Ventilation scintigraphy of the middle ear.

In this study, an attempt was made to administer radioactive gas into the tympanic cavity to measure initial gas trappings as well as clearance from the middle ear to evaluate eustachian tube function. Methods: Twenty-eight patients were administered 50 MBq 133 Xe gas. Three different methods for gas application were tested: (a) direct injection through a tympanostomy tube in two patients, (b) administration through a nasopharyngeal catheter combined with Valsalva maneuvers in six subjects without middle ear dysfunction and (c) insufflation into the pharyngeal space through a nose olive performed in 12 patients with normal eustachian tube function and in eight patients with one-sided tube dysfunction. Results: All three approaches were successful in visualizing middle ear ventilation, demonstrating tracer trapping within the tympanic cavities in 20 of 28 patients. Semiquantitative evaluation by region of interest techniques revealed a left-to-right uptake ratio of 48.4%-51.6% in 13 patients without tube dysfunction. Five patients with one-sided tube dysfunction showed a significantly lower median uptake of 31.6% (p = 0.01). The clearance half-lives ranged from 9 to 283 min in normal subjects and 37-64 min in patients with one-sided tube malfunction, demonstrating no statistically significant difference between the two groups and a trend towards increased washout in patients with tympanic dysfunction. Conclusion: Middle ear ventilation scintigraphy with 133 Xe through a nose olive is an easy-to-perfom test to evaluate eustachian tube function and has a success rate of about 70%, thus, reflecting the complex physiological mechanisms involved.