This study aimed to investigate the prevalence of and risk factors for Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation via tracheostomy tube.

A total of 40 patients on chronic ventilation were included in a prospective cohort study. Middle-ear status was determined by tympanometry. Tympanograms were categorised as types A, B or C; types B and C were defined as middle-ear pathology.

In all, 57 ears of 40 patients were examined. Disease was found in at least 1 ear in 26 out of 40 patients. Middle-ear pathology was found in 25 out of 34 patients who were tube fed (via nasogastric tube or percutaneous endoscopic gastrostomy) vs 1 patient out of the 6 fed orally (p = 0.014), and in 23 out of 31 with conscious or cognitive impairment vs 3 out of 9 cognitively intact patients (p = 0.044).

Middle-ear pathology is common in patients on chronic mechanical ventilation via tracheostomy tube. The highest prevalence was in those with impaired consciousness or cognition, and oral feeding appeared protective.

Nasogastric tube insertion is often difficult, due to a variety of reasons, e.g. skewed laryngeal anatomy. We present a previously unreported method of facilitating nasogastric tube insertion, using a flexible nasendoscope.

The nasogastric tube is anchored to a flexible nasendoscope using sodium alginate dressing ties. The nasendoscope is then passed into the upper oesophagus, along with the nasogastric tube. Once the nasogastric tube has passed the cricopharyngeus, gentle traction on the nasendoscope releases it from the nasogastric tube. The nasendoscope can then be withdrawn. A previous safety study of sodium alginate ingestion showed no adverse effects.

This method enables nasogastric tube insertion under direct vision, and allows the tube to be guided past the larynx and into the upper oesophagus.