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Endoscopic assessment of eustachean tube function

OtologyIntroduction:

The eustachean tube connects the middle ear cavity with atmospheric air. It thus plays an important role in ventilating the middle

ear cavity, clearing the secretions from the middle ear cavity. It also plays a vital role in protecting the middle ear cavity from

the nasopharyneal secretions. Anatomically the proximal third of the eustachean tube is bony in nature and is lined by a thin

layer of respiratory epithelium. This portion of the tube is fixed in its dimensions and does not vary much.

The lateral 2/3 of this tube is cartilageanous. This portion of the eustachan tube is acted upon by

the peritubal muscles, hence its dimensions are variable.

How secretions are cleared from the middle ear cavity?

Secretions are cleared from the middle ear cavity by the following mechanisms:

By the mucociliary activity

Muscular pumping action that occurs due to tubal closing

The proximal bony portion of the eustachean tube is permanently open

The distal portion of the eustachean tube is closed at rest. It opens with active dilatation of the pharyngeal end of the

eustachean tube due to contraction of the peritubal muscles. This occurs primarily during swalling / yawning.

How is the middle ear protected from the secretions of nasopharynx?

The middle ear is protected from the reflux of secretions from the nasopharynx due to the normal closed position of the

pharyngeal end of the eustachean tube. The entrapped air in the middle ear cavity acts as a gas cushion preventing reflux.

Role of endoscopy in studying the function of eustachean tube:

Small diameter flexible endoscopes have been used to study the eustachean tube function. It should be remembered that the

narrowest portion of the eustachean tube is the isthumus area. The cross section of the isthumus is about 1 – 1.5 mm.

So 1 mm endoscopes are ideal tool for studying the function of ET.

Studies have shown that the act of swallowing produced transient opening of the eustachean tube. Repeated acts of

swallowing causes fatigue of peritubal muscles causing the eustachean tube to open only up to the level

of isthumus failing to open up the valve area. 1 mm flexible endoscopes can be passed through the pharyngeal end of eustachean tube to study its interiors.

These studies reveal the fundamental problems in eustachean tube dysfunctions.

These problems include:

Primay mucosal disease caused by infections, inflammation and allergy

Reflux from the nasopharynx

Muscle dyskinesias

Anatomical obstruction due to congential abnormalities

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