Excluded from this legal reservation are short excerpts related to scientific reviews or analyses, or materials provided specifically for the purpose of being entered and executed on a computer system, for the exclusive use of the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the publisher's location, in its current version, and permission for use must always be obtained from Springer.
Introduction
47 ] describes both its impact on the opening and closing function of the Eustachian tube. However, not only MRI but also low-dose sequential CT scans are suitable for assessing the anatomy as well as the function of the Eustachian tube.
Orientation and Length
One of Joseph Toynbee's key contributions is to point out that the Eustachian tube is closed at rest and opens only briefly during swallowing [190. MRI is an excellent method for assessing anatomical landmarks in and around the Eustachian tube. tube [ 99.
Compartments
- Cartilage
- Lumen
- Ligaments
- Membranous Wall
There is a gradual transition between the bony and fibrous cartilaginous part of the Eustachian tube. The slender salpingopharyngeal muscle is attached to the distal end of the Eustachian tube.
Neural Control
Between the muscle fibers are tendon fibers of the pharyngotubal ligament (“Zuckerkandl”). The role of the medial pterygoid muscle for tensor action is described in Chap.
Eustachian Tube Function
Relaxation of the medial pterygoid muscle rotates the tensor veli palatini muscle anterolaterally to the lumen of the Eustachian tube. Most researchers agree that the tensor veli palatini muscle is the primary dilator of the auditory tube [12.
Epidemiology of the Diseased Eustachian Tube
Eustachian Tube Dysfunction in Children
The last vector may indicate the role of the salpingopharyngeal muscle as an anchoring chain for the cartilage. One is the loss of Ostmann's adipose tissue, which has been described as a factor in the development of a patulous Eustachian tube [137.
Eustachian Tube Dysfunction in Cleft Palate Patients
In addition, the neuromuscular development of the tensor veli palatini muscle is generally incomplete before 7 years of age [59. It is obvious that during veloplasty the integrity of the hamulus as well as the tensor veli palatini muscle is at risk.
Eustachian Tube Function Tests
It is possible to study the mechanism of the opening of the Eustachian tube during swallowing using endoscopy with microfiber endoscope tubes less than 1 mm in diameter. However, the quality of the image, as well as the visualization of the lower anatomical structures of the middle ear (hypotympanum, foot plate, round window) are limited. 30 ] could demonstrate that the extent of wall motions varied depending on the position of the endoscope within the Eustachian tube and the individual.
CT and MRI can show the tissue surrounding the Eustachian tube, especially Ostmann's fat, and the position and diameter of the muscles.
Defi nition
Many of these patients can modify their symptoms by increasing the venous pressure in the mucosal vessels and the surrounding venous plexus of the Eustachian tube by compressing the jugular veins or by tilting the head. During sniffing, the Eustachian tube and middle ear are emptied by forced inhalation of the nose, which causes the eardrum and ossicular chain to harden. The risk of a long-term sniffing habit is the creation of chronic negative middle ear pressure and the development of middle ear disease.
On the other hand, reducing the intrathoracic pressure during sniffing causes a lower pressure of the cervical vein and, consequently, of the peritubal veins and may therefore even improve the symptoms [106.
Established Aetiological Factors and Therapeutic Procedures
Of these, 19 appeared to have a failure of Eustachian tube closure, but only 5 showed the clinical symptoms of a pET. Estrogen is thought to influence the viscosity of intratubal mucus [44] as well as the compliance of tubal cartilage [141. Neither edema-inducing drugs [130], nor paratubal injections into the pharynx [148], ventilation tubes in the ear drum [102], surgical manipulations of the tensor veli palatini muscle [206], nor a complete obstruction of the Eustachian tube can show more than temporary effects on symptoms.
The last two, however, can affect the opening function of the Eustachian tube and should be considered very critically regarding the development of chronic middle ear disease.
Diagnosis
Moreover, increased estrogen causes increased fat metabolism leading to a reduction of the Ostmann's fat block [ 188. One neuromuscular factor is a disturbance of the controlled tube opening during respiratory rest in the nasopharynx, with a delayed closure and the result of a relative closure failure [89. In addition, pathological changes of the central and peripheral nervous system must be considered, such as trauma or neurological system diseases, such as multiple sclerosis, Parkinson's disease or poliomyelitis [149.
The range of the etiological spectrum of pET explains the multitude of interventions proposed to treat symptoms.
Therapy
- Conservative Treatment
- Injection Therapy
- Surgical Therapy
- The “Dynamic Stabilization”
A frequently suggested therapy is the enlargement of the nasopharyngeal opening of the Eustachian tube. Surgical obstruction of the Eustachian tube can be performed in the nasopharyngeal or the tympanic opening. Factors of the hamulus and surgical manipulations at the tensor veli palatini muscle are known as the.
The tensor veli palatini opens the Eustachian tube for ventilation and at the same time provides active drainage of the middle ear. Contraction of the medial pterygoid muscle provides a posteromedial movement of the tensor veli palatini muscle to the Eustachian tube, increasing the tube opening pressure. Note the hypotrophy of the medial pterygoid muscle ( * ) and the straight course of the tensor veli palatini muscle.
Eustachian Tube and Middle Ear Mucosa: Two Players
General Assessment Prior to Middle Ear Surgery
Of great importance is the situation in the nasopharynx, soft palate, lymphatic tissue, adenoids and tubal opening and its surroundings. Although a plain radiograph (according to Schüller) can be obtained to obtain information about the aeration status of the middle ear space, CT scanning of the temporal bone provides more accurate visualization. Prior to middle ear surgery, a complete audiometric evaluation, including pure tone and speech audiometry and speech discrimination, should be performed in all patients.
The tuning fork examination according to Weber and Rinne is also necessary to confirm findings obtained in the audiogram.
Eustachian Tube: Preoperative Testing and Evaluation
If information about the soft tissue of the Eustachian tube is needed, MRI scanning is necessary. Even if the situation for ventilation of the middle ear space is unclear, the Eustachian tube can still drain well. A patient who can perform Valsalva's maneuver may be able to open his/her Eustachian tube postoperatively, allowing middle ear secretions to be transported out of the middle ear space.
However, this only indicates that there is an open passage; it is not a robust test of Eustachian tube function.
Conservative Treatment of the Eustachian Tube Obstruction
- Tubal Insertion
- Tubal Augmentation
- Laser Tuboplasty
- The Unaerated Middle Ear: Total Stenosis
In BET, a balloon catheter is placed in the cartilaginous part of the Eustachian tube by transnasal endoscopy-controlled insertion. Eustachian tube function tests were significantly better in more than 90% of cases. The reports of augmentation surgery in the osseous part of the Eustachian tube are few.
It is not a general tube treatment and does not cover the mucosal/eustachian tube system.
Eustachian Tube and Tympanoplasty
Basic Considerations in Tympanoplasty
The first goal of treatment in chronic middle ear disease is to cure the chronic inflammation. The risk of complications will depend on the entity of the middle ear disease. A loop ear with slowly increasing hearing loss can be seen as a less dramatic situation, and the risk of life-threatening complications is negligible.
Nevertheless, in the case of chronic purulent otitis media or even in non-spectacular chronic otitis media with effusion, all these major complications are possible.
Materials for Reconstruction of the Tympanic Membrane
For cosmesis, the cut through the skin and cartilage should be performed approximately 2-3 mm below the free edge of the tragus (Fig. 4.3a, b). To create a cartilage/perichondrium island flap, the cartilaginous edge of the har- The established composite piece of cartilage and perichondrium is thinned using a number 10 blade. The technique consists of placing longitudinal strips of cartilage parallel to the hammer handle, avoiding blockage of the Eustachian tube opening in the middle ear [64.
The tympanic membrane reconstruction begins anteriorly, just above the opening of the Eustachian tube in the middle ear.
Materials for Reconstruction of the Ossicular Chain
Hydroxyapatite can be molded in the manufacturing process, reducing the sharp edges that can lead to elongation, but it is the slightly heavier of the two materials and less malleable. Due to the common phenomenon of atelectasis in the chronically diseased middle ear, there is always a tendency to lengthen the prostheses. Therefore, when using the palisade technique, it is important to ensure complete coverage of the prosthesis with the cartilage parts.
This means that lengthening of the bony chain is part of the natural course of disease.
Eustachian Tube Function in Different Middle Ear Disease
- Chronic Otitis Media with Effusion
- Chronic Suppurative Otitis Media
- Atelectatic Ear (Adhesive Process)
- Tympanosclerosis and Tympanofi brosis
- Cholesteatoma
- Eustachian Tube Function, Eradication of Sinonasal
The surgical treatment consists in removing all the retracted epithelium from the eardrum. This type of surgery is one of the most delicate operations in the middle ear. If the tympanic membrane does not perforate and the aeration of the tympanic membrane remains stable, there is a chance of.
Probing the Eustachian tube is possible in most patients, and the mastoid can be well ventilated.
Prediction of Tympanoplasty Results, Eustachian
Eustachian Tube Function and Mastoid Surgery
However, in cases of combined problems, eradication of the sinus disease should be performed first and the time period before tympanoplasty should be at least 6 months.
Ventilation Tubes, Tympanoplasty and Eustachian
Furthermore, it has been suggested that ventilating the reconstructed tympanic membrane will facilitate healing of the middle ear mucosa after tympanoplasty [200.
Alternatives for the Unaerated Middle Ear: Conventional
Hecht CS, Gannon PJ, Eden AR (1993) Motor innervation of the Eustachian tube muscles in the guinea pig. Murti K, Stern R, Cantekin EI, Bluestone CD (1980) Sonometric evaluation of Eustachian tube function using broadband stimuli. Kumagami H (2007) Measurement of angle and length of the Eustachian tube on computed tomography using the multiple reconstruction technique.
