Eustachian Tube Function, Anatomy & Diagram | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Pharyngotympanic tube The eustachian tube is a canal that connects the middle ear to the nasopharynx, which consists of the upper throat and the back of the nasal cavity. It controls the pressure within the middle ear, making it equal with the air pressure outside the body. Most of the time the eustachian tube is closed, opening only during activities such as yawning, swallowing, and chewing, to allow air through the passage between the middle ear and nasopharynx. When atmospheric pressure changes rapidly, causing a sudden feeling of blockage in the ear (such as during airplane travel), these activities can be done on purpose to open the tube and equalize the pressure within the middle ear. When the eustachian tube will not open enough to equalize pressure, symptoms such as discomfort, dizziness, or ringing in the ear may result.

Visual examination of the eardrum with a lighted scope helps to determine if the cause is inflammation, swelling, or fluid in the ear. Conditions such as nasal congestion, infection of the ear or sinus, or allergies may cause these symptoms and lead to eustachian tube problems. These causes can often be treated with decongestant medication or antibiotics, but in severe cases, surgery may be necessary. Pharynx. Part 2 Pharynx. Part 2 Description This section is from the book " Applied Anatomy: The Construction Of The Human Body ", by Gwilym G. Davis. Also available from Amazon: Applied anatomy: The construction of the human body . Pharynx. Part 2 Introducing The Eustachian Catheter In introducing the Eustachian catheter, the tip of the nose is to be tilted upward until the anterior nares are raised to the level of the floor of the nose. The tip of the catheter is then passed first upward (Fig. 152), then along the floor until it is felt to pass beyond the soft palate and strike the posterior wall of the pharynx (Fig. 153).

It is usually advised to enter the catheter in a vertical position and then change to a horizontal one as soon as the beak passes over the elevation which marks the separation of the vestibule of the nose from the interior. If this method is used, care should be taken to keep the tip of the catheter on the floor of the nose and not pass it up in the region of the middle turbinate bone . There are three ways of introducing the beak of the catheter into the mouth of the tube after it is felt touching the posterior pharyngeal wall. The first is to withdraw the beak about 2 cm. away from the wall of the pharynx and then turn it upward and outward, pushing it a trifle onward. The second way is to turn the beak directly outward and draw it forward, when it can be felt passing over the cartilaginous opening of the tube. The third way is to turn the beak inward and draw it forward until it catches behind the septum . This is opposite the anterior edge of the mouth of the tube. The beak is then rotated downward and then upward and outward into the tube.

Liquids and sprays are sometimes injected into the ear through the catheter; bougies are also passed into the tube in the same manner as the catheter or, if flexible bougies are used, they are passed through the catheter. As the tip of the bougie passes into the bony portion of the canal, the constriction of the isthmus can be felt 2.5 cm. up from its mouth. The bougie should not be passed farther than 3 cm. into the tube, otherwise, if the tympanum is entered, the ossicles are apt to be injured. Openings Of The Mouth, Larynx, And Oesophagus The opening of the mouth into the pharynx is sometimes narrowed from cicatricial contractions, resulting from ulcerative processes due to syphilis, caustics, etc. I here is rarely obstruction downward, so that these patients can usually swallow, but the cicatrices contract the opening upward, and the soft palate, its arches, and the walls of the pharynx may be all bound together in one cicatricial mass, preventing, as I have seen, all respiration through the nose.

This condition is an exceedingly difficult one to remedy, as the contraction tends to recur even after the most radical operations . FlG. 152. - Introducing the Eustachian catheter, first step. Fig. 153. - Introducing the Eustachian catheter, second step. Fig. 154. - Introducing the Eustachian catheter, third step. The opening into the larynx is more accessible than is often supposed. On drawing the tongue well forward, the tip of the epiglottis can be seen. If a long straight tongue depressor is used, Kirstein has shown that in many patients the arytenoid cartilages and even a portion of the vocal cords can be seen. The opening into the larynx can readily be felt by a finger introduced into the mouth. In cases of suffocation from a foreign body, as a piece of meat, it is usually lodged at this point, part of the foreign body being in the larynx and part in the pharynx. It can readily be dislodged by the finger, as I have done in impaction of meat, the result of vomiting in ether narcosis.

The forefinger should be thrust its full length into the mouth and throat and swept from side to side. The obstructing body can usually be brushed aside and brought up in front of the finger into the mouth. The opening of the oesophagus is in a line with the long axis of the pharynx; it is at its lower end. The opening of the larynx, on the contrary, is more on its anterior wall. It is for this reason that when an oesophageal tube is introduced, either through the mouth or through the nose, it goes down into the oesophagus and does not enter the larynx. The oesophagus is narrowest at this point. The pharyngeal tonsil stretches across the posterior wall and roof of the pharynx from the opening of one Eustachian tube to that of the other. It is also known as Luschka's tonsil. It is composed of lymphoid tissue, and when enlarged constitutes the disease known as adenoids. It is not true secreting gland tissue, though it contains some mucous glands.

It hangs from the vault of the pharynx in a more or less lobulated mass and when large, in children, obstructs nasal respiration. Mouth-breathing results, the child is apt to snore and make queer sounds when sleeping, and the habit of keeping the mouth open causes a peculiar expression of the face almost pathognomonic of the affection. The blood supply at times is abundant. When adenoids are present, their removal is usually undertaken. This is done by introducing an instrument either through the nose or through the mouth and scraping them off. A curette is used for this purpose. That known as Gottstein's consists of an oval-shaped ring set at right angles to a long shaft. It is introduced through the mouth and up behind the soft palate. It is then pushed against the vault of the pharynx and posterior wall and drawn downward cutting and scraping the adenoid tissue away. A much smaller ring curette set on a long, delicate, but stiff handle may be used through the nose for the same purpose. In using the latter instrument, it is common to use an anaesthetic and operate with the head in a hanging position. Free bleeding may occur from this operation.

To control it, injections of ice water or a strong alum solution may be tried or gauze may be packed behind the soft palate or pushed in from the anterior nares. A folded pad of gauze may be attached to the thread of a Bellocq cannula and the pad introduced as is done in plugging the posterior nares. A curved forceps with cutting blades is also used to remove this growth. Fig. 155. - Lateral view of the pharyngeal region. Eustachian Tube Function: Overview, Embryology of the Eustachian Tube, Anatomy of the Eustachian Tube Embryology of the Eustachian Tube Overview Overview The eustachian tube (pharyngotympanic tube) connects the middle ear cavity with the nasopharynx. It aerates the middle ear system and clears mucus from the middle ear into the nasopharynx. Opening and closing functions of the eustachian tube are physiologically and pathologically important. Normal opening of the eustachian tube equalizes atmospheric pressure in the middle ear; closing of the eustachian tube protects the middle ear from unwanted pressure fluctuations and loud sounds.

Mucociliary clearance drains mucus away from the middle ear into the nasopharynx, thus preventing infection from ascending to the middle ear. Anatomy of the ear. Abnormal or impaired eustachian tube functions (ie, impaired opening or closing, defective mucociliary clearance) may cause pathological changes in the middle ear. This in turn can lead to hearing loss and other complications of otitis media . These pathological changes include recurrent acute otitis media and otitis media with effusion. Chronic retraction of the tympanic membrane may also lead to middle ear atelectasis and subsequent adhesive otitis media. A retraction pocket of the tympanic membrane secondary to chronic eustachian tube dysfunction may eventually evolve into cholesteatoma and potentially serious complications. Next: Embryology of the Eustachian Tube The eustachian tube lumen develops in the embryo by the lateral extension of the endoderm of the first pharyngeal pouch as it touches the inner surface of the ectoderm of the first branchial cleft. During this process, the distal portion of the pouch expands, forming the tubotympanic recess, which will later evolve into the middle ear cavity.

The proximal portion narrows to form the eustachian tube. This process takes place during the first 10 weeks of gestation. The cartilage and muscles of the eustachian tube develop from the surrounding mesoderm during the ensuing weeks. The levator veli palatini and the tensor veli palatini muscles seem to develop earlier than the cartilage and glandular tissue. The cartilaginous portion of the tube elongates during the middle and third trimester until it reaches approximately 13 mm in length at term. Other morphologic changes also occur during that time with further development of the glandular structures and folding of the epithelium. As the skull base grows down, the angle of the eustachian tube changes gradually from horizontal to oblique. This process continues after birth and well into adulthood. Previous Anatomy of the Eustachian Tube Cartilaginous and bony framework The eustachian tube in the adult is approximately 36 mm long and is directed downward, forward, and medially from the middle ear.

It consists of 2 portions, a lateral third (12 mm), which is a bony portion arising from the anterior wall of the tympanic cavity, and a medial two thirds (24 mm), which is a fibrocartilaginous portion entering the nasopharynx. The tube opens about 1.25 cm behind and slightly below the posterior end of the inferior turbinate. The bony portion is widest at its tympanic end. It passes through the squamous and petrous portions of the temporal bone but narrows gradually to the isthmus, which is the narrowest part of the eustachian tube. The cartilaginous portion consists of a plate of cartilage posteromedially. The cartilage bends forward to form a short flange. The rest of the anterolateral wall is formed by fibrous tissue. The apex or lateral end of the cartilaginous part joins the bony portion at the isthmus; the wider medial end lies under the mucosa of the nasopharynx and raises the mucosa to form the tubal elevation (torus tubarius).

Just behind this elevation is a recess called the fossa of Rosenmüller, which is a common site of origin for nasopharyngeal carcinoma and occult primary tumors. The cartilaginous eustachian tube is attached to the skull base in a groove between the petrous part of the temporal bone and the greater wing of the sphenoid. The lumen of the eustachian tube is roughly triangular, measuring 2-3 mm vertically and 3-4 mm horizontally. The bony portion is always open; the fibrocartilaginous portion is closed at rest and opens only on swallowing, yawning, or forceful inflation. The eustachian tube in infants measures approximately 18 mm in length. It is about half the size of the adult eustachian tube and is generally more horizontal and less angulated. The bony portion is relatively longer and wider in diameter, the nasopharyngeal end of the cartilaginous portion lies more inferiorly. At its nasopharyngeal opening, the eustachian tube is lined by respiratory epithelium that includes columnar ciliated cells, goblet cells, and mucous glands.

The respiratory epithelium blends with the middle ear mucosa in the bony portion of the tube. A recent study Ozturk et al, [ 1 ] found that the length of the mucosal surface of the posterior wall of the eustachian tube was longer than the anterior wall and, in pediatric specimens, that the posterior wall had more mucosal folds (microturbinates) than adult specimens. They concluded that these microturbinates may provide important protection and clearance functions for children and play a role in the pathogenesis of eustachian tube dysfunction (see Eustachian Tube Dysfunction). Ostmann fat pad This fat pad is located in the inferolateral aspect of the eustachian tube and is thought to be an important contributing factor in closing the tube. It is also quite likely to contribute in the protection of the eustachian tube and the middle ear from retrograde flow of nasopharyngeal secretions. Previous Relations of the Eustachian Tube Muscles The muscles of the eustachian tube system help open and close the tube, thus allowing it to perform its function.

These muscles are the (1) tensor veli palatini, (2) levator veli palatini, (3) salpingopharyngeus, and (4) tensor tympani. The tensor veli palatini muscle originates from the bony wall of the scaphoid fossa and from the whole length of the short cartilaginous flange that forms the upper portion of the front wall of the cartilaginous tube. The muscle runs downward, converging into a short tendon that turns medially around the pterygoid hamulus. It then fans out within the soft palate and mingles with the fibers from the opposite side in the midline raphe. The tensor veli palatini separates the eustachian tube from the otic ganglion, the mandibular nerve and its branches, the chorda tympani, and the middle meningeal artery. The salpingopharyngeus is a delicate muscle that is attached to the pharyngeal end of the eustachian tube and blends with the palatopharyngeus muscle downward.

The levator veli palatini has 2 origins: the lower surface of the cartilaginous tube and the lower surface of the petrous bone. At first, the levator is inferior to the tube; it then crosses to the medial side and merges into the soft palate. Blood vessels The arterial supply of the eustachian tube is derived from the ascending pharyngeal and middle meningeal arteries. The venous drainage is carried to the pharyngeal and pterygoid plexus of veins. The lymphatics drain into the retropharyngeal lymph nodes. Ozturk et al (2012) studied the anatomical relation between the eustachian tube and petrous portion of the internal carotid artery (ICA). [ 2 ] They found that the junctional part of the eustachian tube may be a safe landmark to identify and protect the ICA. Knowledge of the anatomical relationships of the eustachian tube with other surgical and radiological landmarks is definitely useful during endoscopic endonasal procedures and cranial base surgery.

Nerves The pharyngeal branch of the sphenopalatine ganglion derived from the maxillary nerve (V2) supplies the ostium. The nervus spinosus derived from the mandibular nerve (V3) supplies the cartilaginous part, and the tympanic plexus derived from the glossopharyngeal nerve supplies the bony portion of the eustachian tube. Previous Three Physiologic Functions of the Eustachian Tube The physiologic functions of the eustachian are as follows: Ventilation or pressure regulation of the middle ear Protection of the middle ear from nasopharyngeal secretions and sound pressures Clearance or drainage of middle ear secretions into the nasopharynx Ventilation or pressure regulation The normal eustachian tube at rest is collapsed, with perhaps slight negative middle ear pressure. Repeated opening of the eustachian tube actively maintains normal atmospheric pressure. The eustachian tube opens upon swallowing or yawning by contraction of the tensor veli palatini muscle. Defective tensor veli palatini muscle function in cleft palate results in eustachian tube dysfunction. The role of the levator veli palatini muscle is unclear.

Its contribution in opening the eustachian tube has been questioned. Eustachian tube ventilatory function is less efficient in children than in adults. In addition, repeated upper respiratory tract infections and enlarged adenoids in children further contribute to the increased incidence of middle ear disease in children. However, as children grow, eustachian tube function improves as evidenced by the reduced frequency of otitis media from infancy to maturity. Normally, the eustachian tube opens frequently, stably maintaining the middle ear pressure between +50 mm and -50 mm H2 O. However, pressures above and below this range do not necessarily indicate middle ear disease. About 1 mL of air or gas may be absorbed from the middle ear in 24 hours. The mastoid cell system is thought to function as a gas reservoir for the middle ear. Protection The eustachian tube is closed at rest. Sudden loud sounds are thus dampened before reaching the middle ear through the nasopharynx. Patulous eustachian tube is an abnormal but not uncommon condition in which the tube is abnormally patent. The patient often complains about echoing when he or she talks (autophony), as well as ear fullness.

Rapid weight loss may lead to decreased size of the Ostmann fat pad, which is thought to contribute to this condition. The eustachian tube drains normal secretions of the middle ear by the mucociliary transport system and by repeated active tubal opening and closing, which allows secretions to drain into the nasopharynx. A derangement in the closed middle ear system, such as tympanic membrane perforation or after mastoid surgery, sometimes results in reflux of nasopharyngeal secretions into the tube and can cause otorrhea. Similarly, forceful nose blowing creates high nasopharyngeal pressure and may force nasopharyngeal secretions into the middle ear. Laryngopharyngeal reflux (LPR) was recently implicated in the etiology of otitis media with effusion (OME). Al-Saab et al (2008) demonstrated the presence of pepsinogen in 84% of middle ear effusions (MEEs) at concentrations 1.86 to 12.5 times higher than that of serum.

[ 3 ] Conversely, a relative negative middle ear pressure, as occurs in aircraft or scuba diving descent, may lock the eustachian tube. This leads to stagnation of secretions, and effusion collects in the middle ear as otitic barotrauma evolves. Inflation of the eustachian tube by the Valsalva maneuver or by politzerization can break the negative pressure in the middle ear and clears the effusion. The middle ear is also protected by the local immunologic defense of the respiratory epithelium of the eustachian tube, as well as its mucociliary defense (clearance). A pulmonary immunoreactive surfactant protein has been isolated from the middle ears of animals and humans. It is thought to have the same protective function in the middle ear. Clearance or drainage Drainage of secretions and occasional foreign material from the middle ear is achieved by the mucociliary system of the eustachian tube and the middle-ear mucosa and muscular clearance of the eustachian tube, as well as surface tension within the tube lumen.

The flask model proposed by Bluestone and his colleagues helps to better explain the role of the anatomic configuration of the eustachian tube in the protection and drainage of the middle ear. [ 4 ] In this model, the eustachian tube and middle ear system is likened to a flask with a long narrow neck. The mouth of the flask represents the nasopharyngeal end, the narrow neck represents the isthmus, and the middle ear and mastoid gas cell system represents the body of the flask. Fluid flow through the neck depends on the pressure at either end, the radius and length of the neck, and the viscosity of the liquid. When a small amount of liquid is instilled into the mouth of the flask, the liquid flow stops somewhere in the narrow neck due to the narrow diameter of the neck and the relative positive air pressure in the chamber of the flask. However, this does not take into consideration the dynamic role of the tensor veli palatini muscle in actively opening the nasopharyngeal orifice of the eustachian tube. Previous Next: Eustachian Tube Function Tests A functional and patent eustachian tube is necessary for ideal middle ear sound mechanics.

A fully patent eustachian tube may not necessarily have perfect functioning, as is the case with the patulous eustachian tube or with mucociliary abnormalities. Testing of both eustachian tube patency and function are therefore important. Pneumatic otoscopy Permeatal examination of the tympanic membrane assesses the patency and perhaps the function of the tube. A normal appearing tympanic membrane usually indicates a normally functioning eustachian tube, although this does not preclude the possibility of a patulous tube. Otoscopic evidence of tympanic membrane retraction or fluid in the middle ear indicates eustachian tube dysfunction but cannot be used to differentiate between functional impairment and mechanical obstruction of the tube. Normal tympanic membrane mobility on pneumatic otoscopy (siegalization) indicates good patency of the eustachian tube. Nasopharyngoscopy Nasopharyngoscopy by posterior rhinoscopic mirror examination or more accurately by fiberoptic endoscope helps visualization of any mass (eg, adenoids, soft tissue growth in the nasopharynx) that may be obstructing the pharyngeal end of the eustachian tube.

Attempts have been made to assess eustachian tube function with the help of nasopharyngoscopy. Yagi and colleagues evaluated the patency of the eustachian tube using a fiberoptic endoscope and a photoelectric device (phototubometry). [ 5 ] Using videoendoscopy of the ear, Poe and colleagues assessed tubal function in adults and observed various disease processes such as inflammation of the tube and patulous dysfunction. This method has been gaining popularity in the assessment of patients suspected to have eustachian tube dysfunction. Tympanometry Measuring middle ear pressure with an electroacoustic impedance meter helps to assess eustachian tube function. High negative middle ear pressure (>-100 daPa) indicates eustachian tube dysfunction. High negative pressures may be seen in individuals with normal hearing; however, a nearly normal middle ear pressure may be associated with hearing loss. In the presence of tympanic membrane perforation, the air passes into the middle ear resulting in a large canal volume on tympanometry. Imaging With the recent development of advanced imaging technology, studies have been used to better define the anatomy and pathology of the eustachian tube.

MRI has been used to visualize the eustachian tube and to assess its anatomy and pathology in patients with nasopharyngeal carcinoma. Moreover, MRI has been used in experimental animal models to evaluate middle ear inflammation. It has more accurately been also used to assess the effect of experimentally induced functional obstruction of the eustachian tube by botulinum toxin A on the middle ear. CT has also been used to assess the tube in normal individuals, in patients with patulous eustachian tube, and in otitis media. It has also been used in studying eustachian tube clearance. Fluoroscopy with contrast provides dynamic evaluation of mucociliary clearance. Yoshioka et al (2013) studied the movement of the eustachian tube during sniffing in patients with patulous tube using a 320-Row Area Detector CT scanner. [ 6 ] They demonstrated various patterns of eustachian tube closure during sniffing in these patients. This method may be useful for evaluating different types of eustachian tube dysfunction.

A prospective study by Tarabichi and Najmi indicated that in most persons with healthy ears, temporal bone CT scans performed during the Valsalva maneuver can visualize the distal third of the eustachian tube lumen, suggesting that this imaging strategy could help to localize disorders in patients with symptoms of eustachian tube obstruction. The study was performed on 38 patients (76 ears), with the distal third of the lumen visualized in 71 ears (93%) and the entire lumen visualized in 27 ears (36%). [ 7 ] Eustachian tube catheterization Catheterization of the eustachian tube with a curved metal cannula via the transnasal approach has been used to assess tubal function for more than 100 years. It can be done blindly, with the help of a nasopharyngoscope, or transorally with a 90° telescope. The catheter is passed along the floor of the nose until it touches the posterior wall of the nasopharynx. The catheter is then rotated 90° medially and pulled forward until it impinges on the posterior free part of the nasal septum.

The catheter is then rotated 180° laterally, so that its tip lies at the nasopharyngeal opening of the eustachian tube. A Politzer bag is attached to the outer end of the catheter, and an auscultation tube with 2 ear tips is used with one tip in the patient's ear and the other in the examiner's ear. Air is pushed into the catheter by means of the Politzer bag. The examiner hears the rush of air as it passes through the catheter into the eustachian tube and then into the middle ear. Successful transferring of applied positive pressure from the proximal end of the cannula into the middle ear suggests tubal patency. Normal blowing sounds mean a patent eustachian tube and bubbling indicates middle ear fluid. Whistling suggests partial eustachian tube obstruction while absence of sounds indicates complete obstruction or failed catheterization. Valsalva and Politzer tests In the Valsalva test, the eustachian tube and middle ear are inflated by a forced expiration with the mouth closed and the nose pinched by the thumb and forefinger.

The effect of high positive nasopharyngeal pressures at the proximal end of the eustachian tube system can be evaluated qualitatively. When the tympanic membrane is intact, the overpressure in the middle ear can be observed by otoscopy as a bulging tympanic membrane. When the tympanic membrane is perforated, the sound of the air escaping from the middle ear can be heard with a stethoscope or with the Toynbee tube. The Politzer test is similar to the Valsalva test, but instead of positive nasopharyngeal pressure being generated by the patient, the nasopharynx is passively inflated. This is achieved by compressing one nostril into which the end of a rubber tube attached to an air bag has been inserted while compressing the opposite nostril by finger pressure. The subject is asked to swallow or to elevate the soft palate by repeating the letter "k." Both the Valsalva and Politzer tests are outdated and rarely used clinically for assessment of eustachian tube function. These maneuvers may be more beneficial in the management of some patients. Nevertheless, the efficacy of these procedures for treatment of middle ear effusion is controversial, and they are not without potential risks.

The author has encountered a case of meningitis following Politzerization for the treatment of otitis media with effusion in an otherwise healthy elderly man. Toynbee test This test is considered more reliable than the previous 2 in the assessment of eustachian tube function. On closed nose swallowing, negative middle ear pressure develops in healthy persons. In an intact tympanic membrane, pneumatic otoscopy or tympanography can be used to measure changes in middle ear compliance. In a perforated tympanic membrane, the manometer of the impedance bridge can be used to measure middle ear pressure changes. Previous Next: Other Tests of Eustachian Tube Function Other tests have been developed for assessment of eustachian tube function. A 9-step inflation-deflation tympanometric test is used to assess changes in resting middle ear pressure after applying positive and negative ear canal pressures while the patient is swallowing. Other methods include microflow technique, impedance method, sonometry, forced response test, and videoendoscopy of the nasopharyngeal end of the eustachian tube. A self-described method by patients with perforated tympanic membranes is the bitter taste of ear drops in the mouth when used topically.

This indicates a patent eustachian tube. A final testing mechanism is sonotubometery. The advantage of this diagnostic test is the ability to evaluate the eustachian tube function with or without an intact tympanic membrane under physiologic conditions. Previous Contributor Information and Disclosures Author Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology , Canadian Society of Otolaryngology-Head & Neck Surgery Disclosure: Nothing to disclose. Harpreet Singh, MBBS, MS FRACGP, General Physician (ENT), Head and Neck Surgeon, Australia Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape.

Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance Institute; Board of Directors, Ponchartrain Surgery Center Disclosure: Nothing to disclose.

Chief Editor Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery , American Academy of Otolaryngology-Head and Neck Surgery , American Head and Neck Society Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors B Viswanatha, DO, MBBS, PhD, MS, FACS Professor of Otolaryngology (ENT), Sri Venkateshwara ENT Institute, Victoria Hospital, Bangalore Medical College and Research Institute, India B Viswanatha, DO, MBBS, PhD, MS, FACS is a member of the following medical societies: Indian Medical Association , Indian Society of Otology , Association of Otolaryngologists of India Disclosure: Nothing to disclose. Acknowledgements Emad Massoud, MB, BCh, MSc, FRCS(C) Associate Professor, Program Director, Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Canada Eustachian Tube Dysfunction - familydoctor.org Eustachian Tube Dysfunction Overview What is eustachian tube dysfunction? The eustachian tubes are small passageways that connect the upper part of your throat (pharynx) to your middle ears. When you sneeze, swallow or yawn, your eustachian tubes open, allowing air to flow in and out. But sometimes a eustachian tube might get plugged. This is called eustachian tube dysfunction.

When this happens, sounds may be muffled and your ear may feel full, or you may have ear pain. Symptoms What are symptoms of eustachian tube dysfunction? If you have eustachian tube dysfunction: Your symptoms may get worse when you are flying (because of altitude changes). Riding in elevators, driving through mountains or diving may also make your symptoms worse. Your ears may feel plugged or full. Sounds may seem muffled. You may feel a popping or clicking sensation (children may say their “ear tickles”). You may have pain in one or both ears. You may hear ringing in your ears (called tinnitus). You may sometimes have trouble keeping your balance. Causes & Risk Factors What causes eustachian tube dysfunction? The most common cause of eustachian tube dysfunction is excessive mucus and inflammation of the tube caused by a cold, the flu, a sinus infection or allergies. Who is at risk for eustachian tube dysfunction? Children are at greater risk of eustachian tube dysfunction because their tubes are shorter and straighter than those of an adult. This makes it easier for germs to reach the middle ear and for fluid to become trapped there.

Also, children’s immune systems are not fully developed, so it’s harder for them to fight off infections. Smoking and obesity are also risk factors. Smoking damages the cilia (the tiny hairs that sweep mucus from the middle ear to the back of the nose). This can allow mucus to gather in the tubes. In people who are obese, fatty deposits around the tubes can also lead to eustachian tube dysfunction. Diagnosis & Tests How will my doctor know I have eustachian tube dysfunction? Your doctor will be able to tell if you have eustachian tube dysfunction by talking to you about your symptoms and by examining you. Your doctor will examine your ear canals and eardrums, and your nasal passages and the back of your throat. Prevention How can I avoid eustachian tube dysfunction? Treating the underlying cause of the mucus or blockage—such as symptoms of allergies, a cold or the flu—can help reduce your risk of developing eustachian tube dysfunction. Treatment How is eustachian tube dysfunction treated? Symptoms of eustachian tube dysfunction usually go away without treatment.

Eustachian tube exercises, such as swallowing, yawning or chewing gum, can help open the eustachian tubes. You can help relieve the “full ear” feeling by taking a deep breath and blowing with your mouth shut and your nostrils pinched closed. If you think your baby may have eustachian tube dysfunction, give him or her a bottle or a pacifier to encourage the swallow reflex. If these strategies don’t help, your doctor may suggest other options. These can include: Using a decongestant to reduce the swelling of the lining of the tubes. Taking an antihistamine or using a steroid nasal spray to reduce the allergic response if allergies are a factor. Implanting pressure equalization tubes (PETs) in your eardrums to maintain equal ear pressure. Making a tiny incision in the eardrum and suctioning out the fluid in the middle ear. This gives the eustachian tube lining time to shrink while the eardrum is healing (usually 1 to 3 days). Questions to Ask Your Doctor My ears feel full and don’t feel better when I yawn. Could I have Eustachian tube dysfunction? What can I do to make my child more comfortable?

My child has Eustachian tube dysfunction. Does this mean he/she will have ear infections? Is there anything I can do when I travel to make myself more comfortable? Could my allergies make Eustachian tube dysfunction worse? What is the best way to treat my Eustachian tube dysfunction? FDA Warning The. U.S. Food and Drug Administration (FDA) advises against the use of ear candles. Ear candles can cause serious injuries and there is no evidence to support their effectiveness. For more information, please visit the FDA Web site . Last Updated: October 2009 October 2009 Copyright © American Academy of Family Physicians This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Ear, Nose, and Throat Facts | Johns Hopkins Medicine Health Library Ear, Nose, and Throat Facts See related health The ear is the organ of hearing and balance. The ear consists of: External or outer ear, consisting of: Pinna or auricle. This is the outside part of the ear. External auditory canal or tube. This is the tube that connects the outer ear to the inside or middle ear.

Tympanic membrane (also called the eardrum). The tympanic membrane divides the external ear from the middle ear. Middle ear (tympanic cavity), consisting of: Ossicles. These are the 3 small bones that are connected and transmit the sound waves to the inner ear. The bones are called: Malleus Incus Stapes Eustachian tube. A canal that links the middle ear with the back of the nose. The eustachian tube helps to equalize the pressure in the middle ear. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat. Inner ear, consisting of: Cochlea. This contains the nerves for hearing. Vestibule. This contains receptors for balance. Semicircular canals. This contains receptors for balance. What is the nose? The nose is the organ of smell and is part of the peripheral nervous system. The nose consists of: External nose. A triangular-shaped projection in the center of the face. Nostrils. These are two chambers divided by the septum. Septum.

This is made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose. Nasal passages. Passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air. Sinuses. Four pairs of air-filled cavities that are also lined with mucous membranes. What is the throat? The throat is a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. The throat consists of: Larynx. This houses the vocal cords and is crucial to speech and breathing. The larynx also serves as a passageway to the trachea (windpipe to the lung). Epiglottis. This is located above the larynx and works with the larynx and vocal cords to push the food into the esophagus, therefore keeping food from entering the windpipe. Tonsils and adenoids. These are made up of lymph tissue and are located at the back and sides of the mouth. They protect against infection, but generally have little purpose beyond childhood.

Experience Our Care eustachian tube | anatomy | Britannica.com Eustachian tube tympanic membrane Eustachian tube, also called Auditory Tube, tube that extends from the middle ear to the pharynx (throat). About 3 to 4 centimetres (1.2–1.6 inches) long in humans and lined with mucous membrane , it is directed downward and inward from the tympanic cavity, or middle ear, to that portion of the pharynx called the nasopharynx, the space above the soft palate and behind and continuous with the nasal passages. The upper end of the eustachian tube is narrow and surrounded by bone . As it nears the pharynx, the tube becomes wider and cartilaginous. The mucous lining is continuous with that of the middle ear. Small cilia (hairlike projections) cover it to aid the drainage of mucous secretions from the middle ear to the pharynx. The main function of the auditory tube is ventilation of the middle ear and maintenance of equalized pressure on both sides of the tympanic (drum) membrane. Closed at most times, the tube opens during swallowing. This permits equalization of the pressure without conscious effort.

During an underwater dive or rapid descent in a plane the eustachian tube may remain closed in the face of rapidly increasing surrounding pressure. The pressure on both sides of the eardrum membrane can usually be equalized by holding the nose and blowing, by swallowing, or by wiggling the jaws. Learn More in these related articles: Patent US20110268669 - Composition and method for treating eustachian tube dysfunction - Google Patents Composition and method for treating eustachian tube dysfunction US 20110268669 A1 Abstract A method of treating Eustachian tube dysfunction in a person includes placing the person's body in a position substantially lying on one of the person's left or right sides. The side on which the person is lying is the side affected by Eustachian tube dysfunction. A composition of simethicone in a concentration of about 0.05% to 0.65% wt/vol diluted in an aqueous carrier is introduced through the nasal cavity of the same side on which the person is lying. The simethicone composition is then allowed to coat the person's pharynx on the side of which the person is lying.

Images(3) Claims(20) 1. A method of treating Eustachian tube dysfunction in a person comprising the steps: placing the person's body in a position to receive a composition for coating the person's pharynx; introducing, a composition of simethicone emulsion diluted in an aqueous carrier; allowing the simethicone composition to coat the person's pharynx. 2. The method according to claim 1 wherein the position in which the person is placed is lying on one of the person's left and right sides, the side being a side affected by Eustachian tube dysfunction. 3. The method according to claim 2 wherein the simethicone composition is introduced through the nasal cavity of the same side on which the person is lying. 4. The method according to claim 3 wherein the manner of composition introduction is by nasal spray. 5. The method according to claim 3 wherein the manner of composition introduction is by instilled drops. 6. The method according to claim 1 wherein the introduced simethicone composition is in a concentration of about 0.05% to 0.65% wt/vol. 7.

The method according to claim 6 wherein said allowing step includes allowing the introduced simethicone composition to drain from the nasal cavity and coat the person's pharynx on the side of which the person is lying. 8. The method according to claim 1 including after said allowing step, the step of removing the simethicone from the Eustachian tube opening by orally administering a liquid emulsifier. 9. The method according to claim 8 wherein the liquid emulsifier is selected from the group consisting of soy lecithin and egg lecithin. 10. The method according to claim 1 wherein the position in which the person is placed is an upright position. 11. The method according to claim 10 wherein the simethicone composition is introduced orally. 12. The method according to claim 11 wherein the introduced simethicone composition is in a concentration of about 0.05% to 30% wt/vol. 13.

A method of treating Eustachian tube dysfunction in a person comprising the steps: combining into a composition, a simethicone emulsion with a second active ingredient; orally introducing the combined simethicone and active ingredient to the person; allowing the simethicone composition to coat the person's pharynx. 14. The method according to claim 13 wherein the simethicone emulsion is combined with xylitol in a chewing gum. 15. The method according to claim 13 wherein the simethicone emulsion is compounded with a medication. 16. The method according to claim 15 wherein the medication is selected from the group consisting of a steroid, a non-steroidal anti-inflammatory, gold nanocrystals, antibiotic, and antihistamine. 17. A composition for topically treating Eustachian tube dysfunction, said composition comprising: an aqueous carrier; and a simethicone emulsion in a concentration of about 0.05% to 30%. 18. The composition according to claim 17 wherein said aqueous carrier is distilled water. 19. The composition according to claim 17 wherein said aqueous carrier is a saline solution. 20.

The composition according to claim 17 wherein said simethicone emulsion includes: simethicone USP; CROSS-REFERENCE TO RELATED APPLICATION [0001] This Non-Provisional Utility application claims the benefit of co-pending U.S. Provisional Patent Application Ser. No. 61/329,619, filed on Apr. 30, 2010, which is incorporated herein in its entirety. FIELD OF THE INVENTION [0002] The present disclosure generally relates to methods for treating Eustachian tube dysfunction. More particularly, the present disclosure relates to the pharyngeal introduction of a simethicone emulsion composition acting as a surfactant and surface coating for treatment of Eustachian tube dysfunction. BACKGROUND OF THE INVENTION [0003] The Eustachian tube (ET) is a very narrow air passage in the wall of a human's middle ear which connects it to the nasopharynx, a midline air filled space in the back of the nose. The tube is approximately 37 mm long and is slightly hourglass shaped, flattened anterior-posteriorly.

The small lumen of the Eustachian tube permits the exchange of ambient gases between the middle ear and nasopharynx and the transport of middle ear secretions into the nasopharynx. The lateral one-third of the Eustachian tube (tympanic segment) is made of bone, while the medial two-thirds (pharyngeal segment) is cartilaginous. A constriction at the junction of the bony and cartilaginous segments, called the isthmus, may be as narrow as 1.0 mm by 1.5 mm. This tube regulates the intermittent exchange of air to or from the middle ear space to maintain equal pressure on both sides of the eardrum. The surface of the epithelium of the middle ear and Eustachian tube is covered by a raucous blanket, which is a defensive barrier against inhaled pollutants and a multitude of microorganisms. Middle ear secretions are normally eliminated through the ET.

[0004] In humans, the Eustachian tube is a very unique structure that enables the middle ear pressure to adapt to various altitude changes and, when closed, it prevents the endogenous intraoral sounds of respiration and vocalization from reaching the middle ear to compete with and mask out the environmental sounds for reception and relay to the inner ear. [0005] Normally, the Eustachian tube maintains an isobaric relationship between the middle ear space and the ambient air exchanged within the nasal passages during breathing. The critical opening pressure for the tube to ventilate the middle ear chamber is related to the surface tension and diameter of the ET opening onto the lateral wall of the nasopharynx. This is modified by the rheological properties of the mucus blanket on the endothelial tissues. In its natural state, the Eustachian tube orifice is always closed, but may actively open spontaneously several times a minute or when swallowing or yawning. As integral part of the middle ear, the Eustachian tube functions to prevent and ameliorate the same inflammatory diseases such as otitis media etc. and its complications.

[0006] Blockage of the Eustachian tube isolates the middle ear space from the outside environment. The lining of the middle ear absorbs the trapped air and creates a negative pressure that pulls the eardrum inward. The eardrum is thin and pliable, like plastic wrap, and is densely innervated. When it becomes stretched inward, patients often experience pain, pressure, and hearing loss. Long-term blockage of the Eustachian tube leads to the accumulation of fluid in the middle ear space that further increases the pressure and hearing loss. This is called serous otitis media. Should bacteria contaminate this fluid, a middle ear infection may result, called acute otitis media. [0007] Failure of the Eustachian tube to open during yawning, swallowing or barometric pressure changes between the middle ear and pharynx is called Eustachian tube dysfunction. This can occur when the lining of the nose becomes irritated and inflamed, narrowing the Eustachian tube opening or its passageway. Illnesses like the common cold or influenza are often to blame. Pollution and cigarette smoke can also cause Eustachian tube dysfunction.

In many areas of the country, nasal allergy (allergic rhinitis) is the major cause of Eustachian tube dysfunction. For reasons that are unclear, the incidence of allergies is increasing in the United States. Obesity can also predispose a patient to Eustachian tube dysfunction because of excess fatty deposits around the passageway of the Eustachian tube. Rarely, Eustachian tube blockage may be the sign of a more serious problem such as nasal polyps, a cleft palate, or a skull base tumor. [0008] Young children (especially ages 1 to 6 years) are at particular risk for Eustachian tube dysfunction, serous otitis media, and acute otitis media because they have very narrow Eustachian tubes. Also, they may have adenoid enlargement that can block the opening of the Eustachian tube. Since children in daycare are highly prone to getting upper respiratory tract infections, they tend to get more ear infections compared to children that are cared for at home. [0009] The anatomy of the Eustachian tube in infants and young children is different than in adults.

It runs horizontally, rather than sloping downward from the middle ear. The horizontal course of the Eustachian tube also permits easy transfer of bacteria from the nose to the middle ear space. This is another reason that children are so prone to middle ear infections. [0010] Certain bacteria are reported to be the primary causes of acute otitis media (AOM) and are detected in about 60% of cases. The bacteria most commonly causing ear infections are: Streptococcus pneumoniae (also called S. pneumoniae or pneumococcus), the most common bacterial cause of acute otitis media, causing about 40% to 80% of cases in the U.S.; Haemophilus influenzae, the next most common culprit and is responsible for 20% to 30% of acute infections; and Moraxella catarrhalis, also a common infectious agent, responsible for 10% to 20% of acute infections. Less common bacteria are Streptococcus pyogenes and Staphylococcus aureus.

[0011] A serious sequalae of bacterial chronic otitis media includes otitis media with effusion (OME) that is associated with complications such as a ruptured tympanic membrane (TM). The failure of the Eustachian tube to expel or eliminate the natural secretions, microorganisms, biofilms and toxic products result in destruction of the tissues, TM rupture and hearing loss. When the fluid becomes infected the increased pressure is very painful and causes the delicate tympanic membrane to rupture releasing the toxins into the external ear canal for elimination [0012] In the past, antibiotics have been the mainstay of eliminating bacterial microorganisms by direct biochemical interaction. However, antibiotics can only treat the infection when and if the agent is capable of penetrating the biofilm barrier and altering the biochemistry of the microorganism internally. [0013] Of note, about 15% of these bacteria are now believed to be resistant to the first-choice antibiotics. With the overuse of antibiotics and the development of resistance by microorganisms, such treatment has become less effective and frequent side effects have become common.

[0014] More recently, because the chemical structure of the newer anti-infective agents are more complex, antibiotics are not absorbable in the gastrointestinal tract, necessitating that the medication be administered by intravenous injection which is further associated with serious side effects such as ototoxicity, hearing loss and tinnitus, and allergic reactions. Scientific studies have identified prenatal markers, such as smoking, that predispose the infant to develop middle ear infections. [0015] Various medical treatments other than antibiotics are utilized to alleviate the symptoms of ETD. In many cases, leaving it alone without any specific treatment is sufficient as the condition may only be temporary as the result of a cold or other respiratory disease. Swallowing and chewing are encouraged to manipulate the tissues surrounding the Eustachian tube thereby promoting the opening of the tube to equalize pressure to the middle ear. Self-inflation can be accomplished by doing a gentle Valsalva maneuver to force air up into the Eustachian tube. However, blowing too forcibly can make the condition worse by forcing fluids and bacteria from the throat into the tube. These procedures may not be sufficient to provide the individual with the length and degree of relief desired.

[0016] Synthetic and natural (pork or beef lung) pulmonary surfactant compounds have been in use in neonatology since the early 1980's. Tracheal administration of surfactant to premature infants with respiratory distress syndrome improves lung compliance, opens small air passages and has significantly improved life expectancy. Studies in the 1960's were unsuccessful because isolated surfactant proteins alone were being used. It was not until the addition of the emulsifier/spreading agent phosphatidylglycerol, derived from egg lecithin, that efficacy was finally demonstrated. Emulsifiers not only distribute pulmonary surfactant but also change its physical properties to be more fluid. [0017] In animal studies, bacteria are injected into the middle ear space to increase Eustachian tube opening pressure. Nebulized bovine pulmonary surfactant compound administered intranasally to these animals demonstrated improved clearance of fluid from the middle ear, thus decreasing Eustachian tube opening pressure. However, individuals with allergies to beef or pork protein may suffer complications from this natural surfactant therapy, and the method of nebulized administration may be cost prohibitive for widespread use.

[0018] Medical professionals can also recommend or prescribe a variety of drugs to treat ETD. Decongestants, either orally or nasally, may promote the opening of the Eustachian tube. Nasal corticosteroids can relieve tissue inflammation, one of the major causes of ETD. Antihistamines may reduce the amount of rhinorrhea and post-nasal drainage that may contribute to ETD. Use of over-the-counter or prescription drugs, which are absorbed into the user's system, may not be tolerated by the individual because of various side effects. [0019] It is therefore desirable to provide a composition for the treatment of Eustachian tube dysfunction that is effective in unblocking a clogged Eustachian tube and that is well tolerated without undesirable side effects. SUMMARY OF THE INVENTION [0020] The present disclosure is generally directed to a method for applying a surfactant to the pharynx opening of the Eustachian tube in the treatment of Eustachian tube dysfunction. The method includes placing the person's body in a position for coating the person's pharynx.

A composition of simethicone emulsion diluted in an aqueous carrier is introduced. The simethicone composition is then allowed to coat the person's pharynx. [0021] In one aspect of the invention the position in which the person is placed is lying on one of the person's left and right sides, the side being a side affected by Eustachian tube dysfunction. [0022] In another aspect, the simethicone composition is introduced through the nasal cavity of the same side on which the person is lying and allowing the introduced simethicone composition to drain from the nasal cavity and coat the person's pharynx on the side of which the person is lying. [0023] In yet other aspects, the manner of composition introduction is by nasal spray or by instilled drops. [0024] In yet a further aspect of the invention, the introduced simethicone composition is in a concentration of about 0.05% to 0.65% wt/vol. [0025] In a further aspect of the invention, the simethicone from the Eustachian tube opening is removed by orally administering a liquid emulsifier.

The emulsifier being either soy lecithin or egg lecithin. [0026] In another aspect, the position in which the person is placed is an upright position. [0027] In a further aspect, the simethicone composition is introduced orally. [0028] In yet a further aspect, the orally introduced simethicone composition is in a concentration of about 0.05% to 30% wt/vol. [0029] In another aspect of the invention, a method of treating Eustachian tube dysfunction in a person includes the steps of combining into a composition, a simethicone emulsion with a second active ingredient. The combined simethicone and active ingredient is orally introduced to the person. The simethicone composition is then allowed to coat the person's pharynx. [0030] Another aspect of the invention is combining the simethicone emulsion with xylitol in a chewing gum. [0031] Yet a further aspect of the invention is compounding the simethicone emulsion with a medication.

The medications can be selected from the group of a steroid, a non-steroidal anti-inflammatory, gold nanocrystals, antibiotic, and antihistamine. [0032] Another aspect of the invention is a composition for topically treating Eustachian tube dysfunction wherein the composition includes an aqueous carrier and a simethicone emulsion in a concentration of about 0.05% to 30%. [0033] A further aspect of the invention includes the aqueous carrier being distilled water or a saline solution. [0034] In yet another aspect of the invention the simethicone emulsion includes simethicone USP, a food grade emulsifier, sodium carboxymethylcellulose, and sorbic acid. BRIEF DESCRIPTION OF THE DRAWINGS [0035] The invention will now be described, by way of example, with reference to the accompanying drawings, where like numerals denote like elements and in which: [0036] FIG. 1 presents a person afflicted with Eustachian tube dysfunction lying on one side for treatment according to the present invention; [0037] FIG.

2 presents a block diagram of a method for treating Eustachian tube dysfunction using a simethicone composition. [0038] Like reference numerals refer to like parts throughout the various views of the drawings. DETAILED DESCRIPTION OF THE INVENTION [0039] The following detailed description is merely exemplary in nature and is not intended to limit the described embodiments or the application and uses of the described embodiments. As used herein, the word “exemplary” or “illustrative” means “serving as an example, instance, or illustration.” Any implementation described herein as “exemplary” or “illustrative” is not necessarily to be construed as preferred or advantageous over other implementations. All of the implementations described below are exemplary implementations provided to enable persons skilled in the art to make or use the embodiments of the disclosure and are not intended to limit the scope of the disclosure, which is defined by the claims. For purposes of description herein, the terms “upper”, “lower”, “left”, “rear”, “right”, “front”, “vertical”, “horizontal”, and derivatives thereof shall relate to the invention as oriented in FIG. 1 .

Furthermore, there is no intention to be bound by any expressed or implied theory presented in the preceding technical field, background, brief summary or the following detailed description. It is also to be understood that the specific devices and processes illustrated in the attached drawings, and described in the following specification, are simply exemplary embodiments of the inventive concepts defined in the appended claims. Hence, specific dimensions and other physical characteristics relating to the embodiments disclosed herein are not to be considered as limiting, unless the claims expressly state otherwise. [0040] The Eustachian tube is a small tube-like canal which connects the inner part of the ear called the middle ear to the back of the nose and upper throat area known as the pharynx with the stoma (opening) of the tube being located in the pharynx. The tube stoma in the pharynx is normally in a closed position to prevent food particles and mucous from being forced into the tube as a result of blowing one's nose, coughing or other similar bodily functions. The function of the Eustachian tube is to equalize the air pressure within the middle ear and the pressure outside it.

While a positive pressure differential within the middle ear is generally easily relieved, most individuals having difficulty with Eustachian tube dysfunction primarily experience difficulty when there is a negative pressure differential within the middle ear and the tube opening in the pharynx failing to open to equalize the pressure. The greater outside ambient air pressure compared to the pressure within the inner ear further contributes to the pharynx stoma remaining closed. [0041] Research has shown that the Eustachian tube (ET) in humans is lined with a substance that lowers surface tension and thus facilitates the opening of the Eustachian tube and aeration of the middle ear. However, when a human suffers from ETD, oftentimes a mucosal film is found on the surface of the pharynx and over the stoma of the Eustachian tube. The surface tension of this mucosal film can be sufficiently great as to hinder or prevent the tube from opening to aerate the inner ear and equalize the negative pressure differential.

[0042] Poly (dimethylsiloxane), silicon dioxide, most commonly known as Simethicone, is a well known surfactant that acts as an anti-foaming agent to decrease the surface tension of gas bubbles, causing them to combine into larger bubbles. Simethicone (chemical structure illustrated below) has long been used in humans to treat [0000] [0000] intestinal gas by causing smaller intestinal gas bubbles to combine into large bubbles, which are more easily passed by burping. While Simethicone does not prevent the formation of gas, it increases the rate at which the gas exits the body. Simethicone is not absorbed by the body into the bloodstream, and is therefore considered relatively safe. [0043] Since simethicone polymer is an inert substance, it is not absorbed, will not react with other substances, and is generally considered to be safe. Simethicone emulsion contains water, simethicone USP, food grade emulsifiers, sodium carboxymethylcellulose (a thickener) and sorbic acid.

Removing simethicone polymer from the Eustachian tube opening may be accomplished by dilution with nasal saline lavage, or administering an emulsifier alone by mouth such as liquid soy lecithin or egg lecithin. [0044] Simethicone emulsion has been safely administered to newborn infants at a dose of up to 6 drops twelve times daily by mouth. Any complications would come from the penetration of the polymer to below the mucosal surface as during a traumatic injury, which would not ordinarily be expected. Studies are currently being conducted to determine simethicone emulsion's effect on Eustachian tube opening pressure; however clinical application has shown anecdotal reduction in ear pain to within 30 minutes of oral administration, and reduced incidence of ear infection. [0045] Simethicone polymer coating of mucosal pharyngeal structures such as the larynx, vocal cords, nasal cavity, sinuses and Eustachian tube may offer conditioning effects that are not yet fully understood. Decreasing mucosal surface tension may produce a relative increase in submucosal vascular oncotic pressure therefore drawing fluid into blood vessels to relieve symptoms of rhinorrhea or excess mucous.

Polymer spread to within the Eustachian tube may act as a thin layer stent preventing the stoma from complete closure. This effect could decrease Eustachian tube opening pressure by having a small amount of polymer between mucosa-to-mucosa contact points. Air and fluid would still flow through the open Eustachian tube to maintain a middle ear environment that is not conducive to bacterial overgrowth or barotrauma. [0046] The surface tension reducing characteristics of Simethicone in combination with its non-absorbability can also be beneficial for treating, with minimal side effects, conditions such as Eustachian tube dysfunction wherein reduction of the surface tension of the mucosal film can aid in allowing the tube stoma in the pharynx to more easily open and equalize the pressure within the middle ear. However, an appropriate delivery mechanism must be utilized since Simethicone, when used to control intestinal gas, is normally introduced orally through the swallowing or chewing of solid tablets. [0047] An exemplary embodiment Simethicone composition for use in treatment of the symptoms of ETD includes a simethicone emulsion diluted in an aqueous carrier such as distilled water or saline solution.

The liquid composition comprises 0.05% to 0.65% Simethicone by weight or volume since concentrations exceeding 0.65% may present a risk of olfactory nerve damage. The simethicone composition is introduced through the nasal cavity by nasal spray or instilled drops. Alternately, 2 to 6 drops of a composition of simethicone emulsion in the concentration of 0.05% to 30% by weight or volume diluted in an aqueous carrier is introduced orally. Alternately, a composition of simethicone emulsion in the form of a tablet or thin strip is introduced orally. Repeat administration is recommended once daily for two weeks during upper respiratory congestion or ear discomfort for children over 6 months of age and adults. To maintain reduced Eustachian tube opening pressure, administration may continue once every 3 to 4 days. Simethicone emulsion could also be administered 30 minutes prior to an anticipated period of environmental barometric pressure change in which ear discomfort, pain or barotrauma would be expected.

[0048] Blocked Eustachian Tubes-Topic Overview Blocked Eustachian Tubes Blocked Eustachian Tubes - Topic Overview Blocked Eustachian Tubes Credits What are the eustachian tubes, and how do they get blocked? The eustachian (say "you-STAY-shee-un") tubes connect the middle ears to the back of the throat. The tubes help the ears drain fluid. They also keep air pressure in the ears at the right level. When you swallow or yawn, the tubes open briefly to let air in to make the pressure in the middle ears equal to the pressure outside of the ears. Sometimes fluid or negative pressure gets stuck in the middle ear. The pressure outside the ear gets too high. This causes ear pain and sometimes trouble hearing. See a picture of the eustachian tube . What causes blocked eustachian tubes? Swelling from a cold, allergies , or a sinus infection can keep the eustachian tubes from opening. This leads to pressure changes. Fluid may collect in the middle ear. The pressure and fluid can cause pain .

You also can have ear pain from changes in pressure while you are flying in an airplane, driving up or down mountains, or scuba diving. Fluid in the ear can lead to an infection ( acute otitis media ). Young children have a high risk of ear infections , because their eustachian tubes are shorter and more easily blocked than the tubes in older children and adults. What are the symptoms? Blocked eustachian tubes can cause several symptoms, including: Ears that hurt and feel full. Ringing or popping noises in your ears. Hearing problems. Feeling a little dizzy. How are blocked tubes diagnosed? Your doctor will ask about your symptoms. He or she will look in your ears. The doctor also may check how well you hear. How are they treated? Blocked eustachian tubes often get better on their own. You may be able to open the blocked tubes with a simple exercise . Close your mouth , hold your nose, and gently blow as if you are blowing your nose. Yawning and chewing gum also may help. You may hear or feel a "pop" when the tubes open to make the pressure equal between the inside and outside of your ears.

Continued If you can't open the tubes, your doctor may suggest an over-the-counter pain medicine. If you have allergies , the doctor may prescribe a steroid medicine that you spray into your nose. Decongestants that you take by mouth or spray into your nose may be helpful. You may need antibiotics if you have an ear infection . A warm washcloth or a heating pad set on low can help with ear pain. Put a cloth between the heating pad and your skin so you don't burn your skin. Do not use a heating pad with children. In some cases, people need surgery for a blocked eustachian tube. The doctor makes a small cut in the eardrum to drain fluid and to make the pressure the same inside and outside the ear. Sometimes the doctor will put a small tube in the eardrum . The tube will fall out over time. How can you keep your eustachian tubes from getting blocked? If you have allergies , talk to your doctor about how to treat them so your sinuses stay clear and your eustachian tubes stay open. When you are in an airplane, you can chew gum, yawn, or drink liquids during takeoff and landing.

Try the exercise where you gently blow while holding your nose shut. WebMD Medical Reference from Healthwise This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.© 1995-2015 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Pagination

Question: The Eustachian tube links the pharynx to which other part of the body?
Answer: The ear