelling in the Eustachian tube, allowing it to function normally again.
But the Eustachian tube's major function is maintaining pressure in the middle ear equal to that outside the body. In a normal ear, it opens and closes when you swallow. If you change elevation, particularly when you descend from a higher elevation -- by elevator, by airplane or by a car traveling down a mountain -- you may hear your ears crack or pop. Or you may feel pressure in your ears that you relieve by swallowing or by holding your nose while you blow. That's your Eustachian tubes doing their work.
But some people can't even force their Eustachian tubes to pop.
Thirty percent of people have problems with their Eustachian tubes when their flight descends, Mr. Doyle said. The researchers are using their pressure chamber to try to find out why, and, if they do, "perhaps we can treat them ahead of time."
Similarly, the researchers are trying to find out why some scuba divers have trouble getting their Eustachian tubes to open when they dive and others don't. Again, they hope to be able to diagnose ahead of time who's going to have trouble getting their Eustachian tubes to equalize pressure and treat them ahead of time, Mr. Doyle said.
The team also wants to diagnose kids and adults who have no problems in normal atmospheric pressure but block up when they have a cold, and then test them to see if they're the ones who can't open their Eustachian tubes when they are under pressure in the chamber, he said.
During recent tests on his normal ear tube, Peter happily accompanies research technician Jenna El-Wagaa into the National Institutes of Health-funded chamber, which sits within an office painted to look like it's under water in the Oakland Medical Building on Fifth Avenue. Senior research technician Julie Banks seals the door.
Ms. Banks changes the atmospheric pressure within the chamber, and Peter feels as if he is 2 feet under water. Ms. El-Wagaa asks him to swallow to see if his Eustachian tubes can open adjusting for the pressure change. She records the pressure in the middle ears before and after she uses sound in his nose while listening at his ears with microphones to see whether the tubes opened.
Ms. Banks changes the atmospheric pressure back to street level, and Ms. El-Wagaa asks Peter to swallow again, records the pressure and puts the sound in his nose. Ms. Banks then increases the pressure to an elevation of about 500 feet (Ms. El-Wagaa tells Peter they're going to the top of the U.S. Steel Tower), and Peter and Ms. El-Wagaa go through the swallowing and testing again.
Ms. Banks once more returns the atmospheric pressure to street level for more swallowing and testing before she increases the elevation to 2,200 feet (Ms. El-Wagaa tells Peter they're going up a mountain in Uniontown). This time Peter is asked to not swallow, but the microphones are in his ears as the researchers try to find out if and when his Eustachian tubes opened without him swallowing.
Among other studies under way, one involves three groups of children. One group comprises kids without ear disease who can open their Eustachian tubes; another group is children who had multiple infections, but they recovered between them and shouldn't be able to open their Eustachian tubes; and the third group has kids with a particular type of ear disease, and the researchers don't know if the subjects will be able to open their Eustachian tubes.
The purpose of this study is to identify characteristics of the kids that predict which of them will continue to have middle ear disease and require treatment. Again, the researchers are hoping to identify problems unique to those children so they will have an insight into how to treat or, they hope, cure them.
Researchers are still looking for study subjects. To volunteer, call 412-692-3595.
First Published September 3, 2012 12:00 am
