title: New insights into mechanism of Eustachian tube ventilation based on cine computed tomography images.
abstract: There is debate concerning the mechanism of Eustachian tube (ET) ventilation. While a mechanism of complete opening has been advocated previously, sequential contraction of the levator veli palatini and medial pterygoid muscles followed by the tensor veli palatini and lateral pterygoid muscles may produce a transient sequential opening mechanism, allowing an air bolus to traverse the ET. This may explain confusion surrounding sonotubometry reports that not every swallow leads to sound passage in normal subjects. We hypothesize that the ET may not need to open completely when ventilating the middle ear; rather, a discrete air bolus can pass through it. Five normal and five disordered subjects underwent low-radiation dose cine computed tomography (CT) scans of the ET. Sixteen contiguous 2.5 mm slice locations were chosen through a 4 cm area in the nasopharynx that were parallel to and encompassed the entire ET. Twelve images were acquired at each slice over 4.8 s during swallowing and other tasks. Serial images were analyzed. An air bolus was observed passing through the ET in the normal subjects, but not the subject with ET dysfunction. Medial and lateral pterygoid contractions were also observed. A new hypothetical mechanism of transient sequential ET ventilation is presented. This is not a definitive conclusion, as the number of scans taken and maneuvers used was limited. Improved understanding of ET ventilation may facilitate management of middle ear disease as treatment evolves from ventilatory tube placement to ET manipulation.
authors: Department of Surgery, Division of Otolaryngology,Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA.
authors: Michael H
authors: MH
authors: McDonald
authors: Matthew R
authors: MR
authors: Hoffman
authors: Lindell R
authors: LR
authors: Gentry
authors: Jack J
authors: JJ
authors: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003679:Deglutition; D004427:Ear Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005064:Eustachian Tube / Q000000981:diagnostic imaging / Q000502:physiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010156:Palatal Muscles / Q000000981:diagnostic imaging / Q000502:physiology* / Q000503:physiopathology; D011312:Pressure; D011626:Pterygoid Muscles / Q000502:physiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed