eustachian tube final pp anatomy,embryology,functions,dysfunctions treatment,patulous et
TRANSCRIPT
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Presented by : Dr Siddeshwar K G
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ContentsContents
• Introduction & history
• Embryology, anatomy and physiology
• Functions
• Tests for Eustachian tube function
• Eustachian tube dysfunction
• Treatment
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INTRODUCTION
Eustachian tube – Narrow channel connecting the tympanic cavity & the nasopharynx.
Understanding the role of ET in the health and disease of middle ear has tremendous impact on the management & outcome.
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HistoryHistory: first described by Alcamaeon of Croton(500 B.C).Bartolomeo Eustachi Antonio Maria Valsalva
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Embryology
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7th week of gestation
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IMPORTANT EVENTS
Osseous part - Petrous, Squamous, greater wing of Sphenoid
Cartilagenous - Two discrete chondrification center
part
Muscles - TVP, DT & Tensor tymp – Mandibular Nerve
- LVP – Vagus Nerve
Various events - Patency, elongation.
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Anatomy• Bony part
• Fibrocartilagenous part and • Isthmus
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Elastin Hinge • Junction of medial & lateral lamina is rich in elastin fibre
Ostmann’s Pad of Fat• Fatty tissue lateral to membranous part of cartilagenous
tube
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RELATIONS WITH IMPORTANT STRUCTURES
• Osseous part – TM joint (laterally), middle cranial fossa (superiorly), ICA (medially).
• Fibrocartilagenous part - skull base (sulcus tubarius), nasopharynegal end (toras tubaris) & fossa of Rosenmuller
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Muscles attached to ET
1.Tensor veli palatini (TVP)
2. Dilator tubae
3. Levator veli palatini (LVP)
4. Salpingopharyngeus
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Schematic representation of muscles attachment
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Representation of muscle at various plane
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Histology• Bony part - low cuboidal ciliated
epithilium• Cartilagenous - pseudostratified part ciliated columnar &
goblet cells • Mucosal folds - micro turbinate • MALT
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Blood supply
• Bony part - Tubal artery (accesory meningial artery) & caroticotympanic artery - internal carotid artery
• Cartilagenous part – internal maxillary,ascending palatine & ascending pharyngeal artery
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Nerve Supply• Tympanic branch of IX CN –sensory and
parasympathetic secretomotor to tubal mucosa
• Pharyngeal branch of sphenopalatine ganglion - tubal ostium
• Nervus spinosus – cartilagenous part • Tympanic plexus – bony part
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Differences Between Infant & Adult ETDifferences Between Infant & Adult ET
Infant Adult
Length 13-18 mm(approx.half) 36 mm
Direction more horizontal 45 deg to horizontal
10 deg at birth
Angulation at isthmus Absent present
Bony/cartilagenous bony more than 1/3rd bony 1/3rd
& wider cartilagenous 2/3rd
Tubal cartilage flaccid – causes reflux rigid -prevents reflux
Elastin Hinge density less more
Ostmann’s pad of fat less more
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Functions of ET
1. Regulation of middle ear pressure & ventilation
2. Middle ear protection
3. Mucociliary Clearance & drainage
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Regulation of middle ear pressure & ventilation
• Periodic opening & closing of NP end of the ET
• Co-ordinated contraction of TVP & LVP • Dilatation propagates from NP end to bony end.
• Surfactant B
• Opens 1- 2 times / hr
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Opening and closing of ET
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Closing of ET
• Passive phenomenon.
• Elastic recoil force generated by supporting structures & intraluminal mucosal adhesion force.
• Closure propogates towards NP end.
• ANS plays minor role
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Mucociliary clearance & drainage
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MIDDLE EAR PROTECTION
• Protection from nasopharyngeal environment
• Maintain the sterile environment
• Sound protection
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ET FUNCTION TEST
1. Valsalva Manoeuver
2. Toynbee’s Manoeuver
3. Siegalisation & pneumatic otoscopy
4. Politzer Test
5. Catheterization
6. Tympanometry
7. Sonotubometry
8. ET Salphingography
8. Radiological Test
9. Sachharine or Methylene Blue Test
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Valsalva maneuverPrinciple: positive pressure in the nasopharynx causes air to enter the Eustachian tube
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Toynbee maneuver
- physiological
- swallowing with mouth and nose closed.
- retraction of tympanic membrane
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Pneumatic otoscopy and Siegalization
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FINDINGS
• Blowing sound - normal patency
• Bubbling sound - middle ear fluid
• Whistling sound - partial obstruction
• No sound - complete obstruction
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8. Sono-tubometry
9. E.T salpingogram
10. C.T scan and MRI
11. Test for E.T patency in T.M perforation.
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Dysfunction of Eustachian tube
•Mucosal and submucosal edema
•Decreased muscular function
•Failure of muscular coordination
•Mechanical obstruction
•Functional
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Other causes
• Cleft palate
• Down’s syndrome
• Deviated nasal septum
• Sinusitis
• Nasal polyposis
• Barotrauma
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Effect of ET blockage/dysfunctionTube blockage /dysfn
Absorption of ME gases
Negative pressure in ME
Retraction of TM
Transudate / haemorrhage
Acute otitis media
Perforation of TM
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Sign & Symptoms
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PATULOUS ET• Abnormally patent• Causes
– Idiopathic– Sudden weight loss
– Pregnancy 3rd trimester
– Multiple sclerosis
– Terminal malignancy– Contraceptive pills– Diuretics in elderly
• Complaints - ear blockage , autophony
- Disappears in supine position
• Tympanic membrane moves with inspiration and expiration
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TREATMENT
MEDICAL
1.Nasal decongestants / antihistaminics.
2.Oral & intra nasal steroids
3.Antibiotics
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SURGICALMyringotomy / grommet insertion
Tubal surgeries
1) Laser or microdebrider removal of superficial & deeper tubal mucosa.
2) Ballon tuboplasty
Patulous ET
Submucosal graft implantation/ cartilage slurry injection at NP tubal opening/ LASER cross hatching / endoluminal fat placement or suture ligation.
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THANK YOUTHANK YOU