Anatomy and Physiology of

the Eustachian Tube System

 Dysfunction
• Too closed
• Too open
• Too short
• Too stiff
• Won’s open
 Anatomy
• Wider at both end
• Isthmus is the most narrow
• Isthmus near the distal end of
cartilaginous portion and not at the
junction of the cartilaginous and osseous
portions.
 Torus Tubarius
• Abundant soft tissue overlying the
cartilage of the E-tube
• Behind the torus lies a deep pocket, the
fossa of Rosenmuller, varies in depth from
3-10mm and height from 8-10mm
• Adenoid tissue usually extends into this
pocket, giving soft-tissue support.
 Length
• Most of the increases in length take place
before age 6 years
• Usually 31 ~ 38mm
• Post 1/3 is osseous
• Ant 2/3 is cartilaginous and membrane
• Adult: 45 degree
• Infant: 10 degree
• The osseous E-tube (protympanum) within
the petrous portion
• The healthy osseous portion is open at all
times.
• The fibrocartilaginous portion is closed at
rest and opens during swallowing,
yawning, sneezing, or when forced open.
• The osseous and cartilaginous portions
meet at an irregular bony surface and form
an angle of about 160 degree.
• The medial wall of bony portion consists of
tow parts – posterolateral (labyrinthine)
and anteromedial (carotid)
• The tubal lumen is shaped like two cones
• The apex is the narrowest point of lumen
and called isthmus
 Histology
• Mucosal lining is characterized as respiratory
epithelium
• Mucous glands predominate at NPx and graded
change occurs to a mixture of goblet, columnar,
and ciliated cells near the tympanum
• The lining is folded, providing greater surface
area
• Mucosa-associated lymphoid tissue (MALT) is
present
 Muscles
• Tensor veli palatini
• Levator veli palatini
• Salpinogopharyngeus
• Tensor tympani
 Open and Close
• Open solely by tensor veli palatini muscle
• Close by passive reapproximation of tubal
walls by extrinsic forces exerted by
surrounding deformed tissues, by the
recoil of elastic fibers
 Tensor Veli Palatini
• Two bundles
• Mediolateral and the most lateral
 Pre-OP Assessment
• The status of the contralateral ear
• Age at onset
• Eustachian tube function
• Microscopic examination is the most
important aspect of the initial evaluation
• Pre-OP culture and x-rays are of
questionable value.
 Intraoperative Approach
The author’s preferences for OP setup
• The author’s preferences for OP setup
• Scrub nurse: across from the surgeon
• Microscope is at the top of the pt’s head
• Anesthesiologist on the same side as surgeon toward the foot
• Lidocaine with epinephrine is injected. Allow 2~3 mins.
• Zofran and Decadron are given intra-OP, usually at the start of OP
for prevention of post-OP N/V
• After OP, antibiotics solution is irrigated.
– Tazocin 3.375g in 20ml N/S in mastoid and middle ear. A few mls for
subcutaneous tissue
– Solu-medrol irrigation follows
• Occasionally, ceftriaxone 1g given intra-OP
• Gelfilm is used
• A subcuticular suture with Steri-Strips and mastoid dressing applied
 Post-OP Care
• Discharge occurs the day of surgery
• Remove mastoid dressing on next day by family or
patient
• The Steri-Strips are removed in 1 week.
• The cotton ball in ear is changed as needed until no
bleeding.
• Leave the ear open to air
• Allow to wash hair but keep air dry
• Oral antibiotics: quinolones or cephalosporins are given
for 5 days.
• Extra-strength acetaminophen or ibuprofen is usually
sufficient for pain
 Post-OP Care
• The first post-OP check is at 6 weeks, at
which time the dried Gelform is removed
• No antibiotics drops are given before this
time
• An audiogram is obtained
• Patient may begin to perform Valsalva
maneuver
• Return in 3 months for another audiogram
and recheck