Eustachian tube

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Eustachian tube

  1. 1. Eustachian Tube :Anatomy & Disorders & Secretory Otitis Media Sreelakshmi M 1
  2. 2. Anatomy 2
  3. 3. 3
  4. 4. Muscles Related to E.T 4
  5. 5. Lining of Eustachian Tube• Pseudostratified ciliated columnar epithelium interspersed with mucous secreting goblet cells• Submucosa of cartilagenous part rich in seromucinous gland• Cilia beat in direction of nasopharynx 5
  6. 6. Nerve Supply• Sensory & parasympathetic : tympanic branch of glossopharyngeal N• Tensor veli palatini: V3• Levator veli palatini pharyngeal plexus• Salpingopharyngeus (cranial part of XI N via vagus) 6
  7. 7. Infant ET v/s Adult ET INFANT ADULTLENGTH 13-18 mm at birth 36 mmDIRECTION More horizontal Forms an angle of 45 with the horizontalANGULATION AT ISTHMUS No angulation Angulation presentBONY VERSUS Bony part> 1/3 of the total Bony part 1/3; cartilaginousCARTILAGINOUS PART length part2/3TUBAL CARTILAGE flaccid Comparatively rigidDENSITY OF ELASTIN AT THE Less dense More denseHINGEOSTMANN’S PAD OF FAT Less in volume Large & helps to keep the tube closed 7
  8. 8. 8
  9. 9. Functions1. Ventilation & regulation of ME pressure2. Protective funtions – Nasopharyngeal sound pressure – Reflux of nasopharyngeal secretions3. Clearance of ME secretions 9
  10. 10. ET Function Tests• VALSALVA TEST – Principle: positive pressure in the nasopharynx causes air to enter the Eustachian tube 10
  11. 11. – Tympanic membrane perforation- a hissing sound– Discharge in the middle ear- cracking sound– Only 65% of persons can do this test.– Contraindications: • Atrophic scar of tympanic membrane which can rupture • Infection of nose & nasopharynx 11
  12. 12. • Politzer test – Done in children who are unable to perform valsalva test. – Olive shaped tip of the politzer’s bag is introduced into the patient’s nostril on the side of which the tubal function is desired to be tested – Other nostril closed & the bag compressed while at the same time the patient swallows or says “ik,ik,ik” 12
  13. 13. – By means of an auscultation tube a hissing sound is heard.– Compressed air can also be used instead of politzer’s bag– Test is also therapeutically used to ventilate the middle ear. 13
  14. 14. • Catheterisation 14
  15. 15. – Complications: • Injury to Eustachian tube opening • Bleeding from nose • Transmission of nasal & nasopharyngeal infection into middle ear • Rupture of atrophic area of tympanic membrane 15
  16. 16. • Toynbee’s test – Uses negative pressure• Tympanometry (inflation-deflation test) – +Ve & -ve pressures are created in the external ear and the patient swallows repeatedly – in patients with perforated or intact tympanic membrane• Radiological Test• Saccharine/ Methylene blue Test – Saccharine solution – Methylene blue dye – Ear drops into ear with TM perforation• Sonotubometry 16
  17. 17. Disorders of ET 17
  18. 18. Tubal Blockage ACUTE TUBAL BLOCKAGE ABSORPTION OF ME GASES -VE PRESSURE IN ME RETRACTION OF TMTRANSUDATE IN ME/HAEMORRHAGE PROLONGED TUBAL BLOCKAGE/DYSFUNCTION OME(THIN WATERY OR MUCOID DISCHARGE) ATELECTATIC EAR/PERFORATION RETRACTION POCKET/CHOLESTEATOMA EROSION OF INCUDOSTAPEDIAL JOINT 18
  19. 19. mechani • intrinsic cal • ExtrinsicBlock functional •Collapse both 19
  20. 20. • Symptoms of tubal occlusion – Otalgia – Hearing loss – Popping sensation – Tinnitus – Disturbances of equilibrium• Signs of tubal occlusion – Retracted TM – Congestion along the handle of malleus and pars tensa – Transudate behind TM 20
  21. 21. • Clinical causes of ET obstruction – Upper respiratory tract infection – Allergy – Sinusitis – Nasal polypi – DNS – Hypertrophic adenoids – Nasopharyngeal tumour/ mass – Cleft palate – Submucous cleft palate – Down’s syndrome 21
  22. 22. Adenoids• Adenoids cause tubal dysfunction by: – Mechanical obstruction of the tubal opening – Acting as reservoir for pathogenic organisms – Inflammatory mediators in allergy cause tubal blockage• Adenoids can cause otitis media with effusion or recurrent acute otitis media• Adenoidectomy 22
  23. 23. 23
  24. 24. large adenoid blocking left et 24
  25. 25. Cleft palate• Tubal dysfunction due to: – Abnormalities of torus tubaris – Tensor veli palatini doe not insert into the torus tubaris• Otitis media with effusion is common in these patients 25
  26. 26. Down’s syndrome• Dysfunction due to: – Poor tone of tensor veli palatini – Abnormal shape of nasopharynx 26
  27. 27. Retraction Pockets & ET 27
  28. 28. • Any obstruction in the ventilation pathway retraction pockets or atelectasis of tympanic membrane – Obstruction of Eustachian tube  total atelectasis of tm – Obstruction at additus  cholesterol granuloma & collection of mucoid discharge in mastoid air cells 28
  29. 29. 29
  30. 30. • Other changes – Thin atrophic TM – Cholesteatoma – Ossicular necrosis – Tympanosclerotic changes• Management – Repair of irreversible pathologic processes – Establishment of ventilation 30
  31. 31. 31
  32. 32. Patulous Eustachian Tube• ET is abnormally patent• Causes: – Idiopathic, rapid weight loss, pregnancy (esp 3rd trim) & multiple sclerosis• Chief complaints – Autophony, hearing his own breath sounds• Pressure changes in the nasopharynx are easily transmitted to the ME• Movements of the TM can be seen with inspiration & expiration 32
  33. 33. • Management – Acute cases Usually self-limiting – Weight gain & oral administration of KI – Long standing cases = cauterisation/ insertion of grommet 33
  34. 34. EXAMINATION OF EUSTACHIAN TUBEPharyngeal end of eustachian tube :posterior rhinoscopy, rigid nasal endoscope or flexible nasopharyngoscopeTympanic end :microscope or endoscopeSimple examination of TM may reveal retraction pockets or fluid in the meMovements of TM with respiration point to patulous eustachian tube 34
  35. 35. • Aetiologic causes of eustachian tube dysfunction assessed through: – Nasal examination – Endoscopy – Tests of allergy – CT scan of temporal bones – MRI to exclude multiple sclerosis 35
  36. 36. Otitis Media with Effusion 36
  37. 37. Serous otitis mediaSecretory otitis mediaMucoid otitis media“Glue Ear” 37
  38. 38. • Insidious condition characterized by accumulation of non purulent effusion in ME cleft• Effusion is thick & viscid.• Fluid is sterile 38
  39. 39. Pathogenesis• Malfunctioning of Eustachian tube• Increased secretory activity of ME mucosa 39
  40. 40. Aetiology1. Malfunctioning of Eustachian tube – Adenoid hyperplasia – Chronic rhinosinusitis – Chronic tonsillitis – Tumors ( to be excluded in unilateral ser. OM in adults)2. Allergy3. Unresolved otitis media4. Viral infections 40
  41. 41. Clinical FeaturesSymptoms : affects 5-8 yrs age gp Hearing loss Delayed & defective speech Mild earaches 41
  42. 42. Otoscopic Findings – Dull & opaque TM – Loss of light reflex – TM: yellow grey or bluish – Fluid level & air bubbles may be seen – Restricted mobility of tm – Thin leash of vessels along malleus handle/ periphery of TM == differentiate from acute supp. Otitis media – TM: varying degree of retraction 42
  43. 43. 43
  44. 44. 44
  45. 45. Hearing Tests• Tuning fork test-conductive hearing loss• Audiometry-conductive hearing loss of 20-40db• Impedance Audiometry-reduced compliance indicates presence of fluid• X-ray mastoid-clouding of air cells due to fluid. 45
  46. 46. TreatmentMedical Surgical Decongestants  Myringotomy & Aspiration  Grommet Insertion Antihistaminics  Tympanotomy/ cortical Steroids mastoidectomy( loculated thick fluid/ chol. granuloma) Antibiotics  Surgical treatment of causative factor 46
  47. 47. 47
  48. 48. 48
  49. 49. Sequelae of Chronic Secretory Otitis Media• Atrophic TM & atelectasis of ME• Ossicular necrosis• Tympanosclerosis• Retraction pockets & cholesteatoma• Cholesterol granuloma 49
  50. 50. The above picture shows a very thin or atelectatic eardrum (tympanic membrane) 50which is draped over the promontory and round window nitch.
  51. 51. Cholesterol granuloma 51
  52. 52. ThankYou 52

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