Pathology of the eustachian tube in otitis media: an electron microscopic study

The ultrastructure of the mucosa of the eustachian tube was studied in four temporal bones showing tympanosclerosis, cholesteatoma, otitic meningitis and a grafted tympanic membrane (tympanoplasty). The mucosa of tube was abnormal in the four cases confirming the relationship between the state of the eustachian tube and the inflammatory process in the middle ear. The observed abnormalities included: ciliary loss, abnormal ciliary morphology and motility, oedema of the microvilli, hyperplasia of the goblet cells and the seromucinous acini, desquamation of the non-ciliated cells and appearance of mast cells in the lamina propria of the tube. Ciliary changes were the most frequent abnormalities and the morphological changes, in general, were fewest in the case of healed tympanoplasty. The pathophysiology of the morphological changes was discussed and correlated with the disease in the middle ear.     

Type I allergic reactions of the middle ear and eustachian tube: an experimental study

To clarify the role of type I allergic reactions in etiology and pathogenesis of otitis media with effusion and to determine whether or not the middle ear is an allergic "shock" organ, we made animal models of nasal allergy in guinea pigs by passive sensitization with serum of homologous animals containing specific IgE antibodies. We also examined the eustachian tube, tympanic cavity (histologically), and tubal function after the induction of type I allergic reactions of the nose. However, the involvement of histologic changes was limited only up to the area near the pharyngeal orifice. The tubal dysfunction evoked by nasal allergic reactions was transient, culminating in no middle ear effusion. Upon direct antigen-challenge into the tympanic cavity, allergic changes were observed in the mucosa lining the tympanic bulla, even though no microscopic effusion was present. Findings of the present study suggest that type I allergic reactions of the nose are not an etiologic factor for otitis media with effusion, although the middle ear is potentially an allergic shock organ.     

Effect of formalin-fixed Hemophilus influenzae and Streptococcus pneumoniae on dye transport by the chinchilla eustachian tube

An in situ method for measuring the ability of the middle ear and eustachian tube ciliated epithelium to transport dye to the nasopharynx was used to assess the role endotoxin-containing killed bacteria have on the development of otitis media with effusion. In addition, electron microscopy was used to monitor histological changes induced by exposure to these organisms and the ability of the mucosa to recover. The results indicated that exposure to a killed gram-negative but not a gram-positive otitis media pathogen leads to early production of middle ear fluid, evidence of capillary leakage and significant slowing of mucociliary transport. The damage was, however, reversible with the epithelium returning to normal both functionally and histologically within 7 days of exposure.     

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.     

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.     

Mucociliary function of the eustachian tube in the eustachian tube dysfunction

Background: Most of the tests to evaluate the eustachian tube (ET) function are focused on the ventilation function of the ET.

Aim: Here we evaluate mucociliary function of the ET in patients with ET dysfunction.

Materials and methods: Ten patients with ET dysfunction were enrolled into the study. Six patients had chronic tympanic membrane retraction and four patients had chronic middle ear effusion (MEE). All patients had intact tympanic membranes. Tympanometry and clinical examinations were done to all patients. Mucociliary function was evaluated with technetium labeled albumin and blue dye. Tympanometry and clinical examinations were done to six patients with chronic tympanic membrane retraction and four patients with chronic middle ear effusion (MEE). Mucociliary function of the ET was evaluated with technetium labeled albumin and blue dye placed into middle ear through an intact tympanic membrane and followed from nasopharynx ET orifice (blue dye) and with gamma camera (technetium).

Results: Blue dye was observed in tubal orifice in six (6 of 10) patients during 30?min observation. Five of those patients (5 of 6) had tympanic membrane retraction and one patient (1 of 6) had MEE. Tracer activity decreased from middle ear in six (6 of 10) patients. Four of those patients had tympanic membrane retraction and two had MEE.

Conclusion: Mucociliary function of the ET seems to be better in patients with tympanic membrane retraction than patients with middle ear effusion.

Significance: Mucociliary function of the ET is an important function for middle ear aeration, blue dye test is easily available to be used also in clinical practice.     

Patulous eustachian tube syndrome: the relationship with sensorineural hearing loss. Treatment by eustachian tube diathermy

The patulous Eustachian tube syndrome has previously been regarded as a troublesome but benign condition. Nine out of 13 patients reported here had evidence of cochlear damage similar to that caused by acoustic trauma. These patients also had vestibular symptoms which improved with treatment of the patulous tube. It is postulated that abnormal patency of the Eustachian tube may allow excessive middle ear pressure changes to occur which may be transmitted by abnormal ossicular movement to the cochlea. Eustachian tube diathermy using a ureteric diathermy probe is a safe and effective method of treating this condition.     

Anatomy of the bony portion of the eustachian tube in tubal stenosis: multiplanar reconstruction approach

OBJECTIVES: We sought to clarify possible pathological conditions of the bony portion of the eustachian tube (ET) in patients with ET stenosis. METHODS: We measured the total length, the cross-sectional area of the bony frame, and the air space of the ET lumen at an interval of 1 mm on the reconstructed computed tomographic images of the ET using a multiplanar reconstruction method on 20 normal subjects (control group) and 25 patients with stenotic ET judged by the inflation test (stenotic group). RESULTS: In the cross-sectional areas, both the bony frame and air space were significantly smaller in the stenotic group than in the control group. The soft tissue ratio was significantly greater in most parts of the mid-bony portion and the tympanic orifice of the stenotic group than in those of the control group. At the anterior tip of the bony portion, only the bony frame was found to be significantly smaller in the stenotic group than in the control group. CONCLUSIONS: We suggest that a smaller framework of the bony ET may possibly be related to the pathogenesis of ET stenosis.     

Dermoid cyst of the eustachian tube.

We report a case of dermoid cyst of the Eustachian tube in a 2 1/2 -year-old-girl with CT and MRI imaging. This is the 12th described case of such a pathology. Most of the reviewed previous 11 cases affected females on the left side. The surgical approach and the contribution of CT and MRI are discussed.     

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.     

Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report

Pharyngeal orifice of the eustachian tube was ligated on ten patients, 15 ears with intractable patulous eustachian tube. While the eustachian tube orifice was observed by an endoscope inserted through the contralateral nostril, the orifice was ligated transnasally and/or transorally using instruments usually used in the endoscopic nasal surgery. Now 13–27 months after the surgery, the outcome was excellent (both symptoms and sonotubometry were normalized) in two ears, good (either symptoms or sonotubometry was improved) in seven ears, and unchanged in the remaining six ears. In one of the ears with an outcome of unchanged, the ligation was found to be spontaneously released soon after surgery, but the symptom was improved after the second operation 2.5 months after the first operation. Temporary otitis media with effusion was seen in one ear, mild inflammation around the ligated site also in one ear, but no other serious complication has been observed. Although further improvement in the surgical procedure and further discussion about its long-term outcome should be required, this procedure appeared to be one of the therapeutic options for intractable patulous eustachian tube.     

Magnetic resonance imaging of the eustachian tube. A correlative anatomical study

Magnetic resonance (MR) imaging of the eustachian tube (auditory tube) was performed in normal subjects and in a patient with nasopharyngeal carcinoma. The MR images obtained in an anteriorly tilted transaxial plane parallel to the eustachian tubes were compared with serial slices of a cadaver specimen. The eustachian tube cartilage, mucous lining of the eustachian tube, the lateral pharyngeal recess, the tensor veli palatini muscle, and the levator veli palatini muscle were identified in MR images using anatomical relationships. A patient with nasopharyngeal carcinoma is described to demonstrate an example of topographical morbid changes appearing around the eustachian tube.     

球囊导管扩张咽鼓管的初步研究

咽鼓管功能障碍是常见疾病，经内镜鼻球囊导管扩张咽鼓管是一种新的手术技术，本研究的目的是回顾性分析这种新技术的演化并报道其适应症、初步结果和并发症。     

Diagnosis and management of the patulous eustachian tube.

OBJECTIVE: The patulous eustachian tube (ET) seems to be caused by a longitudinal concave defect in the mucosal valve at the superior aspect of its anterolateral wall and causes troublesome autophony of one's own voice and breathing sounds. Patulous ET reconstruction was evaluated to analyze whether submucosal graft implantation to fill in the concavity within the patulous tubal valve may produce lasting relief of symptoms. STUDY DESIGN: Prospective trial. SETTING: Tertiary referral center, ambulatory surgery. PATIENTS: Fourteen ETs in 11 adults with 1 or more years of confirmed continuous patulous ET symptoms refractory to medical care. INTERVENTION: Endoluminal patulous ET reconstruction was performed in 14 separate cases using a combined endoscopic transnasal and transoral approach under general anesthesia. A submucosal flap was raised along the anterolateral wall of the tubal lumen up to the valve and mobilized superiorly off of the basisphenoid. The pocket was filled with autologous cartilage graft or Alloderm implant, restoring the normal convexity and competence to the mucosal lumen valve. MAIN OUTCOME MEASURE: Autophony symptoms were scored as 1) complete relief; 2) significant improvement, satisfied; 3)significant improvement, dissatisfied; 4) unchanged; or 5)worse. RESULTS: All 14 cases reported immediate complete relief of autophony. Results with an average follow-up of 15.8 months are as follows: 1 (7%) case had complete relief; 5 (36%) had significant improvement, satisfied; 7 (50%) had significant improvement, dissatisfied; and 1 (7%) was unchanged. There were no complications. Correlation between patulous ET and other conditions was strongest with previous tubal dysfunction. Autophony of voice, but not breathing sounds, was also found to be experienced by 17 (94%) of 18 patients with superior semicircular canal dehiscence syndrome and could be easily mistaken for patulous ET autophony. CONCLUSION: Patulous ET seems to be caused by a concave defect in the tubal valve's anterolateral wall. Submucosal graft implantation to restore the normal convexity to the valve wall seems to provide lasting relief of symptoms. Long-term study is needed. It is important to differentiate between the autophony of semicircular canal dehiscence syndrome and patulous ET.     

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.