PubMed · 6598273
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J Sadé. 1984. Eustachian tube function.. https://doi.org/10.3109/00016488409122886
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Prolonged observations of the eustachian tube (ET) function were made on 40 ears of 20 patients with nasopharyngeal carcinoma (NPC) who survived more than 5 years after radiotherapy in a state of remission. The ET function tests included passive opening, inflation-deflation, and clearance, and were performed before, at 6 months, and at 5 years after radiotherapy. The test results were found to be worst at 6 months after radiotherapy and improved at 5 years after radiotherapy. Tubal obstruction and inflammation are the main causes of the ET malfunction that results in otitis media with effusion (OME) in NPC patients after radiotherapy. Insertion of a ventilation tube into the ear with OME can relieve tubal obstruction but can aggravate inflammation. Thus, myringotomy and aspiration of effusion and local treatment may be preferable to insertion of a ventilation tube in NPC patients with OME. When hearing improvement in prolonged survival of NPC patients with OME is needed, the use of amplification is recommended.
Serial anatomy of the auditory tube (AT), was studied in nine anatomical specimens, according to transverse, coronal and specific oblique planes and was correlated to computed tomography and magnetic resonance imaging. In order to assess the orientation of the oblique plane, parallel to the AT, 30 AT specimens were catheterized: the mean angle between the AT and the Virchow plane or the bony palate was 34 degrees. The bony portion is better explored with CT, whereas the cartilaginous portion is better studied with MR. The cartilage, posterior and medial, is closed anteriorly and inferiorly by a fibrous membrane (lamina membranacea), which is not seen on CT or MR images. The AT is closely related to the tensor veli palatini muscle (TVPM) anterolaterally, and the levator veli palatini muscle inferiorly (LVPM); both are well imaged on the oblique plane. They are bounded by fascias: the submucosal fascia (tela submucosa) is medial, the pharyngobasilar fascia runs between the TVPM and the LVPM and the auditory tube; the fascia of Weber-Liel is lateral to the TVPM. Fascias are difficult to distinguish from the surrounding fatty tissue and the adjacent muscles. The auditory tube and its muscles, forming the lateral wall of the nasopharynx, are well studied by CT and MR imaging, using the transverse or, preferably oblique plane, together with coronal plane.
This communication uses our recent quantitative morphometric studies to develop a hypothesis for localization of ventilatory, clearance, and protective functions in different portions of the eustachian tube (ET). We hypothesize that the ET roof is involved mainly with ventilation and that the ET floor is involved mainly with clearance, whereas both portions are involved with protection of the middle ear. The hypothesis states that 1) the cross-sectional shape of the ET lumen and the attachment of the tensor veli palatini muscle to the tip of the lateral lamina are important for ventilation, 2) the ciliated cells in the ET floor subserve clearance, 3) the richly distributed elastin in the hinge portion of the ET cartilage, Ostmann's fatty tissue, and rich mucosa-associated lymphoid tissue are protective, 4) the well-developed ET cartilage lateral lamina is important for both ventilation and protection, and 5) the rich mucosal folding, goblet cells, and glands subserve both clearance and protection. Finally, the utility of the hypothesis for elucidating anatomic factors in otitis media is discussed.