This slide gives an overview of the anatomy, physiology, basic function tests and disorders of the eustachian tube.

1. Eustachian Tube
Dysfunction
Group A

2. 3
Eustachian
Tube Anatomy
• Two parts
• 36mm long
• Runs downward, forward and
medially
• Infants vs Adults?

3. Histology
• Mucosa: pseudostratified ciliated
columnar epithelium with goblet cells
• Submucosa: rich in seromucinous glands
particularly in cartilaginous part.

4. Eustachian Tube Functions
Ventilation and
regulation of
middle ear
pressure.
Protective
functions.
Clearance of
middle ear
secretions.

5. Eustachian
Tube
Function Test
• VALSALVA TEST:
• Principle- building of positive pressure in the nasopharynx so
that air enters the eustachian tube.
• Procedure-
• Inference- tympanic membrane move outward: patent
eustachian tube, hissing and crackling sound: presence of
perforation and discharge.
• To be avoided when there is atrophic scar of tympanic
membrane or infection of nose or nasopharynx
• POLITZER TEST: Used in children, procedure? , inference, can
also be used therapeutically to ventilate the middle ear.

6. • TOYNBEE`S TEST: patient is asked to pinch his nose and then swallow
leading to movement of air from middle ear to nasopharynx resulting in
negative pressure in the middle ear which cause inward movement of
the tympanic membrane that can be verified by otoscope.
• CATHETERIZATION

7. • TYMPANOMETRY: The ability of the eustachian to equilibrate positive and negative
pressures to the ambient pressure indicates normal tubal function. Can be done in both
perforated and intact tympanic membranes.
• RADIOLOGICAL TESTS: radio-opaque dye is instilled in the middle ear through a
perforation and x-rays are taken should delineate the tube and any obstruction. The time
taken by dye to reach the nasopharynx also indicates its clearance function.

8. • SACCHARINE or METHYLENE BLUE TEST:
• SONOTUBOMETRY: A tone is presented to the nose and its recording taken from the
external canal. The tone is heard louder when the tube is patent. It also tells the
duration for which the tube remains open. This test is under development.

9. Disorders Of
Eustachian Tube
Tubal Blockage: middle ear and mastoid is
normally filled with air but when tube is blocked all
the gases are absorbed in the blood resulting in
negative pressure in the middle ear.

11. Symptoms and
Signs of Tubal
Occlusion
Otalgia
Hearing loss
Popping sensation
Tinnitus
Equilibrium disturbances/ Vertigo
Retracted tympanic membrane
Congestion along the handle of malleus and pars tensa
Transudate behind the tympanic membrane imparting amber color

12. Adenoids
Adenoids cause tubal dysfunction by:
• Mechanical obstruction
• Reservoir for pathogenic organisms
• Release of inflammatory mediators in case of allergy leading to tubal
blockage
Cleft Palate: causes tubal dysfunction due to
• Abnormalities of torus tubarius, which shows high elastin density
making tube difficult to open
• Tensor veli palatini does not insert into the torus tubarius in 40% cases
of cleft palate and where does it inert , its function is poor.

13. Retraction pockets and Eustachian tube
Eustachian tube
Mesotympanum
Attic
Aditus
Antrum
Mastoid air cell system
Obstruction of the Eustachian tube can
cause total atelectasis of the tympanic
membrane.

14. Patulous
Eustachian
Tube
• Mostly Idiopathic
• Rapid weight loss
• Pregnancy
• Multiple sclerosis
• C/C: Autophony
• Movements of the tympanic
membrane can be seen with
inspiration and expiration.
• Acute condition - self-limiting
• Weight gain, oral potassium iodide is
helpful but may require cauterization
of the tubes or insertion of grommets

15. Examination Of Eustachian Tube
Pharyngeal end: posterior rhinoscopy, rigid nasal endoscope,
flexible nasopharyngoscope.
Tympanic end: Microscopy or endoscopy