The Eustachian tube functions to ventilate and regulate middle ear pressure, protect the ear from nasopharyngeal sound and secretions, and clear secretions from the middle ear. Disorders of the Eustachian tube can cause tubal blockage and dysfunction, leading to symptoms like ear pain, hearing loss, and dizziness. Causes of Eustachian tube obstruction include upper respiratory infections, allergies, sinusitis, nasal polyps, adenoids, and tumors. Tests like tympanometry are used to evaluate Eustachian tube function.

1. Eustachian Tube

5. Functions
Ventilation and thus regulation of
middle ear pressure.
 Protection against
Nasopharyngeal sound pressure
Reflux of nasopharyngeal secretions
 Clearance of middle ear secretions

6. Disorders of Eustachian
Tube

7. Tubal Blockage
 Mechanical
Intrinsic
 Inflammation
 Allergy
Extrinsic
 Tumour in nasopharynx
 Adenoids
 Functional
Collapse of tube
 Both

9. Symptoms
 Otalgia
 Hearing loss
 Popping sensation
 Tinnitus
 Disturbances of equilibrium
Vertigo

10. Signs
 Retracted tympanic membrane
 Congestion along handle of malleus
and pars tensa
 Transudate behind tympanic
membrane - amber colour
 Fluid level with conductive hearing
loss

11.  Severe cases
Tympanic membrane markedly retracted
Haemorrhage in subepithelial layer
Haemotympanum
Perforation

12. Effects of Tubal Blockage
Acute tubal blockage
Absorption of middle ear gases
Negative pressure in middle ear
Retraction of tympanic membrane
Transudate in middle ear/haemorrhage
(Acute Otitis Media)

13. Acute Otitis Media (Thin Watery or Mucoid
Discharge)
Atelectatic Ear/Perforation
Retraction pocket/Cholesteatoma
Erosion of Incudostapedial Joint

14. Causes of Eustachian Tube
Obstruction
 Upper Respiratory
Tract Infection
 Allergy
 Sinusitis
 Nasal Polyps
 Deviated Nasal
Septum
 Hypertrophic
Adenoids
 Nasopharyngeal
tumour/mass
 Cleft palate
 Submucous Cleft
Palate
 Down Syndrome
 Functional

15. Adenoids and Cleft Palate
Adenoids Cleft Palate
 Mechanical
obstruction of the
tubal opening
 Acting as reservoir
for pathogenic
organisms
 Allergy – mast
cells of adenoid
tissue release
 Abnormalities of
torus tubarius – high
elastin density
 Tensor veli palatini
muscle does not
insert into torus
tubarius

16. Down Syndrome
 Poor tone of tensor veli palatini
muscle
 Abnormal shape of nasopharynx
 Children – more prone to otitis media/
otitis media with effusion

17. Barotrauma
 Non-suppurative condition
 Failure of eustachian tube to maintain
middle ear pressure at ambient
atmospheric pressure

18. Causes
Rapid descent during flight
Underwater diving
Compression in pressure chamber

19.  Clinical Features
Severe earache
Hearing loss – conductive type
Tinnitus
Tympanic membrane – retracted &
congested
Middle ear – air bubbles or
haemorrhagic effusion

20.  Treatment
Aim: To restore middle ear aeration
Mild cases
Decongestants & Antihistaminics
Presence of fluids
Myringotomy

21.  Prevention
Avoid travel with URTI
Swallow repeatedly during descent
Avoid sleep during descent
Autoinflation of tube by Valsalva during
descent
Medication
Vasoconstrictor nasal spray
Systemic decongestant

22.  Recurrent barotrauma
Nasal polyps
Septal deviation
Nasal allergy
Chronic sinus infection

23. Patulous Eustachian Tube
 Tube abnormally patent
 Causes
Idiopathic
Rapid weight loss
Pregnancy – 3rd trimester
Multiple sclerosis

24.  Signs and Symptoms
Autophony
Movements of tympanic membrane with
inspiration and expiration
Further exaggerated if patient breathes
after closing opposite nostril

25. Retraction Pockets
 Obstruction of eustachian tube
Total atelectasis of tympanic membrane
 Obstruction in middle ear
Retraction pocket in posterior part of middle ear
Anterior pocket ventilated.
 Obstruction of isthmi
Attic retraction pocket

26.  Obstruction at aditus
Cholesterol granuloma
Collection of mucoid discharge in
mastoid air cells
Middle ear normal
Attic normal

27. Examination of Eustachian
Tube
 Pharyngeal End
Posterior rhinoscopy
Rigid nasal endoscope
Flexible nasopharyngoscope
 Tympanic End
Microscope
Endoscope
Otoscope

28. Eustachian Tube Function
Tests
Valsalva test
 Politzer test
 Catheterisation
 Toynbee’s Test
 Tympanometry
 Radiological test
 Saccharine or
Methylene Blue
test
 Sonotubometry

29. Valsalva test

30. Politzer Test

32. Catheterisation

33. Tympanometry

34. Radiological Test
Instill radio-opaque
dye
in middle
ear
Take X-ray
Observe
eustachian
tube
Check for
obstruction

35. Saccharine or Methylene Blue
Test
Place saccharine
solution in middle
ear
Reaches pharynx
Imparts sweet taste
Measure time taken
Place methylene
blue in middle ear
Stains pharyngeal
secretions
Measure time
taken

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