Stenting the Eustachian tube to treat chronic otitis media - a feasibility study in sheep
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RESEARCH
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Stenting the Eustachian tube to treat chronic otitis media - a feasibility study in sheep Friederike Pohl1,2, Robert A. Schuon1,2, Felicitas Miller1,3, Andreas Kampmann3, Eva Bültmann4, Christian Hartmann5, Thomas Lenarz1,2 and Gerrit Paasche1,2*
Abstract Background: Untreated chronic otitis media severely impairs quality of life in affected individuals. Local destruction of the middle ear and subsequent loss of hearing are common sequelae, and currently available treatments provide limited relief. Therefore, the objectives of this study were to evaluate the feasibility of the insertion of a coronary stent from the nasopharynx into the Eustachian tube in-vivo in sheep and to make an initial assessment of its positional stability, tolerance by the animal, and possible tissue reactions. Methods: Bilateral implantation of bare metal cobalt-chrome coronary stents of two sizes was performed endoscopically in three healthy blackface sheep using a nasopharyngeal approach. The postoperative observation period was three months. Results: Stent implantation into the Eustachian tube was feasible with no intra- or post-operative complications. Health status of the sheep was unaffected. All stents preserved their cylindrical shape. All shorter stents remained in position and ventilated the middle ear even when partially filled with secretion or tissue. One of the long stents became dislocated toward the nasopharynx. Both of the others remained fixed at the isthmus but appeared to be blocked by tissue or secretion. Tissue overgrowth on top of the struts of all stents resulted in closure of the tissuelumen interface. Conclusion: Stenting of the Eustachian tube was successfully transferred from cadaver studies to an in-vivo application without complications. The stent was well tolerated, the middle ears were ventilated, and clearance of the auditory tube appeared possible. For fixation, it seems to be sufficient to place it only in the cartilaginous part of the Eustachian tube. Keywords: Auditory tube, Middle ear ventilation, Stent, Otitis media, Sheep as animal model, Tissue reaction
Background Acute and chronic otitis media continue to be significant issues in human medicine [1]. Especially otitis media with effusion (OME), which is not only common in children under the age of 10, but also the most prevalent reason why advice and treatment from an otorhinolaryngology specialist are needed [2]. In approximately 20% of patients, symptoms become chronic [2], causing severe and often irreversible damage to middle ear structures, * Correspondence: [email protected] 1 Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany 2 Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany Full list of author information is available at the end of the article
including the tympanic membrane and ossicular chain. In the development of these diseases, the Eustachian (or auditory) tube (ET) is one of the key factors [2, 3]. The ET forms the only c
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