Eustachian Tube Dysfunction

Literature Reading
EUSTACHIAN TUBE
DYSFUNCTION
Desti Kusmardiani
Supervisor:
dr. Arif Dermawan M.Kes, Sp.T.H.T.K.L(K)
1
DEPARTMENT OF OTORHINOLARYNGOLOGY - HEAD&NECK

SURGERY
PADJADJARAN UNIVERSITY / HASAN SADIKIN GENERAL HOSPITAL
BANDUNG
2O16
DEFINITION
Eustachian tube dysfunction (ETD) means the
tube does not open properly.
The air pressure on the outer side of the eardrum
becomes grater than the air pressure in the
middle ear.
The eardrum is pushed inward, becomes tense,
and does not vibrate well. A healthy ear is one
that pops easily and feels immediately better.
A.G.M, Schilder et al. Eustachian tube dysfunction: consensus statement on definition, types,clinical presentation and diagnosis. 2015. Clin.
Otolaryngol., 40, 407411
ANATOMI
Bluestone, Charles D, Klein, Jerome. Otitis Media and Eustachian Tube Dysfunction In: Pediatric Otolaryngology. 4 th
Edition. Saunders, 2003
3
Bluestone, Charles D. Anatomy and Physiology of the Eustachian Tube System. In : Head and Neck Surgery-Otolaryngology.
Fourth Edition. Edited by: Bailey B.J. Lippincott Williams & Wilkin. 2006
4
Bluestone, Charles D, Klein, Jerome. Otitis Media and Eustachian Tube Dysfunction In: Pediatric Otolaryngology.
4 th
Descriptive of anatomic Eustachian

tube
Children vs Adult
Long of eustachian tube

Lumen
Size of
Children < adult

smaller
10 vs 45
Large corner m. tensor veli palatini againts

cartilage
Density of cartilage cell
Cartilage Volume
Elastin composite of cartilage
Variable vs stabil
Ostmann lipid layer

Mucosa fold
Relatif more wide

Bigger
More bigger
Less
Less
VASCULARITATION OF EUSTACHIAN
TUBE
Artery:
a. palatine ascenden,
Faringeal brach of arteri maksilari interna,
a. canalis pterygoid,
a. faringeal ascenden and
a. meningeal media.
Venous drainage pleksus pterigoideus.

Limfatic drainageto the retrofaring and deep
servikal
INNERVATION OF EUSTACHIAN TUBE

Faringeal Orifisium from tuba eustakhius
Motoric Branch of otic ganglion , n. sphenopalatinus and
faringeal plexus.
Sensoric timpanicus and faringeal pleksus . N. glossofaringeal
suspend to having eustachian tube innervation.
Simpatic ganglion sphenopalatinus, otic ganglion, n.
glossofaringeal, n. petrosa and n. carticotympanicus
M. tensor veli palatine and m. tensor tympani part of

ventromedial nukleus motor trigeminal ipsilateral througt
trigeminus nerve.
Musculus levator veli palatine n. ambigus through n. vagus
THE FUNCTIONS OF THE

EUSTACHIAN TUBE ARE
Pressure in the middle ear is maintained through

two mechanisms:
middle
ear mucosal gas exchange

Opening of the Eustachian tube to equilibrate
pressure with that in the nasopharynx
3 SUBTYPES OF EUSTACHIAN TUBE DYSFUNCTION:
dilatory Eustachian tube

dysfunction,
baro-challenge-induced
Eustachian tube dysfunction
patulous Eustachian tube

dysfunction.
DILATORY EUSTACHIAN TUBE

DYSFUNCTION CAN BE BROKEN DOWN AS
FOLLOWS:
1 functional
obstruction,
2 dynamic dysfunction
(muscular failure),
3 anatomical
obstruction
CLINICAL HISTORY: SYMPTOMS OF

EUSTACHIAN TUBE DYSFUNCTION
aural fullness or popping or discomfort/pain
pressure, clogged or under water sensation,
crackling, ringing, autophony and muffled hearing
ACUTE DILATORY EUSTACHIAN

TUBE DYSFUNCTION
preceded by :
an
upper respiratory tract infection

an exacerbation of allergic rhinitis, which presumably
causes inflammation in the Eustachian tube orifice or
lumen.
a prior history of otitis media
BARO-CHALLENGE-INDUCED
EUSTACHIAN TUBE DYSFUNCTION
Symptoms :
aural fullness, popping or discomfort/pain
under conditions of alteration to the ambient
pressure.
manifest when scuba-diving or on descent from
altitude
PATULOUS EUSTACHIAN TUBE DYSFUNCTION
Symptoms :
aural
fullness and autophony

worsen during exercise
caused by an abnormally patent Eustachian tube; as
such, it may be precipitated by recent weight loss
SYMPTOMS AND SIGNS
CLINICAL ASSESSMENT: SIGNS OF EUSTACHIAN TUBE

DYSFUNCTION
Ideally assessment should include the following:

1
otoscopy or otomicroscopy,
2 tympanometry,
3 Rinnes and Webers tuning fork tests or pure tone
audiometry,
4 nasopharyngoscopy (to visualise the opening of the
Eustachian tube).
TESTS OF THE VENTILATORY

FUNCTION OF THE EUSTACHIAN
TUBE
The Eustachian Tube Score (ETS) and its

extension the ETS-77 combine subjective (clicking
sound when swallowing, Valsalva) and objective
(tubomanometry, tympanometry) measures of
Eustachian tube function.
19
LR-JP
20
MEP: middle ear pressure; SC: Static compliance; ECV: ear canal
volume
condition: ossicular dislocation or erosion, timpanosklerotik,

pseudomembran
21
condition : otosclerosis or middle ear effusi

on
Normal volume -> middle ear effusion, sclerosis

Small volume -> miss probe position or cerumen 22
Big volume -> MT perforation
Condition : negatif pressure in

eustachian tube eustachian tube
dysfunction
23
Tes
Politzer
Tes
Valsava
Tes Tuba
Patulous
Tes
Toynbee
24
Bluestone, Charles D, Klein, Jerome. Otitis Media and Eustachian
Tube Dysfunction In: Pediatric Otolaryngology. 4th Edition.
Saunders, 2003
DILATORY EUSTACHIAN TUBE DYSFUNCTION
patient-reported symptoms evidence of

negative pressure in the middle ear
As assessed by clinical assessment, either as
follows:
otoscopic
or otomicroscopic evidence of tympanic

membrane retraction and/or
tympanogram indicating negative middle ear
pressure
IN BARO-CHALLENGE-INDUCED EUSTACHIAN TUBE DYSFUNCTION
otoscopy and tympanometry normal, so

diagnosis relies on patient history.
In some cases of baro-challenge-induced
Eustachian tube dysfunction, middle ear effusion
or haemotympanum may be evident.
PATULOUS EUSTACHIAN TUBE

DYSFUNCTION
symptoms + evidence on otoscopy or

tympanometry of tympanic membrane excursion
with breathing
Pure tone audiometry A mild or moderate

conductive hearing loss may be found in some
patients with Eustachian tube dysfunction
NASOPHARYNGOSCOPY
Examination may reveal a cause for Eustachian

tube dysfunction, for example inflammation
adjacent to the Eustachian tube orifice, or
(rarely) neoplasms, scarring or other lesions.
DIFFERENTIAL DIAGNOSIS
ventilatory dysfunction of the Eustachian tube
may contribute to the onset or persistence of
these types of otitis media
cochlear hydrops
temporomandibular joint (TMJ) dysfunction
discomfort
in front of and around the ear, typically

unilateral, and in some cases associated with clicking
or popping noises and altered hearing or tinnitus.
MANAGEMENT
Force
air to flow into the Eustachian tube

Decongestant tablets (e.g. Sudafed) and
nasal sprays (e.g. Afrin, Neo-synephrine)
Antihistamines (e.g. Zyrtec, Benadryl)
Guaifenesin (e.g. plain Mucinex or
Robitussin).
Steroid nasal sprays
HIGHLIGHTS
There are three subtypes of Eustachian tube
dysfunction: dilatory, baro-challenge induced,
and patulous Eustachian tube dysfunction
presents with symptoms of pressure
disequilibrium in the affected ear
In dilatory dysfunction there are signs on
otoscopy or tympanometry of negative middle ear
pressure
In baro-challenge induced dysfunction, symptoms

occur only on changes to ambient pressure.
In patulous dysfunction there is otoscopic or
tympanometric evidence of excursion of the
tympanic membrane with breathing.
Thank You

Eustachian Tube Dysfunction

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Literature Reading

DEPARTMENT OF OTORHINOLARYNGOLOGY - HEAD&NECK

Descriptive of anatomic Eustachian

Long of eustachian tube

Children < adult

Large corner m. tensor veli palatini againts

Ostmann lipid layer

Relatif more wide

Venous drainage pleksus pterigoideus.

INNERVATION OF EUSTACHIAN TUBE

M. tensor veli palatine and m. tensor tympani part of

THE FUNCTIONS OF THE

Pressure in the middle ear is maintained through

ear mucosal gas exchange

3 SUBTYPES OF EUSTACHIAN TUBE DYSFUNCTION:

dilatory Eustachian tube

patulous Eustachian tube

DILATORY EUSTACHIAN TUBE

CLINICAL HISTORY: SYMPTOMS OF

ACUTE DILATORY EUSTACHIAN

upper respiratory tract infection

PATULOUS EUSTACHIAN TUBE DYSFUNCTION

fullness and autophony

SYMPTOMS AND SIGNS

CLINICAL ASSESSMENT: SIGNS OF EUSTACHIAN TUBE

Ideally assessment should include the following:

TESTS OF THE VENTILATORY

The Eustachian Tube Score (ETS) and its

condition: ossicular dislocation or erosion, timpanosklerotik,

condition : otosclerosis or middle ear effusi

Normal volume -> middle ear effusion, sclerosis

Condition : negatif pressure in

DILATORY EUSTACHIAN TUBE DYSFUNCTION

patient-reported symptoms evidence of

or otomicroscopic evidence of tympanic

IN BARO-CHALLENGE-INDUCED EUSTACHIAN TUBE DYSFUNCTION

otoscopy and tympanometry normal, so

PATULOUS EUSTACHIAN TUBE

symptoms + evidence on otoscopy or

Pure tone audiometry A mild or moderate

Examination may reveal a cause for Eustachian

in front of and around the ear, typically

air to flow into the Eustachian tube

In baro-challenge induced dysfunction, symptoms

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