anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...

, the Eustachian tube, also known as the auditory tube or pharyngotympanic tube, is a tube that links the

nasopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

to the

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the ...

, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in diameter. It is named after the sixteenth-century Italian anatomist Bartolomeo Eustachi. In humans and other

tetrapods Tetrapods (; ) are four-limbed vertebrate animals constituting the superclass Tetrapoda (). It includes extant and extinct amphibians, sauropsids (reptiles, including dinosaurs and therefore birds) and synapsids ( pelycosaurs, extinct therapsi ...

, both the middle ear and the ear canal are normally filled with air. Unlike the air of the ear canal, however, the air of the middle ear is not in direct contact with the atmosphere outside the body; thus, a pressure difference can develop between the atmospheric pressure of the ear canal and the middle ear. Normally, the Eustachian tube is collapsed, but it gapes open with swallowing and with

positive pressure Positive pressure is a pressure within a system that is greater than the environment that surrounds that system. Consequently, if there is any leak from the positively pressured system it will egress into the surrounding environment. This is in ...

, allowing the middle ear's pressure to adjust to the atmospheric pressure. When taking off in an aircraft, the ambient air pressure goes from higher (on the ground) to lower (in the sky). The air in the middle ear expands as the plane gains altitude, and pushes its way into the back of the nose and mouth; on the way down, the volume of air in the middle ear shrinks, and a slight vacuum is produced. Active opening of the Eustachian tube (through actions like swallowing or the Valsalva maneuver) is required to equalize the pressure between the middle ear and the ambient atmosphere as the plane descends. A diver also experiences this change in pressure, but with greater rates of pressure change; active opening of the Eustachian tube is required more frequently as the diver goes deeper, into higher pressure.

Structure

The Eustachian tube extends from the anterior wall of the middle ear to the lateral wall of the

, approximately at the level of the

inferior nasal concha The inferior nasal concha (inferior turbinated bone or inferior turbinal/turbinate) is one of the three paired nasal conchae in the nose. It extends horizontally along the lateral wall of the nasal cavity and consists of a lamina of spongy bone, c ...

. It consists of a bony part and a

cartilaginous Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck a ...

part.

Bony part

The bony part () nearest to the middle ear is made of

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

and is about 12 mm in length. It begins in the anterior wall of the tympanic cavity, below the septum canalis musculotubarius, and, gradually narrowing, ends at the angle of junction of the

squamous Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...

and the petrous parts of the

temporal bone The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples, and house the structures of the ears. ...

, its extremity presenting a jagged margin which serves for the attachment of the cartilaginous part. The vestibule of the Eustachian tube is known as the ''protympanum'', The protympanum is also known as the anterior part of the bony part of the tube.

Cartilaginous part

The cartilaginous part of the Eustachian tube is about 24 mm in length and is formed of a triangular plate of

elastic fibrocartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck and ...

, the apex of which is attached to the margin of the medial end of the bony part of the tube, while its base lies directly under the

mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It i ...

of the nasal part of the

pharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its st ...

, where it forms an elevation, the

torus tubarius The base of the cartilaginous portion of the Eustachian tube (auditory tube) lies directly under the mucous membrane of the nasal part of the pharynx, where it forms an elevation or cushion, the torus tubarius or torus of the auditory tube, behind ...

or cushion, behind the pharyngeal opening of the auditory tube. The upper edge of the cartilage is curled upon itself, being bent laterally so as to present on

transverse section The transverse plane (also known as the horizontal plane, axial plane and transaxial plane) is an anatomical plane that divides the body into superior and inferior sections. It is perpendicular to the coronal and sagittal planes. List of cli ...

the appearance of a hook; a groove or furrow is thus produced, which is open below and laterally, and this part of the canal is completed by fibrous membrane. The cartilage lies in a groove between the

petrous part of the temporal bone The petrous part of the temporal bone is pyramid-shaped and is wedged in at the base of the skull between the sphenoid and occipital bones. Directed medially, forward, and a little upward, it presents a base, an apex, three surfaces, and three an ...

and the great wing of the sphenoid; this groove ends opposite the middle of the

medial pterygoid plate The pterygoid processes of the sphenoid (from Greek ''pteryx'', ''pterygos'', "wing"), one on either side, descend perpendicularly from the regions where the body and the greater wings of the sphenoid bone unite. Each process consists of a me ...

. The cartilaginous and bony portions of the tube are not in the same plane, the former inclining downward a little more than the latter. The diameter of the tube is not uniform throughout, being greatest at the pharyngeal opening, least at the junction of the bony and cartilaginous portions, and again increased toward the tympanic cavity; the narrowest part of the tube is termed the isthmus. The position and relations of the pharyngeal opening are described with the nasal part of the pharynx. The mucous membrane of the tube is continuous in front with that of the nasal part of the pharynx, and behind with that of the tympanic cavity; it is covered with

ciliated pseudostratified columnar epithelia A pseudostratified epithelium is a type of epithelium that, though comprising only a single layer of cells, has its cell nuclei positioned in a manner suggestive of stratified epithelia. As it rarely occurs as squamous or cuboidal epithelia, ...

and is thin in the osseous portion, while in the cartilaginous portion it contains many mucous glands and near the pharyngeal orifice a considerable amount of

adenoid In anatomy, the adenoid, also known as the pharyngeal tonsil or nasopharyngeal tonsil, is the superior-most of the tonsils. It is a mass of lymphatic tissue located behind the nasal cavity, in the roof of the nasopharynx, where the nose blends ...

tissue, which has been named by Gerlach the tube tonsil.

Muscles

There are four muscles associated with the function of the Eustachian tube: * Levator veli palatini (innervated by the

vagus nerve The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and righ ...

) * Salpingopharyngeus (innervated by the vagus nerve) *

Tensor tympani The tensor tympani is a muscle within the middle ear, located in the bony canal above the bony part of the auditory tube, and connects to the malleus bone. Its role is to dampen loud sounds, such as those produced from chewing, shouting, or th ...

(innervated by the mandibular nerve of

CN V In neuroanatomy, the trigeminal nerve ( lit. ''triplet'' nerve), also known as the fifth cranial nerve, cranial nerve V, or simply CN V, is a cranial nerve responsible for sensation in the face and motor functions such as biting and chewing; ...

) *

Tensor veli palatini The tensor veli palatini muscle (tensor palati or tensor muscle of the velum palatinum) is a broad, thin, ribbon-like muscle in the head that tenses the soft palate. Structure The tensor veli palatini is found anterior-lateral to the levator ve ...

(innervated by the mandibular nerve of CN V) The tube is opened during swallowing by contraction of the tensor veli palatini and levator veli palatini, muscles of the

soft palate The soft palate (also known as the velum, palatal velum, or muscular palate) is, in mammals, the soft tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is the hard palate. ...

New anatomical perspectives

More recently, two developments have enhanced our understanding of the anatomy of the eustachian tube: Valsalva computerized tomography and endoscopic ear surgery. # Given the greater access to the ear anatomy using endoscopic methods, it has been suggested that the bony part of the eustachian tube is really the anterior extension of the middle ear cavity, or the "Protympanum". The term "Eustachian Tube" should be limited to the fibrocartilaginous structure connecting the protympanum to the nasopharynx. # The Eustachian tube is a sac like irregular structure rather than a tubular structure. # The ear side of the eustchian tube is by far the narrowest segment, called isthmus, and is probably the site of possible obstructive pathology causing chronic ear disease.

Development

The Eustachian tube is derived from the dorsal part of the first pharyngeal pouch and second endodermal pouch, which during embryogenesis forms the tubotympanic recess. The distal part of the tubotympanic sulcus gives rise to the tympanic cavity, while the proximal tubular structure becomes the Eustachian tube. It helps transformation of sound waves. File:Gray908.png, Frontal section through left ear; upper half of section File:Gray911.png, View of the inner wall of the tympanum (enlarged) File:Gray912.png, The right membrana tympani with the hammer and the chorda tympani, viewed from within, from behind, and from above

Function

Pressure equalization

Under normal circumstances, the human Eustachian tube is closed, but it can open to let a small amount of air through to prevent damage by equalizing pressure between the middle ear and the atmosphere. Pressure differences cause temporary

conductive hearing loss Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). If a conductive hearing loss occurs in conjunction with ...

by decreased motion of the

tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the a ...

and ossicles of the ear.Page 152 in: Various methods of ear clearing such as yawning, swallowing, or chewing gum may be used to intentionally open the tube and equalize pressures. When this happens, humans hear a small popping sound, an event familiar to aircraft passengers, scuba divers, or drivers in mountainous regions. Devices assisting in pressure equalization include an ''ad hoc'' balloon applied to the nose, creating inflation by positive air pressure. Some people learn to voluntarily 'click' their ears, together or separately, performing a pressure equalizing routine by opening their Eustachian tubes when pressure changes are experienced, as in ascending/descending in aircraft, mountain driving, elevator lift/drops, etc. Some are even able to deliberately keep their Eustachian tubes open for a brief period, and even increase or decrease air pressure in the middle ear. The 'clicking' can actually be heard by putting one's ear to another's while performing the clicking sound. This voluntary control may be first discovered when yawning or swallowing, or by other means (above). Those who develop this ability may discover that it can be done deliberately without force even when there are no pressure issues involved.

Mucus drainage

The Eustachian tube also drains mucus from the middle ear. Upper respiratory tract infections or allergies can cause the Eustachian tube, or the membranes surrounding its opening to become swollen, trapping fluid, which serves as a growth medium for bacteria, causing ear infections. This swelling can be reduced through the use of decongestants such as pseudoephedrine,

oxymetazoline Oxymetazoline, sold under the brand name Afrin among others, is a topical decongestant and vasoconstrictor medication. It is available over-the-counter as a nasal spray to treat nasal congestion and nosebleeds, as eyedrops to treat eye rednes ...

, and

phenylephrine Phenylephrine is a medication primarily used as a decongestant, to dilate the pupil, to increase blood pressure, and to relieve hemorrhoids. In the United States, it was previously used orally as an over-the-counter decongestant to relieve nas ...

. Ear infections are more common in children because the tube is horizontal and shorter, making bacterial entry easier, and it also has a smaller diameter, making the movement of fluid more difficult. In addition, children's developing immune systems and poor hygiene habits make them more prone to upper respiratory infections.

Clinical significance

Otitis media, or

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

of the

, commonly affects the Eustachian tube. Children under 7 are more susceptible to this condition, one theory being that this is because the Eustachian tube is shorter and at more of a horizontal angle than in the adult ear. Others argue that susceptibility in this age group is related to immunological factors and not Eustachian tube anatomy. Barotitis, a form of barotrauma, may occur when there is a substantial difference in air or water pressure between the outer and the middle ear – for example, during a rapid ascent while

scuba diving Scuba diving is a mode of underwater diving whereby divers use breathing equipment that is completely independent of a surface air supply. The name "scuba", an acronym for " Self-Contained Underwater Breathing Apparatus", was coined by Chr ...

, or during sudden decompression of an aircraft at high altitude. Some people are born with a dysfunctional Eustachian tube that is much slimmer than usual. The cause may be genetic, but it has also been posited as a condition in which the patient did not fully recover from the effects of pressure on the middle ear during birth (retained birth compression). It is suggested that Eustachian tube dysfunction can result in a large amount of mucus accumulating in the middle ear, often impairing hearing to a degree. This condition is known as

otitis media with effusion Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...

. A

patulous Eustachian tube Patulous Eustachian tube (PET) is the name of a physical disorder where the Eustachian tube, which is normally closed, instead stays intermittently open. When this occurs, the person experiences autophony, the hearing of self-generated sounds. ...

is a rare condition in which the Eustachian tube remains intermittently open, causing an echoing sound of the person's own heartbeat, breathing, and speech. This may be temporarily relieved by holding the head upside down. Smoking can also cause damage to the cilia that protect the Eustachian tube from mucus, which can result in the clogging of the tube and a buildup of bacteria in the ear, leading to a middle ear infection. Recurring and chronic cases of

sinus infection Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headac ...

can result in Eustachian tube dysfunction caused by excessive mucus production which, in turn, causes obstruction to the openings of the Eustachian tubes.

Ventilation tubes

In severe cases of childhood middle ear infections and Eustachian tube blockage, ventilation can be provided by a surgical puncturing of the eardrum to permit air equalization, known as

myringotomy A myringotomy is a surgical procedure in which an incision is created in the eardrum (tympanic membrane) to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube may be inserted through th ...

. The eardrum would normally naturally heal and close the hole, so a tiny plastic rimmed grommet is inserted into the hole to hold it open. This is known as a

tympanostomy tube Tympanostomy tube, also known as a grommet or myringotomy tube, is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The ope ...

. As a child grows, the tube is eventually naturally expelled by the body. Longer-lasting vent grommets with larger flanges have been researched, but these can lead to permanent perforation of the eardrum.

Dilation of the Eustachian tube

More recently, dilation of the eustachian tube using balloon catheter has gained attention as a method of treating eustachian tube obstruction. There are two methods of performing this procedure depending on the route of the catheter introduction and the area of the Eustachian tube to be dilated. Dennis Poe popularized the transnasal introduction and the dilation of the nose side of the eustachian tube. Muaaz Tarabichi pioneered the transtympanic (ear) introduction of the balloon catheter and the dilatation of the proximal part (the ear side) of the cartilaginous eustachian tube.

Other animals

In the equids (horses) and some rodent-like species such as the desert hyrax, an evagination of the Eustachian tube is known as the guttural pouch and is divided into medial and lateral compartments by the stylohyoid bone of the

hyoid The hyoid bone (lingual bone or tongue-bone) () is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. At rest, it lies between the base of the mandible and the third cervical vertebra. ...

apparatus. This is of great importance in equine medicine as the pouches are prone to infections, and, due to their intimate relationship to the cranial nerves (VII, IX, X, XI) and the internal and external carotid artery, various syndromes may arise relating to which is damaged.

Epistaxis A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low bl ...

(nosebleed) is a very common presentation to veterinary surgeons and this may often be fatal unless a balloon catheter can be placed in time to suppress bleeding.

References

External links

{{Authority control Ear