PubMed · 3422603
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L L D'Antonio, W D Gay, H R Muntz, J L Marsh. 1988. Obturation and eustachian tube dysfunction?. https://pubmed.ncbi.nlm.nih.gov/3422603/
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The auditory tube is a bony and cartilaginous canal which connects the middle ear to the nasopharynx. The bony portion (protympanum), explored by computed tomography, is cone shaped, with a posterior base. The main relations are: the intrapetrous carotid, the tensor tympani muscle, the middle cerebral fossa and temporo-mandibular joint. The fibrocartilaginous portion is explored by computed tomography and mainly by magnetic resonance. The fibrocartilaginous tube is posteromedial; its upper margin is curled outward to form the roof of the cartilaginous tube. Anterioly and Laterally, the auditory tube is closed by a fibrous membrane extending along the inferior surface of the auditory tube to form its floor. The auditory tube is in contact with two main muscle: the tensor veli palatini anterolateral and the levator veli palatini posterolateral and inferior. They are bounded by fascia: the intrapharyngeal fascia is medial, the pharyngo basilar fascia (salpingopharyngeal fascia of Trölstch, is between the tensor and levator veli palatini muscles; the fascia of Weber Liel is lateral to the tensor veli palatini. The auditory tube and its muscles form the lateral wall of the rhinopharynx and prevent the extension of a pathologic process to the para pharyngeal and infratemporal spaces.
Increasing evidence has been accumulated in the last few years associating immunological mechanisms in the pathogenesis of secretory otitis media. If immunological processes were found to be involved in both of the previously accepted experimental pathogenic models (Eustachian tube obstruction: microbiologically induced) of the disease, recently published data has provided evidence for a third, not Eustachian tube--or microbiological-dependent, exclusively immunological, experimental model. This suggests that immunological mechanisms are probably always involved in the pathogenesis of a disease that is known to be multifactorial in origin, and thus eventually make Immunology the single most important factor in secretory otitis media. In the present article these recent concepts are extensively reviewed by the authors.