EUSTACHIAN TUBE GROWTH AND DEVELOPMENT: ANATOMY/FUNCTIONThe existing literature documents an important role for the Eustachian tube (ET) in the pathogenesis and/orpersistence of Otitis Media (OM). Cross-sectional studies report a lower prevalence of OM in older children, abetter ET pressure-regulating function in older children and age-related differences in ET form, length and width,and the vector orientation of the paratubal musculature. These growth-related changes in ET structuralrelationships are demonstrably predictive of increasingly more efficient ET function (F) and, because the ET andparatubal musculature are intimately related to the cranial base, the vector orientation of the ET system can bereconstructed from osteological or radiographic data. Together, these observations suggest that measurable,age-related changes in ET-paratubal muscle vector relationships are reflected in more efficient ETF and, byconsequence, a decreased OM risk. The overall goal of the proposed longitudinal study is to evaluate thevalidity of this hypothesis. We plan to enroll a total of 90 children at 2 to 3 years of age (Group 1-30with a historyof recurrent actute OM, Group 11-30 with a history of OM with effusion, and Group 111-30 control) and to evaluateETF (yearly) and measure craniofacial morphology (by yearly anthropometry, biyearly cephalometrics, MRI in asubset at age 4 and 6) over a 5 year period. The craniofacial measures will be used to reconstruct vectorrelationships of the ET system for each child and will be submitted along with the ETF results to Core C foranalysis of the translational mechanism underlying the limitations imposed on ETF by craniofacial morphology.These data will be used to test the following hypotheses: 1) certain cephalometric measures of craniofacialmorphology predict increased OM risk; 2) correspondences to these measures are represented by non-invasiveanthropometric measures; 3) ETF variables discriminate between the different clinical presentations of OM; 4)the mechanical properties of the ET are limited by the underlying form/structure of the craniofacial skeleton, and5) growth and development of the craniofacial skeleton are associated with more favorable ET/paratubal musclevector relationships which are then reflected in better ETF test results. In a subset of these children (10/group)selected for their ability to complete MRI testing without sedataion, MRI of the ET-ME system will be obtained atage 4 and 6 years. Data will be used to reconstruct the functional mechanics of the system for comparisonamong groups and also with the respective mechanics generated by the craniofacial measures. This Projectrepresents the translation of past observational studies into a longitudinal clinical study that will, for the first time,test falsifiable hypotheses suggested by those earlier results. Study results may lead to the development andapplication of methods for the early identification of children 'at risk' for OM, for the prognosis of disease coursein young children and for alternative, patient-specific interventions to prevent/cure OM.
Showing the most recent 10 out of 49 publications
