Eustachian Tube

Functions

Ventilation and thus regulation of middle ear pressure.

Protection againstNasopharyngeal sound pressure

Reflux of nasopharyngeal secretions

Clearance of middle ear secretions

Disorders of Eustachian

Tube

Tubal Blockage

MechanicalIntrinsic Inflammation

Allergy

Extrinsic Tumour in nasopharynx

Adenoids

FunctionalCollapse of tube

Both

Symptoms

Otalgia

Hearing loss

Popping sensation

Tinnitus

Disturbances of equilibrium

Vertigo

Signs

Retracted tympanic membrane

Congestion along handle of malleus

and pars tensa

Transudate behind tympanic

membrane - amber colour

Fluid level with conductive hearing

loss

Severe cases

Tympanic membrane markedly retracted

Haemorrhage in subepithelial layer

Haemotympanum

Perforation

Effects of Tubal Blockage

Transudate in middle ear/haemorrhage(Acute Otitis Media)

Retraction of tympanic membrane

Negative pressure in middle ear

Absorption of middle ear gases

Acute tubal blockage

Erosion of Incudostapedial Joint

Retraction pocket/Cholesteatoma

Atelectatic Ear/Perforation

Acute Otitis Media (Thin Watery or MucoidDischarge)

Causes of Eustachian Tube

Obstruction

Upper Respiratory

Tract Infection

Allergy

Sinusitis

Nasal Polyps

Deviated Nasal

Septum

Hypertrophic

Adenoids

Nasopharyngeal

tumour/mass

Cleft palate

Submucous Cleft

Palate

Down Syndrome

Functional

Adenoids and Cleft Palate

Mechanical

obstruction of the

tubal opening

Acting as reservoir

for pathogenic

organisms

Allergy – mast

cells of adenoid

tissue release

inflammatory

Abnormalities of

torus tubarius – high

elastin density

Tensor veli palatini

muscle does not

insert into torus

tubarius

Adenoids Cleft Palate

Down Syndrome

Poor tone of tensor veli palatini

muscle

Abnormal shape of nasopharynx

Children – more prone to otitis media/

otitis media with effusion

Barotrauma

Non-suppurative condition

Failure of eustachian tube to maintain

middle ear pressure at ambient

atmospheric pressure

Rapid descent during flightUnderwater diving Compression in pressure chamber

Causes

Clinical Features

Severe earache

Hearing loss – conductive type

Tinnitus

Tympanic membrane – retracted &

congested

Middle ear – air bubbles or

haemorrhagic effusion

Treatment

Aim: To restore middle ear aeration

Mild cases

Decongestants & Antihistaminics

Presence of fluids

Myringotomy

Prevention

Avoid travel with URTI

Swallow repeatedly during descent

Avoid sleep during descent

Autoinflation of tube by Valsalva during

descent

Medication

Vasoconstrictor nasal spray

Systemic decongestant

Recurrent barotrauma

Nasal polyps

Septal deviation

Nasal allergy

Chronic sinus infection

Patulous Eustachian Tube

Tube abnormally patent

Causes

Idiopathic

Rapid weight loss

Pregnancy – 3rd trimester

Multiple sclerosis

Signs and Symptoms

Autophony

Movements of tympanic membrane with

inspiration and expiration

Further exaggerated if patient breathes

after closing opposite nostril

Retraction Pockets

Obstruction of eustachian tube

Total atelectasis of tympanic membrane

Obstruction in middle ear Retraction pocket in posterior part of middle ear

Anterior pocket ventilated.

Obstruction of isthmiAttic retraction pocket

Obstruction at aditus

Cholesterol granuloma

Collection of mucoid discharge in

mastoid air cells

Middle ear normal

Attic normal

Examination of Eustachian

Tube

Pharyngeal EndPosterior rhinoscopy

Rigid nasal endoscope

Flexible nasopharyngoscope

Tympanic EndMicroscope

Endoscope

Otoscope

Eustachian Tube Function

Tests

Valsalva test

Politzer test

Catheterisation

Toynbee’s Test

Tympanometry

Radiological test

Saccharine or

Methylene Blue

test

Sonotubometry

Valsalva test

Politzer Test

Catheterisation

Tympanometry

Radiological Test

Instill radio-opaque dye

in middle ear

Take X-ray

Observe eustachian

tube

Check for obstruction

Saccharine or Methylene Blue

TestPlace saccharine solution in middle

ear

Reaches pharynx

Imparts sweet taste

Measure time taken

Place methylene blue in middle ear

Stains pharyngeal secretions

Measure time taken

THANK YOU