Professor Dr Holger Sudhoff, FRCS, FRCPath, is a leading specialist in ear, nose and throat medicine and head and neck surgery, and heads the newly opened Bielefeld Head Center. This state-of-the-art facility, which opened its doors in May 2024 at the Seidensticker-Kontor in Stadtholz, is specifically aimed at private patients suffering from various head and skin conditions. With his extensive knowledge and international experience, Prof. Dr Sudhoff, together with a highly qualified team of specialists and surgeons, has created an environment that offers first-class medical care of the highest standard.
The Head Center Bielefeld has two state-of-the-art operating theaters, in which at least 2,000 operations are scheduled annually. The center relies on digitalisation and the implementation of cutting-edge technologies, including artificial intelligence (AI). Particular emphasis is placed on the treatment of malignant and benign tumors in the head and neck region, lymph node disorders, tonsil operations, and cancers of the oral cavity and pharynx. Phonosurgery, salivary gland disorders and conditions affecting the larynx and skin are also among the comprehensive treatment options, which are individually tailored to patients’ needs.
Prof. Dr Sudhoff brings not only his extensive medical training from Ruhr University Bochum and UCSD Medical School, but also an impressive array of scientific publications and awards that have established him as a leading authority in his field. His work in research and teaching has established him as a leading figure, and the highly qualified specialists at the Bielefeld Head Center benefit from his expertise and his commitment to continuous professional development. The Kopfzentrum Bielefeld aims to ensure the best possible care for its patients through innovative approaches and the close integration of clinical practice and scientific progress.
Prof. Dr Sudhoff and his team are tirelessly committed to developing new therapeutic methods to offer patients modern and personalized treatment. This underscores the Head Center Bielefeld’s outstanding position within the medical landscape and its commitment to future-oriented, patient-focused care. As a specialist in ear, nose and throat medicine, Prof. Dr Sudhoff also has extensive experience in dealing with ear conditions. The ear is a highly complex sensory organ, which is why the editorial team at the Leading Medicine Guide wanted to find out more and, together with Prof. Dr Sudhoff, focused on the Eustachian tube and its function.
The ear is a fascinating sensory organ that plays a central role in our perception of the environment. It consists of three main parts: the outer ear, the middle ear and the inner ear, which work together to convert sound waves into electrical signals that are interpreted by the brain. An important structure in the middle ear is the Eustachian tube, which plays a crucial role in regulating pressure within the ear and ventilating the middle ear. Diseases or functional disorders of the Eustachian tube can lead to a range of symptoms, including earache, hearing loss and middle ear infections. Therefore, understanding the Eustachian tube and its function is of great importance to otolaryngology and ear health in general.
The Eustachian tube connects the middle ear to the back of the throat and consists of a bony and a cartilaginous section, which is approximately 3–4 cm long. The cartilaginous part is elastic and allows the tube to open to equalize pressure in the middle ear.
“The Eustachian tube plays a key role in pressure regulation and ventilation of the middle ear. The most important structures in terms of its function are the bony and cartilaginous sections. The cartilaginous parts of the Eustachian tube are flexible and help with opening and closing, while the bony section stabilizes the whole structure. The Eustachian tube also has a number of muscles, such as the tensor tympani muscle or the salpingopharyngeus muscle, which are responsible for actively opening the Eustachian tube. This active opening is essential for regulating air pressure in the middle ear and for preventing fluid build-up and infections. The Eustachian tube opens, for example, when swallowing. Furthermore, the Eustachian tube is lined internally with a mucous membrane that facilitates the transport of secretions from the middle ear, ensuring it remains clean and dry,” explains Prof. Dr Sudhoff.
Normally, the Eustachian tube remains closed, but opens during certain activities such as swallowing or yawning. This allows air to enter the middle ear. The middle ear contains the ossicles – the malleus, incus and stapes – which are responsible for transmitting sound to the inner ear. A balanced pressure ratio in the middle ear is essential for the proper functioning of these ossicles. If the pressure in the middle ear is too low, the ossicles cannot function optimally, which can lead to hearing loss. In addition, the back of the throat, also known as the nasopharynx, plays an important role in ventilating the middle ear. A dysfunction or blockage of the Eustachian tube can lead to problems such as middle ear infections, pain, a feeling of pressure or hearing loss.
Middle ear infections often occur when the Eustachian tube is blocked or cannot open, leading to a pressure imbalance and poor ventilation of the middle ear.
“Children in particular often suffer from upper respiratory tract infections, and the Eustachian tube is supposed to prevent the build-up of secretions and fluid in the middle ear. However, when an infection caused by bacteria or viruses develops, the Eustachian tube swells shut and can no longer fulfill this function. This leads to negative pressure in the middle ear, causing fluid to build up. The ear can no longer function properly in terms of sound transmission, and chronic problems such as bone infection in the middle ear may also develop,” says Prof. Dr Sudhoff.
The diagnosis of Eustachian tube disorders usually begins with a detailed medical history, during which the doctor asks the patient about their symptoms, such as a feeling of pressure in the ear, reduced hearing or earache.
“Following the medical history, the patient’s eardrum is examined and an endoscopy of the nasopharynx is performed to assess the anatomy of the Eustachian tube. Tympanometry is also important, as it measures the resistance to movement of the eardrum. This test provides information about the pressure in the middle ear and can indicate functional disorders of the Eustachian tube, as insufficient ventilation of the middle ear is typically accompanied by abnormal pressure. A tubomanometry may also be performed, a procedure available at the Head Center in Bielefeld. This allows us to check whether the Eustachian tube can be opened actively or passively under varying pressure conditions. Occasionally, specialized hearing tests are required. Furthermore, a CT scan performed while standing may be offered if there is a suspicion that the Eustachian tube is blocked. However, it must not be overlooked that around 90% of children are affected by Eustachian tube dysfunction, at least temporarily. This usually occurs in the first and then in the sixth year of life. Children suffer from ear conditions more frequently because they have a different angle of the Eustachian tube, which is positioned horizontally. This angle becomes steeper as they grow. Consequently, the horizontal orientation in children is less effective at draining secretions and equalizing pressure in the middle ear. In adulthood, the steeper angle of the Eustachian tube ensures that these functions are performed more effectively and problems such as middle ear infections occur less frequently,” explains Prof. Dr Sudhoff, adding:
“In children who have fluid in the middle ear for longer than three months, speech development may be delayed. This results in hearing loss of 20–30 decibels and a sensation of pressure in both ears. Real pain occurs when a bacterial infection also develops, leading to acute middle ear infection. As a rule, so-called otitis media with effusion – that is, fluid in the ear – is not painful, but merely causes a slight sensation of pressure.” Although adults can also suffer from middle ear infections, they are generally less susceptible than children. However, when conditions such as colds or allergies occur, adults may also experience symptoms of Eustachian tube dysfunction due to their often greater exposure to pollutants and allergens; however, these symptoms usually lead to serious complications less frequently than in children.
Middle ear infections, also known as otitis media, are one of the most common ear conditions, particularly in children. They can be acute or chronic and are often associated with colds or other respiratory infections. Acute otitis media involves a sudden inflammation of the middle ear, often accompanied by pain, fever and hearing loss. Chronic middle ear infections, on the other hand, are characterized by recurrent inflammation and long-term impairment of the middle ear, which can lead to permanent changes in the tissue and hearing ability.
There are various approaches to treating Eustachian tube dysfunction.
“Initially, conservative measures such as decongestants or nasal sprays can be used to relieve pressure on the mucous membranes and promote the opening of the Eustachian tube to facilitate ventilation. If this is not sufficient, one must consider (especially in children) whether the adenoids should be removed. Another option is paracentesis, a medical procedure in which a small hole is made in the eardrum. This procedure is performed to remove fluid or pus from the middle ear, usually in the context of an acute or chronic middle ear infection. And if none of this helps, there is the technique of balloon dilation, a minimally invasive medical procedure in which a small balloon catheter is inserted into a narrowed or blocked passageway in the body and inflated there to widen the constriction – similar to what is done with coronary arteries. “All these procedures can be carried out on an outpatient basis,” explains Prof. Dr Sudhoff, adding with regard to the special care required for children: “Children are usually calm because we handle them very gently and explain everything to them in a child-friendly manner and with patience. When preparing for anesthesia, we use plasters with anesthetic ointments to temporarily numb specific areas of skin and make them less sensitive to pain. It is very important that the anesthesia is administered in the presence of the parents.”
“In general, there has been an increase in tubal dysfunction. This is linked to environmental factors and the rise in allergies. Due to global warming, allergies are spreading more rapidly. There is also an increase in particulate matter pollution. At the Bielefeld Head Center, we can offer patients the most advanced allergy diagnostics in the world, test for all 270 known molecular allergens from a single blood sample, and prepare our patients for specific immunotherapies,” emphasises Prof. Dr Sudhoff.
In some cases, surgical intervention may be necessary, particularly if recurrent middle ear infections occur. In such cases, inserting ventilation tubes into the eardrum can help to equalize pressure in the middle ear and improve ventilation. These tubes allow air to enter the middle ear and excess fluid to drain away. In severe or chronic cases where there is persistent dysfunction of the Eustachian tube, surgery to correct the anatomy or improve the function of the Eustachian tube may be considered.
Environmental factors and changes in pressure have a significant impact on the function of the Eustachian tube.
During sudden changes in pressure, such as those experienced when flying or diving, the Eustachian tube may struggle to open and equalize the pressure. This can lead to an unpleasant sensation of pressure or pain in the ear, known as ‘ear pressure’, as well as hearing problems and, in severe cases, even middle ear infections.
“When flying, the air pressure drops rapidly as the aircraft descends, causing the pressure in the middle ear to be higher than the ambient pressure (known as MBN pressure). This is because aeroplanes are not as well insulated as we might imagine. If the Eustachian tube cannot open sufficiently to equalize this pressure difference, earache and hearing impairment may occur. Anyone experiencing problems during the descent can try yawning to equalize the pressure and provide relief. Those who experience significant difficulties can undergo balloon dilation. Flight attendants, of course, face this situation every day, and we have already treated a number of them here at the Head Center in Bielefeld. Otherwise, they would suffer long-term problems due to the lack of pressure equalization. In fact, this can lead to what is known as barotrauma – the eardrum can burst due to the pressure differences, potentially leading to deafness,” explains Prof. Dr Sudhoff.
The term MBN usually stands for ‘myringo-basal-nasal’ and refers to the pressure between the eardrum (myringo), the basal region of the middle ear and the nasopharynx (nasal region), which is regulated by the Eustachian tube (ear trumpet).
Similar problems also occur when diving, where the increasing water pressure in deep waters requires effective pressure equalization. To counteract these unpleasant and potentially harmful effects, there are various preventive strategies that can help those affected. A widely used method is chewing gum or swallowing water, as these activities stimulate the muscles that open the Eustachian tube, thereby facilitating pressure equalization. Yawning has the same effect and can help with changes in pressure. For people who fly or dive frequently, special earplugs can be helpful, as they equalize pressure more slowly.
Highly specialized ENT medicine and microsurgical expertise at the Bielefeld Head Center
The Seidensticker-Kontor offers a comprehensive range of medical services in the fields of ear, nose and throat medicine, phoniatrics, pediatric audiology, oral and maxillofacial surgery, dermatology and allergology. Both conservative and surgical treatment methods are employed. The focus is on individualized and personalized medical care in a specialized environment. Two state-of-the-art operating theaters enable high-quality, patient-centered care. A particular focus is on microsurgical procedures to improve hearing. These include operations to treat vertigo and hearing loss, cochlear implantations, and the fitting of implantable hearing systems. In addition, procedures on the nose and paranasal sinuses, the removal of adenoids, and operations on the tonsils and salivary glands are carried out regularly.
“In Bielefeld, we have a very high level of expertise in the field of ear and middle ear surgery, sinus surgery, as well as in salivary gland disorders and the entire spectrum of ear, nose and throat surgery. And because we have inpatient beds in a neighboring clinic, we can also offer skull base surgery, such as cochlear implants and implantable hearing systems, as well as complex head and neck tumor surgery. “For instance, during a fellowship at the University of Cambridge, I operated on around 700 patients with acoustic neuroma – this enables us to offer highly specialized advice on treatment strategies,” emphasises Prof. Dr Sudhoff, and with that we conclude our conversation.
Thank you very much, Prof. Dr Sudhoff!
