The Eustachian tube connects the middle ear cavity to the nasopharynx. It has three parts - a bony portion, a junctional portion, and a cartilaginous portion. The cartilaginous portion is normally closed but opens during swallowing due to the action of the tensor veli palatini and levator veli palatini muscles. The Eustachian tube functions to ventilate and drain the middle ear and protect it from pressure changes and pathogens from the nasopharynx. Dysfunction can lead to conditions like otitis media and patulous Eustachian tube. Evaluation methods include otoscopy, endoscopy, Valsalva maneuver, and ty
Eustachian tube is commonly overlooked even by many physicians as effect of chronic otitis media rather than a cause. this is a humble attempt to explain the role eustachian tube dysfunction and interventions to reduce the same
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Eustachian tube dysfunction diagnosis and treatmentShruti Baruah
Anatomy of Eustachian tube
Physiology of Eustachian tube function
ET function under special circumstances
ET Dysfunction- pathophysiology, assessment, treatment.
Eustachian tube is commonly overlooked even by many physicians as effect of chronic otitis media rather than a cause. this is a humble attempt to explain the role eustachian tube dysfunction and interventions to reduce the same
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Eustachian tube dysfunction diagnosis and treatmentShruti Baruah
Anatomy of Eustachian tube
Physiology of Eustachian tube function
ET function under special circumstances
ET Dysfunction- pathophysiology, assessment, treatment.
CONGENITAL MALFORATION OF EAR AND ITS MANAGEMENTabhijeet89singh
CONGENITAL MALFORMATION OF MIDDLE AND EXTERNAL EAR AND SURGICAL MANAGEMENT OF MICROTIA AND CONGENITAL AURAL ATRESIA PRESENTED AS A SEMINAR IN DEPARTMENT OF ENT PGIMER CHANDIGARH
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
the ppt includes the anatomy of larynx, the physiology of sound production and pathology of vocal cords explaining the myoelastic aerodynamic theory and bernoulli effect in phonation
Skull base osteomyelitis is a rare complication of otitis externa in which soft tissue pathogens have spread to the periosteum and temporal bone of the skull causing necrosis.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Links the pharynx to the middle ear
Eustachius (1562) termed it as Pharyngotympanic tube and Antonio Valsalva as the Eustachian tube. It
Develops from tubotympanic recess which is derived from endoderm of 1st pharyngeal pouch It is
36 mm long in adults .It is
Directed anteriorly, inferiorly and medially from anterior wall of middle ear forming an angle of 45degrees with horizontal and sagittal planes
It enters the lateral wall of nasopharynx 1.25 cm behind posterior end of inferior turbinate.
Lateral 1/3 - bony
Medial 2/3 - fibro-cartilaginous
Junction between 2 parts -- isthmus, narrowest part of Eustachian tube
CONGENITAL MALFORATION OF EAR AND ITS MANAGEMENTabhijeet89singh
CONGENITAL MALFORMATION OF MIDDLE AND EXTERNAL EAR AND SURGICAL MANAGEMENT OF MICROTIA AND CONGENITAL AURAL ATRESIA PRESENTED AS A SEMINAR IN DEPARTMENT OF ENT PGIMER CHANDIGARH
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
the ppt includes the anatomy of larynx, the physiology of sound production and pathology of vocal cords explaining the myoelastic aerodynamic theory and bernoulli effect in phonation
Skull base osteomyelitis is a rare complication of otitis externa in which soft tissue pathogens have spread to the periosteum and temporal bone of the skull causing necrosis.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Links the pharynx to the middle ear
Eustachius (1562) termed it as Pharyngotympanic tube and Antonio Valsalva as the Eustachian tube. It
Develops from tubotympanic recess which is derived from endoderm of 1st pharyngeal pouch It is
36 mm long in adults .It is
Directed anteriorly, inferiorly and medially from anterior wall of middle ear forming an angle of 45degrees with horizontal and sagittal planes
It enters the lateral wall of nasopharynx 1.25 cm behind posterior end of inferior turbinate.
Lateral 1/3 - bony
Medial 2/3 - fibro-cartilaginous
Junction between 2 parts -- isthmus, narrowest part of Eustachian tube
Chronic Otitis Media- mucosal/ Tubotympanic / safe type.
Definition of COM/CSOM
Etiology & Risk factors of COM
Etiopathogenesis
bacteriology
chain of events
Types of COM/CSOM
Classification of COM/CSOM
middle ear dysventilation
perforations of tympanic membrane
clinical features of COM mucosal type
treatment
tympanoplasty
ossiculoplasty
techniques of myringoplasty
steps of tympanoplasty
temporalis fascia graft
Chronic Otitis Media - Squamosal type ( UG)AlkaKapil
Chronic Otitis Media - Squamosal / atticoantral/ unsafe Type
Theories of cholesteatoma
cholesteatoma
levenson's criteria
congenital cholesteatoma
classification of cholesteatoma
sade's classification of retraction of pars tensa
Toss classification of pars flaccida retraction
cholesterol granuloma
clinical features of Squamosal CSOM
Complications of COM/CSOM
Investigations - HRCT Temporal bone
Mastoid exploration
cortical mastoidectomy
modified radical mastoidectomy
Radical mastoidectomy
Physiology of ear.
Basic definition related to sound -hearing,sound,sound wave.
mechanism of hearing
mechanical conduction of sound
transfer action of middle ear
impedence
areal ratio/ hydraulic lever
lever ratio of ossicles
catenary lever
transduction of mechanical energy
travelling wave theory of Bekesy
sound propagation in cochlea
electrical conduction of sound
central auditory pathway
acoustic reflex
Anatomy of ear for undergraduate students ( MBBS ) .
Basic anatomy of ear with its clinical importance
nerve supply of ear
blood supply of ear
middle ear ossicles
malleus incus stapes
muscles of middle ear
mastoid air cells
pinna tympanic membrane
lymphatics of ear
walls of middle ear
organ of corti
middle ear cleft
facial recess
sinus tympani
chorda tympani
embryology of ear
Clinical evaluation of Laryngopharyngeal reflux and its response to Proton P...AlkaKapil
Clinical evaluation of Laryngopharyngeal reflux and its response to Proton Pump inhibitors research paper : introduction and history , review of literature, clinical symptoms & findings, and management protocol. Laryngoscopic findings, methodology for study along with aims and objectives, observations made in the study and interpretation of results in graphical manner
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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6. Eustachian tube anatomy
• Narrow osteocartilaginous channel connecting the
tympanic cavity to the nasopharynx
• Allows passage of : air and fluid
• Begins at tymapnic orifice at protympanum & ends
at pharyngeal orifice on the lateral wall of
nasopharynx
• Hourglass shaped of two
unequal cones
7. • Total length of ET is 33 mm :
-bony part 6.5mm
-junctional part 3mm
-cartilagionus part 23.5mm
• Bony portion patent all times
• Fibrocartilaginous portion that is
- closed at rest
- opens during swallowing or when forced to open, such
as during the Valsalva maneuve
• Lining epithelium: pseudo stratified ciliated columner
8. Mid cartilaginous portion of the Eustachian tube
The cross-sectional view through the
lumen shows two different
compartments:
1. Rüdinger’s safety canal – filled with
air or with mucus; likely always open
2. Auxiliary gap – has longitudinal
mucosal folds.
contributes to the clearance and
protection function
9.
10. Saggital cadeveric cut through left Middle ear
bony Eustachian tube
(Pr) and the canal of tensor tympani muscle (asterisk), the
isthmus (I), the cartilaginous Eustachian tube (ET), and its
inferiorly related levator veli palatini muscle (LVP). The
superior wall of the bony Eustachian tube is formed by the
tegmen tubari
11. Tensor veli palatini :
bony wall of the scaphoid fossa and from the
entire length of the short lateral lamina of the
cartilage tube
around the pterygoid hamulus
then fans out within the soft
palate and mingles with the fibers from the
opposite side in the midline raphe
V3
13. Levator Veli Palatini
inferior aspect of the petrous apex of the
temporal bone
Fanning out and blending with
dorsal surface of the soft
Palate
related to the pumping clearance
(drainage)
function of the tube &
Competence of the soft palate
14. Salphingopharyngeus muscle
medial and inferior borders of the tubal cartilage via slips of
muscular and tendinous fibers
keep in position the pharyngeal orifice of the
ET
15. The Eustachian tube (ET) is closed at rest.
The opening of the ET is limited to Rüdinger’s safety canal.
The lateral Ostmann’s fat pad transfers the pressure of the tensor
veli palatini muscle to the ET.
The function of the levator veli palatini muscle is restricted to the
soft palate.
The tensor veli palatini muscle has a dual function: opening the
cranial portion and compression of the lower portion of the ET.
The salpingopharyngeal muscle is an anchor chain of the
cartilaginous part of the ET.
16. Endoscopic Anatomy
• Medial end forms tubal elevation / torus tubarius
• Lymphoid collection over torus is called Gerlach’s tonsil
• Postero-superior to torus is fossa of Rosenmüller
16
23. Physiology of ET
• 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
25. 25
Functions of ET
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.
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
26. Sequence of events during ET dilation
A - ET at rest is closed.
B - Proximal end of the cartilaginous lumen dilates first and is then followed by (C).
C - dilation of the distal end and is open to the middle ear (ME).
D - ET passively closes from the distal end to the proximal end to its resting, closed position
27. ET is short and floppy in the infant
crying insufflates nasopharyngeal gas into the
middle ear
compensate for their inefficient tubal opening
mechanism
But during periods of upper respiratory tract infection, nasopharyngeal
secretions
and viruses and bacteria—may also be insufflated into the middle ear
28. 28
Evaluation of eustachian tube function
Aural fullness
Pain and discomfort
Hearing loss
Tinnitus
Dizziness
29. Pneumatic otoscopic examination
• Positive pressure to the eardrum :
TM move slightly inward
(medially);
• on releasing pressure on the
pneumatic bulb TM will return to
its original position
30. Endoscopic examination
flexible fiberoptic nasopharyngoscope inserted intranasally to examine the nasal
cavities, nasopharynx, fossae of Rosenmüller, and pharyngeal orifices of the tubes.
31. • VALSALVATEST
Principle : to build positive pressure in the nasopharynx so
that air enter the Eustachian tube
31
32. Procedure of Valsalva :
Patient pinches his nose with thumb and index finger
Takes deep breath
Closes his mouth
Tries to blow air into the ears
If air enters the middle ear the tympanic membrane will
move outwards that can be visualized by otoscope
33. 33
• Inference :
- 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
34. 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” 34
35. • 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.
35
36. 36
Toynbee’s test
• Uses negative pressure
• Ask the patient to swallow while
nose is pinched
• Draws air from middle ear to nasopharynx – inward
movement of tympanic membrane visible otoscopically.
37. Negative middle-ear pressure after the Toynbee test or only momentary negative middle-ear pressure
followed by normal middle-ear gas pressure usually indicates good tubal function because it shows that
the tube can open actively (the tensor veli palatini muscle contracts) and that the tubal structure is
sufficiently stiff to withstand nasopharyngeal negative pressure.
38. Eustachian tube Catheterisation
38
Procedure
Nose is anaesthetised
ET catheter passed along the floor of nose till it reaches
naso pharynx
Rotated 90deg medially
Pulled back till posterior border of nasal septum
engaged
Rotated 180 deg laterally – tip lies against tubular
opening
Politzer’s bag connected & Air insufflated
Entry of air to middle ear verified (lateral bulging of
t.m)
39. 39
Air pushed into E.T.catheter by squeezing Politzer bag.
Examiner hears by Toynbee auscultation tube put in pt's ear
Inference :-
Blowing sound = normal E.T.patency
Bubbling sound = middle ear fluid
Whistling sound = partial E.T.obstruction
No sound = complete obstruction of E.T.
40. 40
Complications:
• Injury to Eustachian tube opening
• Bleeding from nose
• Transmission of nasal & nasopharyngeal infection into
middle ear
• Rupture of atrophic area of tympanic membrane
41. • 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
41
44. When the nose or nasopharynx is obstructed, unphysiologic pressures
can develop in the nasopharynx and adversely affect the ET and
middle ear, which is termed the Toynbee phenomenon.
45. Epidemiology / Causes of ET Dysfunction
o Infants – short ET; immature immunity
o Genetic & ethnicity
o Craniofacial abnormalities – Downs; Cleft palate
o Risk factors for inflammation- Passive smoking; air
pollution; pacifiers; sleeping position; gastroesophageal
reflux; cystic fibrosis; adenoiditis
o Trauma – ET catheterisation; #maxilla
o Neoplasm in nose and nasopharynx
o Palatal paralysis
46.
47. Reflux of nasopharyngeal secretions through the ET into the middle
ear (ME) and draining out into the external auditory canal (EC)
49. 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 49
50. The patulous tube is open even at rest, which allows pressure
regulation of middle-ear pressure, but sound pressures are
transmitted to the middle ear, causing autophony
51. • Management
– Acute cases: Usually self-limiting
– Weight gain & oral administration of KI
– Topical decongestants
– Long standing cases: insertion of grommet; PET
reconstruction ; injection of Vox implants.
51