Week 3 - ET Dysfunction Flashcards
What are the 3 normal functions of the eustachian tube (ET)?
- Ventilation: aeration & pressure regulation of ME and nasopharyx
- Protection: from nasopharyngeal secretions ascending into ME and sudden pressure change
- Clearance: mucociliary action clears secretions from ME into nasopharynx
Which 2 muscles help open and close the ET?
Tensor veli palatini
Levator veli palatini
When does the ET open?
Every 4-6 swallows
Yawning
Changes in atmospheric pressure
What is the term for a constantly open ET?
Patulous Eustachian Tube
- may occur d/t rapid weight loss or pregnancy
What might cause the ET to fail to open regularly?
Obstruction - masses in the ME or nasopharynx
Inflammation - allergy, infection, sinusitis (->negative ME pressure and retraction of TM)
ETD may lead to what other pathologies?
Recurrent AOM or OME
Hearing Loss
Chronic retraction of TM (-> adhesions and retraction pockets; retraction pocket may evolve into cholesteatoma)
What is the definition of recurrent AOM?
Greater than or equal to 3 separate cases of AOM in 6 months, or 4 in 12 months
Name 3 symptoms of a closed ET
- fullness or pressure
- otalgia (ear pain)
- difficulty popping ears
- barb-challenged: poor pressure equalization (flying, scuba diving)
What are 3 symptoms of a patulous/constantly open ET?
- fullness
- pulsatile tinnitus including clicking sensation
- autophony of voice or breathing: too loud
Name 3 audiological findings that may indicate occluded ET
- hx of OM
- retracted TM
- negative TPP and/or reduced static admittance
- HL with conductive component
How is the Valsalva Procedure used to assess ET Dysfunction?
- record pre-test tympanogram
- inflate ET and ME c/ gentle, forced expiration
- remeasure tymp (ensure pt doesn’t swallow)
- TPP shifts (usually + pressure change)
What are some contraindications to the Valsalva, and what other problems could it cause?
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
What is the Toynbee Test?
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
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
C) Acute ETD
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
a) chronic ETD
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
d) Baro-Challenge induced ETD
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
b) patulous ET
What is the difference between the Valsalva test and the Politzer test?
With the Politzer test, the nasopharynx is passively inflated
What is the point of conducting a physical examination with a flexible nasopharyngoscope?
To investigate potential obstruction of ET by nasal or pharyngeal masses, such as enlarged adenoids, soft tissue growths
Besides using a nasopharyngoscope, how else might the ET be visualized
MRI and CT can be used to search for nasopharyngeal masses (carcinoma) and ME masses (e.g. cholesteatoma)
How are ET obstructions d/t mass lesions usually managed in comparison to inflammation or infection?
Mass lesions usually surgically removed; inflammation and infections are treated pharmacologically
T/F: The ET cannot be surgically modified
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
