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Eustachian Tube
Functions 
Ventilation and thus regulation of 
middle ear pressure. 
 Protection against 
Nasopharyngeal sound pressure ...
Disorders of Eustachian 
Tube
Tubal Blockage 
 Mechanical 
Intrinsic 
 Inflammation 
 Allergy 
Extrinsic 
 Tumour in nasopharynx 
 Adenoids 
 Func...
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 
...
 Severe cases 
Tympanic membrane markedly retracted 
Haemorrhage in subepithelial layer 
Haemotympanum 
Perforation
Effects of Tubal Blockage 
Acute tubal blockage 
Absorption of middle ear gases 
Negative pressure in middle ear 
Retracti...
Acute Otitis Media (Thin Watery or Mucoid 
Discharge) 
Atelectatic Ear/Perforation 
Retraction pocket/Cholesteatoma 
Erosi...
Causes of Eustachian Tube 
Obstruction 
 Upper Respiratory 
Tract Infection 
 Allergy 
 Sinusitis 
 Nasal Polyps 
 De...
Adenoids and Cleft Palate 
Adenoids Cleft Palate 
 Mechanical 
obstruction of the 
tubal opening 
 Acting as reservoir 
...
Down Syndrome 
 Poor tone of tensor veli palatini 
muscle 
 Abnormal shape of nasopharynx 
 Children – more prone to ot...
Barotrauma 
 Non-suppurative condition 
 Failure of eustachian tube to maintain 
middle ear pressure at ambient 
atmosph...
Causes 
Rapid descent during flight 
Underwater diving 
Compression in pressure chamber
 Clinical Features 
Severe earache 
Hearing loss – conductive type 
Tinnitus 
Tympanic membrane – retracted & 
congested ...
 Treatment 
Aim: To restore middle ear aeration 
Mild cases 
Decongestants & Antihistaminics 
Presence of fluids 
Myrin...
 Prevention 
Avoid travel with URTI 
Swallow repeatedly during descent 
Avoid sleep during descent 
Autoinflation of tube...
 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 
Mu...
 Signs and Symptoms 
Autophony 
Movements of tympanic membrane with 
inspiration and expiration 
Further exaggerated if p...
Retraction Pockets 
 Obstruction of eustachian tube 
Total atelectasis of tympanic membrane 
 Obstruction in middle ear ...
 Obstruction at aditus 
Cholesterol granuloma 
Collection of mucoid discharge in 
mastoid air cells 
Middle ear normal 
A...
Examination of Eustachian 
Tube 
 Pharyngeal End 
Posterior rhinoscopy 
Rigid nasal endoscope 
Flexible nasopharyngoscope...
Eustachian Tube Function 
Tests 
Valsalva test 
 Politzer test 
 Catheterisation 
 Toynbee’s Test 
 Tympanometry 
 R...
Valsalva test
Politzer Test
Catheterisation
Tympanometry
Radiological Test 
Instill radio-opaque 
dye 
in middle 
ear 
Take X-ray 
Observe 
eustachian 
tube 
Check for 
obstructio...
Saccharine or Methylene Blue 
Test 
Place saccharine 
solution in middle 
ear 
Reaches pharynx 
Imparts sweet taste 
Measu...
THANK YOU
Eustachian Tube
Eustachian Tube
Eustachian Tube
Eustachian Tube
Eustachian Tube
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Eustachian Tube

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Eustachian Tube

  1. 1. Eustachian Tube
  2. 2. Functions Ventilation and thus regulation of middle ear pressure.  Protection against Nasopharyngeal sound pressure Reflux of nasopharyngeal secretions  Clearance of middle ear secretions
  3. 3. Disorders of Eustachian Tube
  4. 4. Tubal Blockage  Mechanical Intrinsic  Inflammation  Allergy Extrinsic  Tumour in nasopharynx  Adenoids  Functional Collapse of tube  Both
  5. 5. Symptoms  Otalgia  Hearing loss  Popping sensation  Tinnitus  Disturbances of equilibrium Vertigo
  6. 6. Signs  Retracted tympanic membrane  Congestion along handle of malleus and pars tensa  Transudate behind tympanic membrane - amber colour  Fluid level with conductive hearing loss
  7. 7.  Severe cases Tympanic membrane markedly retracted Haemorrhage in subepithelial layer Haemotympanum Perforation
  8. 8. Effects of Tubal Blockage Acute tubal blockage Absorption of middle ear gases Negative pressure in middle ear Retraction of tympanic membrane Transudate in middle ear/haemorrhage (Acute Otitis Media)
  9. 9. Acute Otitis Media (Thin Watery or Mucoid Discharge) Atelectatic Ear/Perforation Retraction pocket/Cholesteatoma Erosion of Incudostapedial Joint
  10. 10. 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
  11. 11. Adenoids and Cleft Palate Adenoids Cleft Palate  Mechanical obstruction of the tubal opening  Acting as reservoir for pathogenic organisms  Allergy – mast cells of adenoid tissue release  Abnormalities of torus tubarius – high elastin density  Tensor veli palatini muscle does not insert into torus tubarius
  12. 12. Down Syndrome  Poor tone of tensor veli palatini muscle  Abnormal shape of nasopharynx  Children – more prone to otitis media/ otitis media with effusion
  13. 13. Barotrauma  Non-suppurative condition  Failure of eustachian tube to maintain middle ear pressure at ambient atmospheric pressure
  14. 14. Causes Rapid descent during flight Underwater diving Compression in pressure chamber
  15. 15.  Clinical Features Severe earache Hearing loss – conductive type Tinnitus Tympanic membrane – retracted & congested Middle ear – air bubbles or haemorrhagic effusion
  16. 16.  Treatment Aim: To restore middle ear aeration Mild cases Decongestants & Antihistaminics Presence of fluids Myringotomy
  17. 17.  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
  18. 18.  Recurrent barotrauma Nasal polyps Septal deviation Nasal allergy Chronic sinus infection
  19. 19. Patulous Eustachian Tube  Tube abnormally patent  Causes Idiopathic Rapid weight loss Pregnancy – 3rd trimester Multiple sclerosis
  20. 20.  Signs and Symptoms Autophony Movements of tympanic membrane with inspiration and expiration Further exaggerated if patient breathes after closing opposite nostril
  21. 21. 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 isthmi Attic retraction pocket
  22. 22.  Obstruction at aditus Cholesterol granuloma Collection of mucoid discharge in mastoid air cells Middle ear normal Attic normal
  23. 23. Examination of Eustachian Tube  Pharyngeal End Posterior rhinoscopy Rigid nasal endoscope Flexible nasopharyngoscope  Tympanic End Microscope Endoscope Otoscope
  24. 24. Eustachian Tube Function Tests Valsalva test  Politzer test  Catheterisation  Toynbee’s Test  Tympanometry  Radiological test  Saccharine or Methylene Blue test  Sonotubometry
  25. 25. Valsalva test
  26. 26. Politzer Test
  27. 27. Catheterisation
  28. 28. Tympanometry
  29. 29. Radiological Test Instill radio-opaque dye in middle ear Take X-ray Observe eustachian tube Check for obstruction
  30. 30. Saccharine or Methylene Blue Test Place 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
  31. 31. THANK YOU

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