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Abbreviation: OMT, Osteopathic Manipulation Treatment. PTSD, post-traumatic stress disorder. CR, osteopathy in the cranial field. ST, soft tissue treatment. MET, muscle energy treatment. CS, counterstrain treatment. MFR: myofascial release technique. VIS, visceralmanipulative treatment.
These prospective results on occurrence of AOM in ears previously associated with severe suture restriction of the temporal bone suggest that the temporal bone has an influence on ET positioning and function. In fact, the ET is anatomically influenced by bones of the cranial base since its bony portion is located within the temporal bone and its fibro-cartilaginous portion travels between the temporal and sphenoid bones . Perturbations in the anatomical relationship of those structures can mechanically affect the isthmus, the smallest portion of the ET, which acts as a functional sphincter and has a diameter of only 0.5 mm in children . It is not surprising that such a small diameter is sensitive to anatomical variations in the area. Indeed, normal ET function requires good positioning and mobility of all bony and myofascial neighboring structures . A change of just a few degrees in the craniofacial morphology associated with suture restrictions, for example, of the temporal bone, could have significant consequences on ET function and play a role in the pathogenesis of AOM . Fortunately, the influence of suture restriction of the cranial base bones on the development of AOM may be a modifiable risk factor, especially in young children. While the sphenoid fontanel is usually closed by 2 years of age, a high resolution computed tomography (CT) study revealed that closure of the synchondrosis between occipital and sphenoid bones by ossification occurs only at 13 years of age . Furthermore, the petrous part of the temporal bone and the basiocciput remain apart during the entire life, separated by vestiges of cartilaginous synchondrosis [16, 27]. Akin to the use of a pacifier after 6 months of age , severe suture restriction of the temporal bone in the young child, whose skull is still very malleable, could be a modifiable factor. Such suture restriction is an interesting target for creative and non-invasive interventions aimed at optimizing ET position and function through its bony environment. Clinically, these results support the need to explore new treatments based on modern insights into the pathophysiology of otitis media . Indeed, the results suggest a holistic vision of ET dysfunction, based not only on the tube itself but also on its surroundings and connections. Specifically, the association between the presence of severe suture restriction of the temporal bone and AOM suggests that temporal bone sutures mobility is important for normal growth and maturation of the ET. Suture restriction of other structures surrounding the ET such as the occiput, sphenoid or facial bones might also affect its maturation. Suture restriction of the temporal bone is an interesting unilateral risk factor that might be considered when facing unilateral recurrent AOM. Future studies should investigate the screening of children at risk for AOM or having recurrent AOM, especially unilateral, using a cranial mobility test: a simple, non-invasive, side-effect-free assessment. Subsequently, the efficacy of manual cranial interventions in young children to reduce occurrence of AOM [29, 30] needs to be further studied in order to explore this mechanical avenue to prevent AOM. 2b1af7f3a8