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Anatomy & Physiology of Eustachian Tube

Anatomy & Physiology of Eustachian Tube. Dr. Vishal Sharma. History & Embryology. Bartolomeus Eustachius first described it as pharyngo-tympanic tube in 1562. Antonio Valsalva named it Eustachian tube. Develops from tubo-tympanic recess , derived from endoderm of 1st pharyngeal pouch. .

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Anatomy & Physiology of Eustachian Tube

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  1. Anatomy & Physiology of Eustachian Tube Dr. Vishal Sharma

  2. History & Embryology • Bartolomeus Eustachius first described it as pharyngo-tympanic tube in 1562. • Antonio Valsalva named it Eustachian tube. • Develops from tubo-tympanic recess, derived from endoderm of 1st pharyngeal pouch.

  3. Bartolomeus Eustachius

  4. Antonio Maria Valsalva

  5. Embryology

  6. Anatomy

  7. Anatomy • 36 mm long in adults. • Directed anteriorly, inferiorly & medially from anterior wall of M.E., forming angle of 450 with horizontal & sagittal planes. • Enters naso-pharynx 1.25 cm behind posterior end of inferior turbinate.

  8. Angulation

  9. Pharyngeal opening

  10. Parts • Lateral 1/3 is bony • Medial 2/3 is fibro-cartilaginous. • Junction b/w 2 parts is isthmus, narrowest part of Eustachian Tube.

  11. Anatomy of medial 2/3rd Cartilage plate lies postero-medially & consists of medial + lateral laminae separated by elastin hinge. Fibrous tissue + Ostmann’s fat pad lie antero-laterally.

  12. Anatomy Muscle attachments: 1. tensor veli palatini or dilator tubae 2. levator veli palatini 3. salpingopharyngeus 4. tensor tympani Nerve supply: 1. Sphenopalatine ganglion 2. Mandibular nv 3. Tympanic plexus

  13. Anatomy • Lining epithelium:respiratory epithelium • Arterial supply: ascending pharyngeal & middle meningeal arteries • Venous drainage:pharyngeal & pterygoid venous plexus • Lymphatic drainage: retropharyngeal node

  14. Endoscopic Anatomy • Medial end forms tubal elevation / torus tubarius • Lymphoid collection over torus is called Gerlach’s tubal tonsil. • Postero-superior to torus is fossa of Rosenmüller.

  15. Adult vs. Child (< 7 yr)

  16. Adult vs. Child (< 7 yr)

  17. Physiology • Bony part is always open. • Fibro-cartilaginous part is closed at rest. • Opens on: 1. swallowing 2. yawning 3. sneezing 4. forceful inflation

  18. Physiology • 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.

  19. E.T. opening

  20. Functions 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

  21. Functions 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

  22. Functions

  23. Conditions of Dysfunction

  24. Bluestone’s Flask Model

  25. Adult vs. Pediatric

  26. TM perforation & nose blowing

  27. O.M.E. & Barotrauma

  28. Grommet insertion in O.M.E.

  29. Tests for E.T. function

  30. 1. Valsalva Maneuver Forced expiration with mouth & nose closed. Otoscopy shows lateral bulging of Tympanic membrane

  31. 2. Frenzel Maneuver • Hands free Valsalva for pilots • Compression of nasopharyngeal air by muscles of tongue • Otoscopy shows lateral bulging of tympanic membrane

  32. 2. Frenzel Maneuver

  33. 3. Toynbee Maneuver • More physiological • Swallowing with mouth & nose closed • Otoscopy shows retraction of tympanic membrane

  34. 4. Pneumatic otoscopy & Siegelization • Air pressure is alternately increased & decreased within external auditory canal • Mobility of tympanic membrane is observed • Normal mobility indicates good patency of Eustachian tube

  35. Siegelization

  36. Pneumatic Otoscope

  37. Normal Tympanic Membrane

  38. Eustachian Tube dysfunction

  39. Early otitis media with effusion

  40. Late otitis media with effusion

  41. Acute suppurative otitis media

  42. Ear drum perforation

  43. 5. Politzerization

  44. Politzer Bag

  45. 5. Politzerization • Rubber tube attached to a Politzer bag put into one nostril & both nostrils pinched • Patient asked to swallow or repeat “k” • Politzer bag is squeezed simultaneously • Otoscopy shows lateral bulging of ear drum in patent Eustachian tube

  46. 6. E.T. catheterization

  47. Eustachian tube catheter

  48. 6. E.T. catheterization • E.T. catheter passed along nasal floor till it touches posterior wall of naso-pharynx. • Catheter rotated 90° medially & pulled forward till it impinges on posterior nasal septum. • Catheter rotated 180° laterally, & its tip inserted into opening of E.T. • Politzer bag attached to outer end of catheter

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