Anomaly of the eustachian tube and its associated structures in patients with multiple congenital malformation: a histopathological and morphometric study

Two temporal bone-eustachian tube (ET) specimens; one from a 1-day-old female newborn with Townes Syndrome (Case 1) and the other from a 15-year-old female with oral-facial-digital syndrome (Case 2) were studied histopathologically and morphometrically. Both specimens had anomalies of the ET and its associated structures as compared with eight age-matched control cases without anomaly (six cases for Case 1 and two cases for Case 2, respectively). Case 1 had a weak attachment of the tensor veli palatini muscle (TVPM) to a poorly developed lateral lamina (LL) of the ET cartilage, a large voluminous medial lamina (ML) of the ET cartilage, a small voluminous ET lumen with a few ridges of mucosal folds, poorly developed ET glands and a poorly developed levator veli palatini muscle (LVPM). Case 2 had a short and longitudinally elongated ET lumen that was insufficiently covered with a poorly developed ML and LL and an aberrant course of the LVPM. Both cases were accompanied by a mild inner ear anomaly (slightly shortened cochlea). We discuss the implications of the observed anomalies with regard to functional and clinical issues. In particular, we speculate that these ET anomalies may closely be related to potential ET dysfunction with high susceptibility to otitis media.     

Histopathological study on temporal bone and eustachian tube in trisomy 22

Two temporal bone-eustachian tube (ET) specimens, one from a 34-gestational week-old male newborn and the other from a 3-month-old female infant, both with trisomy 22, were studied histopathologically. Both cases demonstrated severe inner-ear anomalies including hypoplastic cochlea, atrophy of the saccular macula, and dislocated endolymphatic sac and vestibular aqueduct. In addition, they had several anomalies in the ET including widely developed medial lamina of the ET cartilage, undeveloped lateral lamina of the ET cartilage, and absence of attachment of the tensor veli palatini muscle to the ET cartilage. We discuss the implications of the observed anomalies with regard to developmental and clinical issues.     

Electromyographic study of patients with dysfunction of the eustachian tube

Summary In order to determine how often dysfunction of the tube might arise from dysfunction of the tubal muscles, electromyographic examination of the muscles was carried out on 34 patients with occluded or patent tube. Using a monopolar needle electrode inserted through the nose, selective EMG of the tensor and levator veli palatini muscles were picked up during swallowing. It was found that the patients showed neither abnormally reduced nor increased muscle activity. Comparison of muscle activity of the normal tube and of both the occluded and patent tube revealed no significant differences. Therefore, myogenic cause of tubal dysfunction seems improbable from the clinical viewpoint.     

Histopathologic study of temporal bone and eustachian tube in oculoauriculovertebral spectrum

Bilateral temporal bone specimens from a 21-month-old girl and a left temporal bone-eustachian tube (ET) specimen from a full-term female newborn, both with oculoauriculovertebral spectrum, were studied histopathologically. The external and middle ears demonstrated severe anomalies, similar to those of previous reports describing the histopathologic findings of this syndrome. In addition, despite having a normal auricle, the 21-month-old child had bilateral hypoplastic cochleas as seen in Mondini dysplasia. The newborn had several anomalies of the ET, including a widely opened cartilaginous portion of the ET lumen and absence of the lateral lamina of the ET cartilage. We discuss the implications of the observed anomalies with regard to developmental and clinical issues.     

Update on eustachian tube dysfunction and the patulous eustachian tube

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent knowledge on eustachian tube dysfunction and the patulous eustachian tube. RECENT FINDINGS: A clinically useful test for eustachian tube function is still lacking. Narrowing of the isthmus alone was demonstrated to be an insufficient cause of otitis media. Inflammatory mediators identified within the eustachian tube and middle ear cells were causally linked with otitis media with effusion. Increasing evidence was found that allergic disease and reflux may be two of the most important contributors of tubal inflammation causing otitis media with effusion. The adenoid size and proximity to the torus tubaris may also be important in considering which patients with persistent otitis media with effusion may benefit from adenoidectomy. Computed tomography scan has documented loss of soft tissue within the cartilaginous eustachian tube in patients with patulous eustachian tubes. An endoscopic approach to seal the tubal lumen has been found to be effective in relieving patulous symptoms. SUMMARY: These studies suggest that allergic rhinitis and gastroesophageal reflux should be investigated in patients with eustachian tube dysfunction. Adenoidectomy should also be considered in patients who have adenoids that obstruct the torus tubaris. Patients with a patulous eustachian tube may benefit from an endoscopic closure. Further research is needed to identify a clinically useful test for eustachian tube dysfunction.     

Histopathologic study of the human eustachian tube and its surrounding structures following irradiation for carcinoma of the oropharynx

OBJECTIVE: To describe a histopathologic analysis of a human temporal bone demonstrating patulous changes of the eustachian tube (ET) and its surrounding structures following radiation therapy. DESIGN: Retrospective histopathologic case review and comparison with an age-matched control. SETTING: Elizabeth McCullough Knowles Otopathology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pa. RESULTS: A widened patulous ET was verified by demonstrating fibrous tissue replacement of the surrounding supporting structures related to the ET. The ET lumen was patulous and wider than the control case. Ostmann fatty tissue, the levator veli palatini muscle, and submucosal glands around the ET cartilage were replaced by dense connective tissue. CONCLUSION: This is the first histopathologic report, to our knowledge, demonstrating the effects on the ET lumen and supporting structures following acute weight loss, possible tumor infiltration, and radiation changes for carcinoma of the oropharynx.     

中耳炎颞骨咽鼓管峡部粘-软骨膜的组织病理学观察

目的：了解中耳炎性病咽鼓管峡部粘－软骨膜的影响。方法：用光镜对３２耳各型中耳炎颞骨（中耳炎组）与５０耳正常颞骨（正常组）标本连续切片的咽这峡部粘－软骨膜,中耳腔鼓岬粘骨组织病理学比较观察。结果：中耳炎组和正常组颞骨标本咽鼓管峡部均无病理性阻塞;中耳炎组峡部粘－软骨膜厚度测量和病理观察,未见有明显炎症改变,与正常组比较无明显差异;而其中耳腔粘骨膜均明显炎症病变。这种炎症截然不同反应的界限恰好在咽这的     

Flexible endoscopy and radiologic evaluation of the eustachian tube in adults with eustachian tube dysfunction

This study was conducted on 20 adult patients presenting with eustachian tube dysfunction of about 6 months' duration. It included endoscopy of the pharyngeal end of the eustachian tube and contrast radiologic study. Both methods are now available because of technical progress and practical improvements. By these methods, physiologic movements of the soft palate, tubal torus, and tubal orifice can be observed and studied and anatomic variations and pathologic abnormalities can be detected. This study shows that eustachian tube dysfunction may be caused by salpingitis (acute or chronic) or adenoid or nasopharyngeal carcinoma. Scleroma affecting the lumen of the eustachian tube was reported in one case.     

Compliance of the eustachian tube in patients with otitis media with effusion

To analyze the compliance of the eustachian tube, we measured the decrease in tubal resistance (pressure/air flow) with increasing air flow rate through the eustachian tubal lumen. When the eustachian tube is compliant, the tubal resistance decreases greatly because of the high distensibility of the tube. The tubal compliance index (TCI), which is the ratio of the tubal resistance between two different air flow rates, was compared among three groups: 36 ears of children with otitis media with effusion (OME), 26 ears of adult OME patients, and 10 otherwise normal ears with traumatic perforations of the eardrum. Compared with normal subjects, OME children had a significantly higher TCI (P less than .005), whereas OME adults had a significantly lower TCI (P less than .05). From these results, we concluded that eustachian tubes are compliant in children with OME but rigid in adults with OME.     

Oral submucous fibrosis with its possible effect on eustachian tube functions: A tympanometric study

Oral submucous fibrosis (OSMF) is a chronic inflammatory condition of oral cavity The common sites of involvement are cheek, tongue and soft palate The pathological changes not only involve the mucosa and submucosa but also extend deeper to involve the underlying muscles Atrophic and degenerative changes in the tubal and paratubal muscles have already been reported and involvement of these muscles may lead to eustachian tube dysfunction The present study was therefore, planned to assess the eustachian tube functions by tympanometry in cases of OSMF Out of 106 ears in 53 cases, 80 ears (75 5%) showed normal type-A curve Abnormal tympanograms included type-B curve in 17 (16 0%) and type-C curve in 9 (8 5%) ears On testing the compliance of middle ear there was shift in the compliance peaks in 78 (73 6%) ears with +200 daPa pressure change indicating normal eustachian tube functions In 28 (26 4%) ears, eustachian tube functions were found to be affected as there was no shift in the compliance peaks Similarly on-200 daPA pressure change in 24 (22 7%) ears there was no shift in compliance peaks An identical study was also carried out in 40 ears of 20 normal individuals The data derived were statistically much higher in the disease group Therefore, it was concluded that eustachian tube functions may be affected in OSMF     

Computed tomography in the study of the eustachian tube

Summary A CT study was made of the eustachian tube in normal subjects as a control group and patients with chronic pathological inflammation of the middle ear. CT made it possible to perform contiguous scans at homologous depths of 1.5 mm, showing the whole interior of the tube in clear detail: the protympanum, the bony and cartilaginous portions, and the nasopharyngeal orifice. In most of the cases of pathological middle ear inflammations, the eustachian tube lumen was seen to be constricted and obstructed with isodense matter. Our present results also show the importance of extending CT investigations beyond the tympanic cavity and the mastoid to the eustachian tube in order to have more clinical data on its condition.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

Computed tomography in the study of the eustachian tube

A CT study was made of the eustachian tube in normal subjects as a control group and patients with chronic pathological inflammation of the middle ear. CT made it possible to perform contiguous scans at homologous depths of 1.5 mm, showing the whole interior of the tube in clear detail: the protympanum, the bony and cartilaginous portions, and the nasopharyngeal orifice. In most of the cases of pathological middle ear inflammations, the eustachian tube lumen was seen to be constricted and obstructed with isodense matter. Our present results also show the importance of extending CT investigations beyond the tympanic cavity and the mastoid to the eustachian tube in order to have more clinical data on its condition.     

Growth of the foetal eustachian tube and its dimensions

Summary In a study of the growth and dimensions of the Eustachian tube, 47 tubes from 33 foetuses varying in age from the 12th to the 27th menstrual week were removed in toto, stained with PAS, PAS-alcian blue, and the osmium tetroxide whole-mount method. At the beginning of the 12th menstrual week the tube is 2.4 mm in length, at the beginning of the 27th week 12.5 mm. The rate of increase in tubal length is at a maximum from the 20th to the 27th week, amounting to 0.8 mm per week. Later, the weekly increment is presumably only 0.6 mm. The mean inner circumference of the tube is 1.0 mm at the beginning of the 12th week and 4.4 mm at the beginning of the 27th week. The mean diameter of the tube is 0.32 mm at the beginning of the 12th week and 1.38 mm at the beginning of the 27th week. Up to the 15th week the tube is almost round in cross section, but as cartilage develops it becomes first oval and, in the 27th week, slit-shaped.The development of the tubal cartilage starts towards the end of the 12th week, first in the pharyngeal part of the internal lamina. By the 16th week the newly-formed cartilage attains contact with the tympanic cartilage, and then the development of cartilage starts oin the external lamina. Differentiation of the epithelium and formation of goblet cells in the rhinopharynx starts in the 12th week. Hence, the differentiation spreads towards the tubal orifice, along the tubal floor to the tympanic part and the middle ear.

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Zusammzenfassung Bei Untersuchungen über Wachstum und Dimensionen der Eustachischen Tube wurden 47 Tuben von 33 Foeten der 12.–27. Menstrualwoche in toto herauspräpariert und mit PAS, PAS-alcian-Blau und Osmium Tetroxid in toto gefärbt. Läge und innere Zirkumferenz der Tube wurde gemessen. 12,5 mm lang. Das stäkste Läugenwachstum findet in der 20.–27. Woche statt und beträgt bis zu 0.8 mm wöhentlich. Später beträgt das wöchentliche Wachstum wahrscheinlich our 0,6 mm. Der durchschnittliche innere Umfang der Tube ist am Beginn der 12. Woche 1,0 mm, bei Beginn der 27. Woche 4,4 mm. Der entsprechende mittlere Durchmesser beträgt bei Beginn der 12. Woche 0,32 mm and 1.38 mm am Beginn der 27. Woche. Bis zur 15. Woche ist der Querschnitt der Tube fast rund, aber mit Beginn der Knorpel-Entwicklung wird or oval and in der 27. Woche schlitzfög.Die Entwicklung des Tubenknorpels beginnt gegen Ende der 12. Woche, zuerst im pharyngealen Teil der inneren Wand. In der 16. Woche bekommt der Tubenknorpel Kontakt mit dem tympanalen Knorpel, und zu dieser Zeit beginnt auch die Entwicklung der Lamina externa. Die Differenzierung des Epithels und die Ausbildung von Becher-Zellen beginnt in der 12. Woche im Rhinopharynx. Von bier breitet sich die Differenzierung zur Tubenmündung und entlang des Bodens zum tympanalen Teil and zum Mittelohr aus.

     

Functional study of the eustachian tube with sequential scintigraphy.

The authors investigated the tubal function by means of sequential scintigraphy in 16 patients affected by chronic otitis media and in 3 patients with posttraumatic perforation of the tympanic membrane. Evaluated parameters were: appearance time (AT), radioactivity peak time, rise time in the tympanic cavity, eustachian tube and rhinopharynx, and radioactivity percent values passed in the rhinopharynx. The tubal pressure-equilibrating function was determined by means of the manometer pump section of the impedance meter. A significant relationship between the pressure-equilibrating function and the tubal scintigraphy parameters has been detected. The variability of the AT in the tube and the almost constant time needed by the radioactive tracer to go through the tube and reach the rhinopharynx could indicate that a major role in the tympanic cavity drainage is played by the tympanic ostium and the surrounding mucosa.     

The evaluation of eustachian tube paratubal structures using magnetic resonance imaging in patients with chronic suppurative otitis media

Conclusion Eustachian tube (ET) dysfunction, which plays a role in the pathogenesis chronic suppurative otitis media (CSOM), does not seem to be due to differences in paratubal structures. Objective The aim of this study was to compare the magnetic resonance imaging (MRI) findings of the paratubal structures of the ET between normal ears and ears in patients with CSOM. Methods The MRI records of 40 patients who underwent tympanomastoidectomy for a diagnosis of CSOM were reviewed retrospectively. The healthy ears served as the control group. The length, diameter, surface area and volume of the tensor veli palatini muscle (TVPM) and levator veli palatini muscle (LVPM) were measured, in addition to the diameter of the pharyngeal orifice of the ET, volume of the Ostmann fat pad, bimucosal thickness of the lumen of the ET, and mucosal thickness. Results In the pathological ears, the mean length of the TVPM and LVPM was 22.6?mm and 19.3?mm, the mean diameter was 3.2 and 5.3?mm, and the mean volume was 1.75 and 3.2?cm³, respectively. In addition, the mean diameter of the pharyngeal orifice of the ET was 1.9?mm. There were no significant between-group differences in the paratubal structures (p?>?0.05).     

Site of eustachian tube dysfunction in patients with otitis media with effusion

This study was conducted to identify an exact site of ventilatory dysfunction within the eustachian tube among patients with otitis media with effusion (OME). Using 10 adults with OME, a fine polyethylene tube with a small pore at its tip was inserted into the eustachian tube via its pharyngeal orifice. Negative middle ear pressure was applied through a ventilation tube in the eardrum, and the patients were asked to swallow repeatedly at every 5-mm depth of insertion of the polyethylene tube toward the middle ear. Negative middle ear pressure could be equilibrated by swallowing within 10 mm of tube advancement from the pharyngeal orifice of the eustachian tube in seven of ten patients. It was concluded that the site of tubal ventilatory dysfunction is in the distal part of the cartilaginous portion of the eustachian tube in most adult patients with OME.     

The effects of mastoid aeration on autophony in patients with patulous eustachian tube

The effect of the mastoid pneumatization on sound transmission from the nasopharyngeal cavity to the inner ear, which is one of the important factors to indicate the severity of the patulous eustachian tube (ET), are investigated in patients with patulous ET. Twenty ears of 13 subjects with patulous ET were retrospectively analyzed. Sound transmission from the nasopharyngeal cavity to the inner ear was evaluated by observing the masking effects of noise presented in the nasopharyngeal cavity on the auditory threshold (nasal noise masking audiometry). The relationship between this masking effect and mastoid pneumatization were examined among the patients with similar conditions of ET patency. The masking effect of nasally presented noise was greater with less developed mastoid pneumatization. The present results indicate that the symptoms associated with patulous ET may be more distressful in patients with poorly developed mastoid cavity than in those with well-aerated mastoid under similar conditions of ET patency.     

Osteopetrosis of temporal bone with blockage of the eustachian tube. A case report

Osteopetrosis is an inherited disorder characterized by bone sclerosis. One of the more predominant feature of the disease in the temporal bone is conductive hearing loss due to anomalous bone formation in the middle ear and to otitis media. A 55-year-old woman affected by the adult type of osteopetrosis was referred to our department with a long history of otitis media. CT study demonstrated a narrowing of Eustachian tube due to abnormal deposition of sclerotic bone; this condition was confirmed during surgery. Tubotomy was performed during tympanoplastic surgery and there were no relapse of otitis after 12 months of follow up. Timpanoplastic surgery should be considered in those cases where medical treatment has failed in dealing with otitis media. In our experience an enlargement of Eustachian tube shuld be performed in this kind of patients, thus helping the functional recovery and the potential well-being of the patient as we observed in our case.     

Length of the eustachian tube and its postnatal development: computer-aided three-dimensional reconstruction and measurement study

Eleven normal human temporal bone-eustachian tube (ET) specimens obtained from 11 individuals whose ages were 3 months to 88 years were studied to investigate the path length along the ET lumen and its postnatal development by means of a computer-aided 3-dimensional reconstruction and measurement method. The path length of the ET lumen of the 3-month-old infant was 21.2 mm, and its growth was in correlation with age to attain its adult length (average, 37.00 +/- 4.16 mm). The ratio of the length of the cartilaginous portion together with the junctional portion to the length of the bony portion was 8:1 in an infant at the age of 3 months and 4:1 in adults. That the bony portion of the ET develops relatively more than the cartilaginous and junctional portions may cause this finding. In addition, there is a developmental shift in the orientation of the cartilaginous portion with respect to the bony portion of the ET. In children, the cartilaginous and bony portions are both aligned with the line that connects the pharyngeal orifice and the tympanic orifice. In adults, however, the cartilaginous portion is angled inferiorly and laterally from the bony portion. This change may reflect the relative growth of the face.