EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may...
Transcript of EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may...
![Page 1: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/1.jpg)
EUSTACHIAN TUBAL INSUFFICIENCY
Aetiology
© Bruce Black MD
![Page 2: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/2.jpg)
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
![Page 3: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/3.jpg)
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
![Page 4: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/4.jpg)
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
![Page 5: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/5.jpg)
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
![Page 6: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/6.jpg)
Eustachian dysfunction 3. Prolonged tubal occlusion results in an effusion filling the middle ear cleft as air is
progressively reabsorbed. © Bruce Black MD
![Page 7: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/7.jpg)
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
![Page 8: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/8.jpg)
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
![Page 9: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/9.jpg)
Bifid uvula. This may be associated with a sub-mucosal cleft of the palatal musculature, causing tubal insufficiency.
© Bruce Black MD
![Page 10: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/10.jpg)
Hare lip repair. Beware an associated palate cleft if managing tubal insufficiency.
© Bruce Black MD
![Page 11: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/11.jpg)
Hare lip repair, associated cleft palate, cholesteatoma.
© Bruce Black MD
![Page 12: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/12.jpg)
Cleft palate. Long history of middle ear effusions and repeated vent tube insertions.
© Bruce Black MD
![Page 13: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/13.jpg)
Past cleft palate repair. Bilateral marked adhesive otitis.
© Bruce Black MD
![Page 14: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/14.jpg)
Complications of Eustachian tubal failure.
© Bruce Black MD
![Page 15: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/15.jpg)
“Goldfish Syndrome”: chronic juvenile mouth-breathing due to hypertrophied adenoids. Concurrent middle ear effusions
are common. © Bruce Black MD
![Page 16: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/16.jpg)
Adenoidal hypertrophy causing chronic mouth-breathing and bilateral middle ear effusions. Protruding auricles.
© Bruce Black MD
![Page 17: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/17.jpg)
Bilateral tubal insufficiency. Large tonsils, adenoids similarly enlarged and infected.
© Bruce Black MD
![Page 18: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/18.jpg)
Plain film, lateral post-nasal space, showing total occlusion of the posterior nasal airway due to adenoidal hypertrophy.
© Bruce Black MD
![Page 19: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/19.jpg)
A large adenoid pad touching on the soft palate. Chronic infection and tubal problems likely.
© Bruce Black MD
![Page 20: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/20.jpg)
Total PNS occlusion by a large adenoid pad.
© Bruce Black MD
![Page 21: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/21.jpg)
Deflected nasal septum, chronic right Eustachian insufficiency due to tubal blockage.
© Bruce Black MD
![Page 22: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/22.jpg)
Coronal CT of the previous case sinuses. Septal deflection occluding the right nasal passage.
© Bruce Black MD
![Page 23: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/23.jpg)
Giant haemangioma of the PNS with palatal extension. Palatal dysfunction resulted in tubal insufficiency.
© Bruce Black MD
![Page 24: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/24.jpg)
Atopic dermatitis. Nasal allergy and Eustachian tubal problems commonly co-exist.
© Bruce Black MD
![Page 25: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/25.jpg)
The dry and excoriated skin of chronic atopic dermatitis Chronic tubal problems may result from persistent nasal
allergy and infection. © Bruce Black MD
![Page 26: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/26.jpg)
Lymphoma of the post-nasal space, secondary middle ear effusion. The tumour mass can be glimpsed beyond the soft
palate. © Bruce Black MD
![Page 27: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/27.jpg)
Previous case, catheter retraction of the soft palate revealing the bulk of the tumour mass.
© Bruce Black MD
![Page 28: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/28.jpg)
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
![Page 29: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/29.jpg)
Carcinoma of the right PNS axial MRI view. Common in cases of south Chinese ancestry.
© Bruce Black MD
![Page 30: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/30.jpg)
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
![Page 31: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/31.jpg)
A large PNS carcinoma eroding the pterygoid plates to the left, and impinging on the airway. Middle ear effusion
present . © Bruce Black MD
![Page 32: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/32.jpg)
Right middle ear effusion. The moderately extensive air cell system is opacified compared to the aerated left side.
© Bruce Black MD
![Page 33: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/33.jpg)
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
![Page 34: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/34.jpg)
Chronic Right tubal failure. The mastoid cells are lesser developed and opaque compared with the normal left
system. © Bruce Black MD
![Page 35: EUSTACHIAN TUBAL INSUFFICIENCY Aetiology€¦ · Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS pathology, or the osseous](https://reader030.fdocuments.in/reader030/viewer/2022040305/5ead13da05510576843b8a26/html5/thumbnails/35.jpg)
Coronal view of the previous case. Underdeveloped and opacified Rt mastoid air cell system.
© Bruce Black MD