1. Eustachian Tube :
Anatomy & Disorders
&
Secretory Otitis
Media
Sreelakshmi M
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2. Anatomy
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3. 3

4. Muscles Related to E.T
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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
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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)
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7. Infant ET v/s Adult ET
INFANT ADULT
LENGTH 13-18 mm at birth 36 mm
DIRECTION More horizontal Forms an angle of 45 with
the horizontal
ANGULATION AT ISTHMUS No angulation Angulation present
BONY VERSUS Bony part> 1/3 of the total Bony part 1/3; cartilaginous
CARTILAGINOUS PART length part2/3
TUBAL CARTILAGE flaccid Comparatively rigid
DENSITY OF ELASTIN AT THE Less dense More dense
HINGE
OSTMANN’S PAD OF FAT Less in volume Large & helps to keep the
tube closed
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9. Functions
1. Ventilation & regulation of ME pressure
2. Protective funtions
– Nasopharyngeal sound pressure
– Reflux of nasopharyngeal secretions
3. Clearance of ME secretions
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10. ET Function Tests
• VALSALVA TEST
– Principle: positive pressure in the nasopharynx causes air
to enter the Eustachian tube
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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
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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”
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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.
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14. • Catheterisation
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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
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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
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17. Disorders of ET
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18. Tubal Blockage
ACUTE TUBAL BLOCKAGE
ABSORPTION OF ME GASES
-VE PRESSURE IN ME
RETRACTION OF TM
TRANSUDATE 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. mechani • intrinsic
cal • Extrinsic
Block functional •Collapse
both
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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
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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
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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
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24. large adenoid blocking left et
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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
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26. Down’s syndrome
• Dysfunction due to:
– Poor tone of tensor veli palatini
– Abnormal shape of nasopharynx
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27. Retraction Pockets & ET
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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
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30. • Other changes
– Thin atrophic TM
– Cholesteatoma
– Ossicular necrosis
– Tympanosclerotic changes
• Management
– Repair of irreversible pathologic processes
– Establishment of ventilation
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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
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33. • Management
– Acute cases Usually self-limiting
– Weight gain & oral administration of KI
– Long standing cases = cauterisation/ insertion of grommet
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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. • Aetiologic causes of eustachian tube
dysfunction assessed through:
– Nasal examination
– Endoscopy
– Tests of allergy
– CT scan of temporal bones
– MRI to exclude multiple sclerosis
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36. Otitis Media with Effusion
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37. Serous otitis media
Secretory otitis media
Mucoid otitis media
“Glue Ear”
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38. • Insidious condition characterized by
accumulation of non purulent effusion in ME
cleft
• Effusion is thick & viscid.
• Fluid is sterile
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39. Pathogenesis
• Malfunctioning of Eustachian tube
• Increased secretory activity of ME mucosa
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40. Aetiology
1. Malfunctioning of Eustachian tube
– Adenoid hyperplasia
– Chronic rhinosinusitis
– Chronic tonsillitis
– Tumors ( to be excluded in unilateral ser. OM in
adults)
2. Allergy
3. Unresolved otitis media
4. Viral infections
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41. Clinical Features
Symptoms : affects 5-8 yrs age gp
Hearing loss
Delayed & defective speech
Mild earaches
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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
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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.
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46. Treatment
Medical Surgical
Decongestants  Myringotomy & Aspiration
 Grommet Insertion
Antihistaminics
 Tympanotomy/ cortical
Steroids mastoidectomy( loculated thick
fluid/ chol. granuloma)
Antibiotics
 Surgical treatment of
causative factor
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49. Sequelae of Chronic Secretory Otitis Media
• Atrophic TM & atelectasis of ME
• Ossicular necrosis
• Tympanosclerosis
• Retraction pockets & cholesteatoma
• Cholesterol granuloma
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50. The above picture shows a very thin or atelectatic eardrum (tympanic membrane)
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which is draped over the promontory and round window nitch.

51. Cholesterol granuloma 51

52. Thank
You
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