Head and Neck Imaging

Eustachian tube dysfunction

Dysfunction of the eustachian tube effects middle ear ventilation, and the drainage of secretions from the middle ear to the nasopharynx. It has a wide clinical spectrum, ranging from mild to chronic otitis media. Reasons for eustachian tube dysfunction are:

  • mucosal oedema at the opening of the eustachian tube, caused by an inflammatory process in the surrounding area (such as sinusitis or inflammation of the pharyngeal tonsil)

  • obstruction of the opening of the eustachian tube by a hyperplastic pharyngeal tonsil (common in childhood)

  • insufficiency of the tensor and levator veli palatini muscle such as seen in patients with cleft palate. These muscles open the eustachian tube during swallowing.

  • distortion or infiltration of the eustachian tube by a mass lesion, benign or malignant (Fig.1)

    Otitis in childhood is frequent and usually resolves spontaneously. In adults with persistent symptoms of otitis (more than 6 weeks), exploration of the nasopharynx should be performed, either endoscopically or radiographically, to exclude a tumoral lesion. Nasopharyngeal carcinoma commonly presents with otitis media.

    A eustachian tube may also be patulous (hyperpatent), causing more or less similar symptoms; these patients complain that they can hear their own breathing.

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    Fig.1

    Adult patient presenting with serous otitis media on left side. Axial T2-weighted spin-echo image shows fluid in left mastoid (arrowhead); a submucosal cystic lesion (arrows) distorts the nasopharyngeal end of the eustachian tube. Benign cyst of branchiogenic origin.
    Eustachian tube dysfunction, Fig.1