EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may...

EUSTACHIAN TUBAL INSUFFICIENCY

Aetiology

© Bruce Black MD

Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS

pathology, or the osseous section (middle ear disease). © Bruce Black MD

The middle ear. The site is similar to a watch with a dial (pars tensa) mechanisms (ossicles) and spring (cochlea),

the site is optimally functional only if well aerated. © Bruce Black MD

Tubal function 1. The tube opens upon deglutition, permitting the replenishment of air in the middle ear that

gradually absorbs into the bloodstream. © Bruce Black MD

Tubal dysfunction 2. Failure to replace the continual absorption of middle ear air results in a partial vacuum in

the middle ear cleft, causing drum retraction. © Bruce Black MD

Eustachian dysfunction 3. Prolonged tubal occlusion results in an effusion filling the middle ear cleft as air is

progressively reabsorbed. © Bruce Black MD

Normal tubal function. The tubal orifice (et) is opened during deglutition, as the tensor palati (tp) pulls around the pterygoid hamulus (ph). tc: tubal cartilage sp: soft palate. © Bruce Black MD

Effect of a cleft palate. Dehiscence of the midline raphe eliminates the lower anchor point of the tensor palati

traction on the tube, which then fails to open. © Bruce Black MD

Bifid uvula. This may be associated with a sub-mucosal cleft of the palatal musculature, causing tubal insufficiency.

© Bruce Black MD

Hare lip repair. Beware an associated palate cleft if managing tubal insufficiency.

© Bruce Black MD

Hare lip repair, associated cleft palate, cholesteatoma.

© Bruce Black MD

Cleft palate. Long history of middle ear effusions and repeated vent tube insertions.

© Bruce Black MD

Past cleft palate repair. Bilateral marked adhesive otitis.

© Bruce Black MD

Complications of Eustachian tubal failure.

© Bruce Black MD

“Goldfish Syndrome”: chronic juvenile mouth-breathing due to hypertrophied adenoids. Concurrent middle ear effusions

are common. © Bruce Black MD

Adenoidal hypertrophy causing chronic mouth-breathing and bilateral middle ear effusions. Protruding auricles.

© Bruce Black MD

Bilateral tubal insufficiency. Large tonsils, adenoids similarly enlarged and infected.

© Bruce Black MD

Plain film, lateral post-nasal space, showing total occlusion of the posterior nasal airway due to adenoidal hypertrophy.

© Bruce Black MD

A large adenoid pad touching on the soft palate. Chronic infection and tubal problems likely.

© Bruce Black MD

Total PNS occlusion by a large adenoid pad.

© Bruce Black MD

Deflected nasal septum, chronic right Eustachian insufficiency due to tubal blockage.

© Bruce Black MD

Coronal CT of the previous case sinuses. Septal deflection occluding the right nasal passage.

© Bruce Black MD

Giant haemangioma of the PNS with palatal extension. Palatal dysfunction resulted in tubal insufficiency.

© Bruce Black MD

Atopic dermatitis. Nasal allergy and Eustachian tubal problems commonly co-exist.

© Bruce Black MD

The dry and excoriated skin of chronic atopic dermatitis Chronic tubal problems may result from persistent nasal

allergy and infection. © Bruce Black MD

Lymphoma of the post-nasal space, secondary middle ear effusion. The tumour mass can be glimpsed beyond the soft

palate. © Bruce Black MD

Previous case, catheter retraction of the soft palate revealing the bulk of the tumour mass.

© Bruce Black MD

Carcinoma of the PNS, mirror view. Concurrent effusions. A common problem in southern China; beware the deafness

and an ipsilateral neck mass in this group. © Bruce Black MD

Carcinoma of the right PNS axial MRI view. Common in cases of south Chinese ancestry.

© Bruce Black MD

Carcinoma, Rt PNS, film showing a substantial soft tissue mass at the nasal end of the Eustachian tube, Partial

deafness and effusion, Rt. neck mass. Chinese ancestry. © Bruce Black MD

A large PNS carcinoma eroding the pterygoid plates to the left, and impinging on the airway. Middle ear effusion

present . © Bruce Black MD

Right middle ear effusion. The moderately extensive air cell system is opacified compared to the aerated left side.

© Bruce Black MD

Chronic tubal insufficiency on the left. The cell system is under-developed when compared with the contralateral well

aerated system. An effusion fills the middle ear. © Bruce Black MD

Chronic Right tubal failure. The mastoid cells are lesser developed and opaque compared with the normal left

system. © Bruce Black MD

Coronal view of the previous case. Underdeveloped and opacified Rt mastoid air cell system.

© Bruce Black MD