anatomy & physiology of eustachian tube dr. vishal sharma
TRANSCRIPT
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Anatomy & Physiology of
Eustachian Tube
Dr. Vishal Sharma
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History & Embryology
Bartolomeus Eustachius first described it as
pharyngo-tympanic tube in 1562.
Antonio Valsalva named it Eustachian tube.
Develops from tubo-tympanic recess, derived
from endoderm of 1st pharyngeal pouch.
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Bartolomeus Eustachius
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Antonio Maria Valsalva
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Embryology
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Anatomy
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Anatomy
36 mm long in adults.
Directed anteriorly, inferiorly & medially from
anterior wall of M.E., forming angle of 450 with
horizontal & sagittal planes.
Enters naso-pharynx 1.25 cm behind posterior
end of inferior turbinate.
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Angulation
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Pharyngeal opening
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Parts Lateral 1/3 is bony
Medial 2/3 is fibro-
cartilaginous.
Junction b/w 2 parts
is isthmus, narrowest
part of Eustachian
Tube.
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Anatomy of medial 2/3rd
Cartilage plate lies
postero-medially &
consists of medial +
lateral laminae separated
by elastin hinge. Fibrous
tissue + Ostmann’s fat
pad lie antero-laterally.
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Anatomy
Muscle attachments:
1. tensor veli palatini or dilator tubae
2. levator veli palatini
3. salpingopharyngeus
4. tensor tympani
Nerve supply: 1. Sphenopalatine ganglion
2. Mandibular nv 3. Tympanic plexus
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Anatomy
Lining epithelium: respiratory epithelium
Arterial supply: ascending pharyngeal &
middle meningeal arteries
Venous drainage: pharyngeal & pterygoid
venous plexus
Lymphatic drainage: retropharyngeal node
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Endoscopic Anatomy
Medial end forms tubal
elevation / torus tubarius
Lymphoid collection over
torus is called Gerlach’s
tubal tonsil.
Postero-superior to torus
is fossa of Rosenmüller.
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Adult vs. Child (< 7 yr)
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Adult vs. Child (< 7 yr)ADULT INFANT
Length 36 mm 18 mm
Angle with horizontal 45 0 10 0
Lumen Narrower Wider
Angulation at isthmus Present Absent
Cartilage Rigid Flaccid
Elastic recoil Effective Ineffective
Ostmann’s fat More Less
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Physiology
Bony part is always open.
Fibro-cartilaginous part is closed at rest.
Opens on:
1. swallowing 2. yawning
3. sneezing 4. forceful inflation
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Physiology
Opens actively by contraction of tensor veli
palatini & passively by contraction of levator
veli palatini (it releases the tension on tubal
cartilage).
Closes by elastic recoil of elastin hinge +
deforming force of Ostmann’s fat pad.
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E.T. opening
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Functions
1. Ventilation & maintenance of atmospheric
pressure in middle ear for normal hearing
2. Drainage of middle ear secretions into
nasopharynx by muco-ciliary clearance,
pumping action of Eustachian tube &
presence of intra-luminal surface tension
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Functions
3. Protection of middle ear from:
Ascending nasopharyngeal secretions due
to narrow isthmus & angulation between 2
parts of E.T. at isthmus
Pressure fluctuations
Loud sound coming through pharynx
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Functions
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Conditions of Dysfunction
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Bluestone’s Flask Model
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Adult vs. Pediatric
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TM perforation & nose blowing
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O.M.E. & Barotrauma
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Grommet insertion in O.M.E.
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Tests for E.T. function
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1. Valsalva Maneuver
Forced expiration with
mouth & nose closed.
Otoscopy shows
lateral bulging of
Tympanic membrane
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2. Frenzel Maneuver
Hands free Valsalva for pilots
Compression of nasopharyngeal air by
muscles of tongue
Otoscopy shows lateral bulging of tympanic
membrane
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2. Frenzel Maneuver
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3. Toynbee Maneuver
More physiological
Swallowing with
mouth & nose closed
Otoscopy shows
retraction of tympanic
membrane
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Air pressure is alternately increased &
decreased within external auditory canal
Mobility of tympanic membrane is observed
Normal mobility indicates good patency of
Eustachian tube
4. Pneumatic otoscopy & Siegelization
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Siegelization
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Pneumatic Otoscope
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Normal Tympanic Membrane
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Eustachian Tube dysfunction
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Early otitis media with effusion
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Late otitis media with effusion
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Acute suppurative otitis media
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Ear drum perforation
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5. Politzerization
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Politzer Bag
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5. Politzerization
Rubber tube attached to a Politzer bag put into
one nostril & both nostrils pinched
Patient asked to swallow or repeat “k”
Politzer bag is squeezed simultaneously
Otoscopy shows lateral bulging of ear drum in
patent Eustachian tube
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6. E.T. catheterization
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Eustachian tube catheter
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6. E.T. catheterization E.T. catheter passed along nasal floor till it
touches posterior wall of naso-pharynx.
Catheter rotated 90° medially & pulled forward
till it impinges on posterior nasal septum.
Catheter rotated 180° laterally, & its tip inserted
into opening of E.T.
Politzer bag attached to outer end of catheter
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6. E.T. catheterization
Air pushed into E.T. catheter by squeezing
Politzer bag. Examiner hears by Toynbee
auscultation tube put in pt's ear.
Blowing sound = normal E.T. patency
Bubbling sound = middle ear fluid
Whistling sound = partial E.T. obstruction
No sound = complete obstruction of E.T.
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7. Tymapanometry
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7. Tymapanometry
Type C = E.T. dysfunction
Type B = fluid in middle ear
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200 mm H2O pressure is created in patient’s
external auditory canal
Patient asked to swallow 10 times
Residual pressure in patient’s external auditory
canal after 10th swallow is noted
Test repeated with -ve 200 mm H2O pressure
created in patient’s external auditory canal
8. William’s pressure equalization test
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William’s TestResidual Pressure Result
Up to + 50 mm H2O normal E.T. function
+ 51 to + 100 mm H2O mild dysfunction
+ 101 to + 199 mm H2O moderate dysfunction
+ 200 mm H2O severe dysfunction
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9. Sono-tubometry
Sound made in pt’s nasal cavity & detected with
stethoscope in patient’s external auditory canal
Loud sound = patent Eustachian tube
10. Eustachian tube Salpingogram
Dye instilled through E.T. catheter & X-ray taken
11. C.T. scan & M.R.I. of skull
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12. Trans-nasal E.T. video-endoscopy
13. Test for E.T. patency in T.M. perforation
Saccharine crystal / antibiotic ear drop /
methylene blue placed in middle ear via ear drum
perforation.
Sweet taste / bitter taste / blue staining of
secretions indicates patent Eustachian tube
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Patulous Eustachian Tube
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Clinical Features
Aural fullness, humming tinnitus, hearing their
own voice (autophony), hearing their own breath
sounds (tympanophonia).
Symptoms resolve in supine position, in forward
bending with head between knees, in U.R.T.I.
Aggravated by mastication.
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Otoscopy: T.M. moves during breathing.
Associated conditions: radiation therapy,
hormonal therapy, nasal decongestants, 3rd
trimester pregnancy, stress, sudden weight
loss, multiple sclerosis.
Treatment: Reassurance, weight gain, oral
potassium iodide.
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Surgical interventions
1. Electro-cauterization of E.T. orifice
2. Peri-tubal injection with Teflon paste
3. Transposition of tensor veli palatini muscle
medial to pterygoid hamulus
4. Plugging of E.T. orifice in Middle ear +
myringotomy & grommet insertion
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Thank You