Week 3 - ET Dysfunction

Question 1

What are the 3 normal functions of the eustachian tube (ET)?

Answer 1

1. Ventilation: aeration & pressure regulation of ME and nasopharyx
2. Protection: from nasopharyngeal secretions ascending into ME and sudden pressure change
3. Clearance: mucociliary action clears secretions from ME into nasopharynx

Question 2

Which 2 muscles help open and close the ET?

Answer 2

Tensor veli palatini

Levator veli palatini

Question 3

When does the ET open?

Answer 3

Every 4-6 swallows
Yawning
Changes in atmospheric pressure

Question 4

What is the term for a constantly open ET?

Answer 4

Patulous Eustachian Tube

- may occur d/t rapid weight loss or pregnancy

Question 5

What might cause the ET to fail to open regularly?

Answer 5

Obstruction - masses in the ME or nasopharynx

Inflammation - allergy, infection, sinusitis (->negative ME pressure and retraction of TM)

Question 6

ETD may lead to what other pathologies?

Answer 6

Recurrent AOM or OME
Hearing Loss
Chronic retraction of TM (-> adhesions and retraction pockets; retraction pocket may evolve into cholesteatoma)

Question 7

What is the definition of recurrent AOM?

Answer 7

Greater than or equal to 3 separate cases of AOM in 6 months, or 4 in 12 months

Question 8

Name 3 symptoms of a closed ET

Answer 8

• fullness or pressure
• otalgia (ear pain)
• difficulty popping ears
• barb-challenged: poor pressure equalization (flying, scuba diving)

Question 9

What are 3 symptoms of a patulous/constantly open ET?

Answer 9

• fullness
• pulsatile tinnitus including clicking sensation
• autophony of voice or breathing: too loud

Question 10

Name 3 audiological findings that may indicate occluded ET

Answer 10

• hx of OM
• retracted TM
• negative TPP and/or reduced static admittance
• HL with conductive component

Question 11

How is the Valsalva Procedure used to assess ET Dysfunction?

Answer 11

• record pre-test tympanogram
• inflate ET and ME c/ gentle, forced expiration
• remeasure tymp (ensure pt doesn’t swallow)
• TPP shifts (usually + pressure change)

Question 12

What are some contraindications to the Valsalva, and what other problems could it cause?

Answer 12

Contraindications:

• vascular/coronary disease or abnormal blood pressure
• retinopathy or glaucoma
• 3rd trimester pregnancy

Violent exhalation could cause:

• damage to the inner ear
• fainting
• more serious problems

Question 13

What is the Toynbee Test?

Answer 13

A deflation test to ax changes in rising ME pressure

• record pre-test temp
• perform closed-nose swallowing
• remeasure tymp (TPP shifts)
• usually negative pressure change

Question 14

Aural fullness for less than 3 months with TM retraction would indicate:

a) chronic ETD
b) patulous ET
c) acute ETD
d) Baro-Challenge induced ETD

Answer 14

C) Acute ETD

Question 15

Aural fullness for more than 3 months with negative ME pressure would indicate:

a) chronic ETD
b) patulous ET
c) acute ETD
d) Baro-Challenge induced ETD

Answer 15

a) chronic ETD

Question 16

Discomfort or pain when there is a change in ambient pressure would indicate:

a) chronic ETD
b) patulous ET
c) acute ETD
d) Baro-Challenge induced ETD

Answer 16

d) Baro-Challenge induced ETD

Question 17

Popping and autophony of breathing and voice coupled with breathing induced TM excursion on otoscope or tympanometry would indicate:

a) chronic ETD
b) patulous ET
c) acute ETD
d) Baro-Challenge induced ETD

Answer 17

b) patulous ET

Question 18

What is the difference between the Valsalva test and the Politzer test?

Answer 18

With the Politzer test, the nasopharynx is passively inflated

Question 19

What is the point of conducting a physical examination with a flexible nasopharyngoscope?

Answer 19

To investigate potential obstruction of ET by nasal or pharyngeal masses, such as enlarged adenoids, soft tissue growths

Question 20

Besides using a nasopharyngoscope, how else might the ET be visualized

Answer 20

MRI and CT can be used to search for nasopharyngeal masses (carcinoma) and ME masses (e.g. cholesteatoma)

Question 21

How are ET obstructions d/t mass lesions usually managed in comparison to inflammation or infection?

Answer 21

Mass lesions usually surgically removed; inflammation and infections are treated pharmacologically

Question 22

T/F: The ET cannot be surgically modified

Answer 22

False: surgical inflation or modification of the ET is an option, along with PE tubes to bypass the dysfunctional ET and allow ventilation of ME