Composition and method for the prevention and relief of the symptoms of an
incompetent or patulous Eustachian tube
United States Patent: 7,524,512
Issued: April 28, 2009
Inventors: Di Bartolomeo;
Joseph R. (Santa Barbara, CA)
Appl. No.: 11/777,550
Filed: July 13, 2007
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A composition and methods for the
treatment of symptoms due to disorders, disease or trauma that impairs
normal function of die Eustachian tube and alters vital structures or
tissues of the middle ear. This includes diseases and disorders of the
Eustachian tube altered by tubal incompetence, inflammatory phenomenon as
rhinitis, nasal allergies, infections by microorganisms, tympanic membrane
rupture or trauma and variants. The composition is comprised of solution
including L-Ascorbic acid and a pharmaceutically acceptable liquid carrier
and delivery system. The administration of which is applied topically in
appropriate composition and dosage for intranasal or trans tympanic route
in the form of drops, spray, aerosol, rinse, douche, gel, or devices.
Description of the
FIELD OF THE INVENTION
This invention relates generally to treatment of middle ear disorders and
more specifically to a composition and treatment protocol for treatment of
patulous Eustachian tube disorders of the middle ear and otitis media.
The Eustachian tube (ET) is an adnexa structure in the middle ear in man.
It is a very narrow air passage in the wall of the middle ear which
connects it to the nasopharynx, --a midline air filled space in the back
of the nose. It is approximately 37 mm long and is slightly hour-glass
shaped, flattened anterior-posteriorly. The small lumen of the eustachian
tube permits the exchange of ambient gases between the middle ear and
nasopharynx and the transport of middle ear secretions into the
nasopharynx. The lateral one-third of the Eustachian tube (tympanic
segment) is made of bone, while the medial two-thirds (pharyngeal segment)
is cartilaginous. A constriction at the junction of the bony and
cartilaginous segments, called the isthmus, may be as narrow as 1.0 mm by
1.5 mm. This tube regulates the intermittent exchange of air to or from
the middle ear space to maintain equal pressure on both sides of the
eardrum. The surface of the epithelium of the middle ear and eustachian
tube is covered by a raucous blanket which is a defensive barrier against
inhaled pollutants and a multitude of microorganisms. Middle ear
secretions are normally eliminated through the ET.
In man, the Eustachian tube is a very unique structure that enables the
middle ear pressure to adapt to various altitude changes and, and when
closed it prevents the endogenous intraoral sounds of respiration and
vocalization from reaching the middle ear to compete with and mask out the
environmental sounds for reception and relay to the inner ear.
Normally, the Eustachian tube maintains an isobaric relationship between
the middle ear space and the ambient air exchanged within the nasal
passages during breathing. The critical opening pressure for the tube to
ventilate the middle ear chamber is related to the surface tension and
diameter of the ET opening onto the lateral wall of the nasopharynx. This
is modified by the rheologic properties of the mucus blanket on the
endothelial tissues. In its natural state, the Eustachian tube orifice is
always closed, but may actively open spontaneously several times a minute
or when swallowing or yawning. As integral part of the middle ear, the
Eustachian tube functions to prevent and ameliorate the same inflammatory
diseases such as otitis media etc. and its complications.
Incompetent Eustachian tube disorders refer to those conditions in which
the closure of the facet at the orifice does not occur due to an increase
in the diameter of the lumen of the Eustachian tube, a change in the
surface tension of the secretions or fluid covering the mucous membrane,
or a failure of the normal cartilage valve mechanism to passively relax
for normal closure.
In this small sub set of individuals the Eustachian tube lumen is
abnormally open continuously or intermittently. While the tube is open, it
allows the respiratory sounds and speech of an individual to pass directly
through the patent Eustachian tube to the middle ear sound-receiving
mechanism. These individuals are very uncomfortable and frequently
complain of a paradoxical symptom of a "clogged, plugged or stuffy ear" or
a crackling or squeaking sound in actuality, there is a failure of the
facet of Eustachian tube valve to passively collapse and seal the entrance
at the nasopharynx. When they deny having a respiratory infection, further
questioning may elicit a complaint of autophony (hearing their own breath
sounds amplified in one's ear) and of hearing amphoric sounds in their ear
similar to the sound of air being blown across the mouth of an uncapped
empty bottle, or their voice sounding loud or strange. The symptom of
autophony is pathognomonic of a patulous Eustachian tube disorder of the
While the Eustachian Tube remains open, the continuous free flow of air
from each respiration or vocal effort rushes to the middle ear causing the
tympanum to resonate loudly. This uncontrollably amplifies the endogenous
sounds (autophony) in one's ear. These forceful air currents, or
acoustical energy, produced by breathing and vocalization generated within
the approximate voice box, impact directly through the open Eustachian
tube to the sensitive sound transmission system of the middle ear
producing disturbing sounds and acoustical energy.
Unlike the symptoms of a common cold, PET symptoms totally disappear when
lying down due to a shift of body fluids to the head increases local edema
and passive closure of the tube. And so, to maintain closure, some
patients spend the their day time hours supine, in bed.
The symptom of autophony--hearing the disturbing loud sounds from one's
own breathing and voice, may be so disabling that many patients have
considered suicide, and some attempts have been successful.
The patulous Eustachian tube syndrome and less severe variants such as a
Patent, open, hyper-patent or semi-patulous Eustachian tube are variants
of Eustachian tube incompetence.
In the past, different remedies have been recommended for the patulous
Eustachian tube syndrome. These include sitting, and then bending over
with ones head between the knees to increase nasal edema. Treatments
included nasal insufflation of boric acid-salicylic acid power, local
application of liquid silver nitrate, diathermy, Premarin hormonal or
saturated solution of iodine (SSKI) drops. Another therapy has employed
Kamikihi-To as reported by Jia-Wei-Gui-Pi-Tang. Some were impractical.
None of these treatments have been consistently successful, nor are they
without side effects, or serious complications.
In the inventor's previous related U.S. Pat. No. 5,470,587 (Nov. 28, 1995)
which is herein incorporated by reference, the principle embodiment
included hydrochloric acid (HCl), an inorganic acid. The invention sited
above stimulated the necessary local edematous response to close the tube
with the immediate, but short term, relief of symptoms due primarily to
its pH effect. The properties of the novel invention and novel method of
administration described herein stimulate both the immediate edema and the
products essential for tissue healing, namely, dermatofibroblasts and
Surgical procedures have been advocated, including the injection of
paraffin, Teflon, collagen, or Gelatin sponge injection into the wall
around the Eustachian tube opening. Invasive surgery involving pterygoid
hamulotomy has been performed or occlusion of the Eustachian tube lumen by
a plug. Diathermy probe therapy has been used on the past. Laser-assisted
endoscopic surgery or autologous fat grafting has been recommended for
severely debilitating cases.
Additionally, among children in the US, 35 to 85 percent experience middle
ear disease from otitis media in the first six months of life. Acute ear
infections account for 15 to 30 million visits to the doctor each year in
the U.S. In fact, ear infections are the most common reason why an
American child sees the doctor. This is probably the result of prenatal
deficiencies, and the infant or child's exposure to secondary smoke and
respiratory viruses when their immune system is not fully developed.
Certain bacteria are reported to be the primary causes of acute otitis
media (AOM) and are detected in about 60% of cases. The bacteria most
commonly causing ear infections are: Streptococcus pneumoniae (also called
S. pneumoniae or pneumococcus), the most common bacterial cause of acute
otitis media, causing about 40% to 80% of cases in the U.S.; Haemophilus
influenzae, the next most common culprit and is responsible for 20% to 30%
of acute infections; and Moraxella catarrhalis, also a common infectious
agent, responsible for 10% to 20% of Less common bacteria are
Streptococcus pyogenes and Staphylococcus aureus.
A serious sequalae of bacterial chronic otitis media includes otitis media
with effusion (OME) which is associated with complications such as a
ruptured tympanic membrane (TM). The failure of the Eustachian tube to
expel or eliminate the natural secretions, microorganisms, biofilms and
toxic products result in destruction of the tissues, TM rupture and
hearing loss. When the fluid becomes infected the increased pressure is
very painful and causes the delicate tympanic membrane to rupture
releasing the toxins into the external ear canal for elimination
The ideal treatment should involve a product that is first safe and free
of side effects, non-toxic, exhibit high potency at a pH that facilitates
host tissue defenses while at the same level is detrimental to the
reproductive cycle of most microorganisms, and the biochemical or physical
property to break down the protective biofilm barrier surrounding the
microorganism or toxins. It would be advantageous if embodiment has anti
oxidant properties to reduce free radical toxins on the damaged host
tissue and participate in the production of the essential ingredients
(pre-collagen) to complete the healing process of the tissue and improved
In the past, antibiotics have been the mainstay of eliminating bacterial
microorganisms by direct biochemical interaction. Antibiotics can only
treat the infection when and if the agent is capable of penetrating the
biofilm barrier and altering the biochemistry of the microorganism
internally. This is seldom the case now.
Of note, about 15% of these bacteria are now believed to be resistant to
the first-choice antibiotics. With the overuse of antibiotics and the
development of resistance by microorganisms, such treatment has become
less effective and frequent side effects have become common.
More recently, because the chemical structure of the newer anti-infective
agents are more complex, antibiotics are not absorbable in the
gastrointestinal tract, necessitating that the medication be administered
by intravenous injection which is further associated with serious side
effects such as ototoxicity, hearing loss and tinnitus, allergic
reactions. Scientific studies have identified prenatal markers, such as
smoking, that predispose the infant to develop middle ear infections.
Among the prenatal risk factors for early Otitis Media (OM) that can be
modified, mother's intake of vitamin C and alcohol during pregnancy could
have future health implications. Alcohol may stimulate the fetal liver to
produce metabolic enzymes which degrade vitamin C producing deficiencies
in both the fetus and the infant. Vitamin C--deficient animals have
neutrophils with reduced bactericidal activity and ascorbic acid may also
play a role in the fetal development of cartilage, bone, and the muscle of
the Eustachian tube.
Recent discoveries have identified a universal mechanism by which disease
is transmitted, established, perpetuated and flourishes despite antibiotic
therapy. This is through the protective covering of biofilm. The organic
matter adheres to the surface target organ and shields the penetration of
the external membrane of the microorganisms by many forms of chemotherapy.
To be effective, it is necessary the therapeutic agent to break down the
biofilm, and then inactivate the microorganisms by establishing a pH
environment which is detrimental to their survival.
The relative acidity of a solution or tissue is measured according to a pH
scale that ranges from 0-14. Those registering above 7 function within an
alkaline environment, those below 7 are acidic. A solution with a pH of 7
is considered neutral. The mathematical symbol pH represents the logarithm
of the reciprocal of the hydrogen-ion concentration in gram atoms per
liter of solution. The level of the pH regulates the biochemical
availability of nutrients for the chemical processes of all vital tissues
It is therefore desirable to provide a composition for the treatment of
the fundamental pathologic processes antecedent to patulous Eustachian
tube disorders and to the dysfunctional tubal stenosis in middle ear
diseases by employing an effective, non-toxic composition with known
co-enzymatic and vital tissue healing properties.
The embodiments of the invention disclosed herein provide a novel
formulation and method for the prevention and relief of symptoms of
inflammatory disease or functional disorders of the middle ear adnexa, the
Eustachian tube, manifested by autophony or tubal tinnitus due to a severe
form of Eustachian tube incompetence, patulous Eustachian tube syndrome, or
deformity, acquired or following surgery, radiation or trauma. The inventive
composition and method are further effective for the prevention and relief
of symptoms related to primary inflammatory disease or functional disorders
of the middle ear or such as may occur secondary to allergy, rhinitis or
sinusitis, microorganisms, structural deformities or tubal dysfunction.
A method of treating the patulous Eustachian tube syndrome, and variants of
Eustachian tube incompetence, includes the steps of: applying to a person's
nasal mucosa a composition of at least of L-Ascorbic acid, with a pH level
in the range of about 2.0 pH to about 2.5 pH, and a pharmaceutically
acceptable liquid carrier and delivery system, the L-Ascorbic acid in the
carrier at a concentration form about 25% to about 4% wt./volume.
A method of preventing and treating Middle Ear Diseases including Otitis
Media (OM), Otitis media with effusion (OME), Tympanic Membrane (TM) or
Eustachian Tube (ET) due to dysfunction or associated with allergy,
rhinitis, sinusitis, and inflammatory disease from toxins, microorganisms,
the biofilm and abiotic adhesin co-factors coating the surface of implanted
devices, including the steps of applying a composition comprised of
L-Ascorbic acid at a pH in the range of about 2.3 pH to 4.0 pH level in a
pharmaceutically acceptable liquid carrier at a concentration from about 10.
% to about 0.01% , wt./volume to the middle ear through the natural tubal
stoma, an acquired opening or implants, to prevent or treat middle ear
disease and its sequalae.
The embodiments described herein for the invention provide that when
L-ascorbic acid is dissolved in an aqueous solution, the pH of that solution
decreases sharply due to the dissociation of the hydrogen ion from the
enediol group. The main contribution to the lowering of pH is the hydroxy
group located on the number 3 carbon (C3). This composition provides a more
flexible therapeutic pH range than HCL, is much safer, has no known
toxicity, and is necessary for the production of collagen to support the
strength and healing of these tissues. Unfortunately, man is unable
synthesize L-Ascorbic acid due to the absence of the biochemical step in the
liver of the species to convert L-gulonolactone which is required for the
biosynthesis of L-ascorbic acid. Therefore, in man, the composition provided
by the embodiment includes exogenous L-Ascorbic acid, an essential nutrient
for tissue health. Further the embodiments of the composition and the
methods described assure the availability of the composition directly to the
tissue in obvious need.
The composition of the first exemplary embodiment has known antioxidant
properties, scientifically established, that combat the build up of
metabolic wastes. It restores the defensive bioactive reactions such as
surface tension lowering substance (STLS) to combat the adherence or biofilm
products of microorganisms.
Because man cannot synthesize ascorbic acid, it is a recognized essential
nutrient that has to be provided by an exogenous source as referenced in [At
this time, the Food and Nutrition Board of the U.S. National Research
Council recommends a daily allowance of 60 mg in a 70 kg man to support
certain vital functions.
The exemplary first embodiment employs this essential nutrient in the
therapeutic form required by man for the production of pre-collagen
necessary for the strength and healing process of the tubal tissues.
Unfortunately the early symptoms of PET may include those similar complaints
that appear similar to those reported with the common cold, tubal stenosis,
otitis media, environmental allergies, rhinitis or sinusitis. But in PET the
fundamental cause is an OPEN TUBE, contrary to the inflammatory obstructive
phenomenon of the middle ear congestion from a common cold etc. Therefore,
it is essential to determine the exceptional diagnosis of PET and select the
contrary therapy to relieve the disturbing cardinal symptoms of autophony.
For anyone to recommend any of the conventional medications or non
prescription decongestant remedies because of a misdiagnosis, it will
invariably make the PET symptoms much worse.
OPERATION OF THE FIRST EXEMPLARY EMBODIMENT
The Patulous Eustachian Tube is abnormally open throughout the day when the
individual is upright and about. The lumen of the tube remains open and the
phenomenon of autophony, hearing one's amplified breath sounds and voice
disturbingly loud, will persist throughout the day.
A novel composition for ameliorating patulous Eustachian tube symptoms, is
provided by a solution of L-Ascorbic acid and a pharmaceutically acceptable
liquid carrier in therapeutically effective amounts to normalize the surface
tension of the luminal tissues of the eustachian tube, the solution having a
pH level in the range of about 2 to 2.5 pH. The L-Ascorbic acid or
comparable ingredient is in the form of U.S.P. grade, extra pure fine
powder, granular powder or pure crystals. The L-Ascorbic acid employed in
the embodiment is also known as Vitamin C, hexuronic acid, an antisorbutic
vitamin, with chemical formula C.sub.6H.sub.8O.sub.6 and a molecular weight
of 176.12, or its derivatives: Ester-C, Ascorbate, L-xyloascorbic acid,
3-oxo-L-gulofuranolactone, L-3-keto threo hexuronic acid lactone, or
oxidation forms: dehydro-L-ascorbic acid, hydrophobic ascorbic acid, or
2-O-.alpha-D-glocopyranosyl-L-Ascorbic acid. For their synergistic effect to
enhance the properties of the novel composition, specific antioxidants may
be added. These include the flavon antioxidant, bioflavonoid, and the
nutrient antioxidant, water solubilized vitamin E (alpha-tocopherol) and
zinc salt(s) added to the L-Ascorbic acid composition.
For an exemplary embodiment, the liquid carrier is distilled water and the
solution has a pH level in the range of about pH 1.9 to a pH of about 3.9.
The L-Ascorbic acid is present in the carrier at a concentration from about
2% to about 25% wt./volume. The pH of Ascorbic acid produces the desired
edema, as an immediate effect but also has co-enzyme and bioactive
properties to combat the inflammatory reaction and facilitate the healing
A novel method to prevent or ameliorate the serious symptoms of middle ear
disease due to impairment of its Eustachian tube function is accomplished by
applying the composition through the natural orifices, or acquired openings,
or implanted devices to normalize Eustachian tube function.
The solution is topically applied to the nasal mucosa, however in
alternative embodiments of the method protocol, the solution is applied to
the middle ear chamber mucosa. For application to the nasal mucosa, the
solution is applied in drops into the nose, as a spray into the nose or in
an aerosol into the nose. In one application, the solution is applied via an
ET catheter to the nasopharyngeal stoma of the eustachian tube.
For application to the middle ear chamber mucosa, the solution is applied to
the middle ear employing a syringe and needle, a tympanic membrane puncture
or a myringotomy, by employing an implanted device in the middle ear chamber
or bridging the defect of the tympanic membrane of the middle ear chamber.
In an exemplary first administration protocol, the composition is
administered in the form of nose drops, the patient sniffs them through the
ipsilateral nostril on the side of the symptomatic ear affected with the
disorder. The number of drops administered can be titrated to the needs of
the individual patient. The patient can sniff from two to four drops of the
solution, and the drops are sniffed back into the nostril so as to deliver
the medication to the Eustachian tube opening in the back of the nose.
Administration of the drops may be repeated again in four to six hours. As
desired, the daily dose maybe increased to 4 drops per administration.
The pH of Ascorbic acid produces the desired tubal edema, as an immediate
effect but also has bioactive properties to combat the inflammatory reaction
facilitating the healing process.
An exemplary nasal drop administration protocol has been developed for the
first exemplary embodiment. To achieve normal closure of the lumen, 2-6
drops of the nasal supplement solution are applied to the stoma or opening
of the Eustachian tube. It may take two weeks before changes in symptoms
PatulEND.TM. nose drops are designed to increase the edema of the membrane
at the stomal entrance of the Eustachian tube to the critical closing
pressure level and seal the opening. When drops are instilled into the nasal
chamber, they are slowly absorbed upon contact with the surface. It is
important to sniff the nose drops so that they are drawn back to the opening
of the Eustachian tube where they can be preferentially absorbed at the
stoma. After using the supplement for several days one is usually able to
master the technique and can identify the sensation associated with proper
delivery of the drops to the Eustachian tube area.
Referring to the illustrations in FIGS. 1 and 2 (see Original Patent) for
reference, after the patient been up for a period of time, symptoms begin as
the tubal tissues lose fluid and the lumen increases. When the patient feels
the symptom of autophony is about to occur, gently blowing the nose to clear
any mucous is accomplished.
With the patient 10 lying with head 12 between 45 to 60 degrees above
horizontal. The head is turned 45 to 60 degrees toward the affected ear 14,
right as shown in FIG. 1 and left as shown in FIG. 2. This places the
Eustachian tube stoma (opening) lower than the nostril 16. Gravity will
allow the drops to flow to the back of the nose. Sniffing will draw the
drops further info the nasal passage to the Eustachian tube before the semi-permiable
membrane lining of the nasal passage can absorb them. Alternatively while
sitting in a chair, the head is tilted back at approximately 45 degrees and
then tilted toward the affected ear to place it almost below the nose.
For nasal administration, to instill the drops, put the dropper tip
one-quarter inch (1/4'') into the lower nostril (affected side), closest to
the symptomatic ear.
Instill 2-4 drops depending on individual anatomy. Sniffing briskly to draws
the drops back approximately three inches (3'') to the location of the tube
opening where they will be absorbed. The patient may feel a brief burning or
stinging sensation when the drops are administered properly to stimulate the
closure of the stoma of the tube. The patient then remains lying down in the
administering position for ten (10) seconds.
The solution in the exemplary embodiment is devoid of pharmaceutical agents,
astringent agents, hormones, alcohol, botanicals, yeast, wheat, soy, dairy
products, sugar, salt, starch, and artificial coloring or dyes and is
formulated without the uses of preservatives, artificial flavors or colors.
It is light sensitive and oxygen sensitive.
Claim 1 of 21 Claims
1. A method of treating the patulous
Eustachian tube syndrome, a severe variant, of Eustachian tube
incompetence, comprising: applying to a person's nasal mucosa a
composition of L-Ascorbic acid, in a highly acidic concentration of about
5% to about 20% wt/vol, within a range of about 2.4 to 2.0 pH level, in an
aqueous solution, and a pharmaceutically acceptable liquid carrier and
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