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    Anatomy and Physiology of The Eustachian Tube System

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    李丞永
    The document discusses the anatomy and physiology of the Eustachian tube system. It describes common dysfunctions and provides details on the anatomy, histology, muscles, and function of opening and closing. It also outlines the author's approach to pre-operative assessment, intraoperative setup, and post-operative care for Eustachian tube surgery.

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    Anatomy and Physiology of The Eustachian Tube System

    Uploaded by

    李丞永
    17 views16 pages
    The document discusses the anatomy and physiology of the Eustachian tube system. It describes common dysfunctions and provides details on the anatomy, histology, muscles, and function of opening and closing. It also outlines the author's approach to pre-operative assessment, intraoperative setup, and post-operative care for Eustachian tube surgery.

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    Anatomy and Physiology of the Eustachian Tube System

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    The document discusses the anatomy and physiology of the Eustachian tube system. It describes common dysfunctions and provides details on the anatomy, histology, muscles, and function of opening and closing. It also outlines the author's approach to pre-operative assessment, intraoperative setup, and post-operative care for Eustachian tube surgery.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    17 views16 pages

    Anatomy and Physiology of The Eustachian Tube System

    Uploaded by

    李丞永
    The document discusses the anatomy and physiology of the Eustachian tube system. It describes common dysfunctions and provides details on the anatomy, histology, muscles, and function of opening and closing. It also outlines the author's approach to pre-operative assessment, intraoperative setup, and post-operative care for Eustachian tube surgery.

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    You are on page 1of 16

    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

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