ENT (Otorhinolaryngology) · MU Sofia

9. Eustachian tube dysfunction and serous otitis with effusion.

Covers Eustachian tube dysfunction and its three types: obstructive, patulous and baro-challenge induced, with their causes. It then describes serous otitis media with effusion, its origin from dilatory tube dysfunction, and its classification by duration, fluid nature and laterality. Clinical signs, tympanometry findings, medical and surgical treatment options, complications and differential diagnoses are set out for both conditions.

Inside: 12 sections · 6 labelled pictures · 14 flashcards · 5 min

Topic 9 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 10 sections, about 757 words (5 min of reading), with 14 flashcards.

In this note

  1. Eustachian tube dysfunction and serous otitis with effusion.
  2. Paraclinical & radiological examinations
  3. Treatment options
  4. Possible complications
  5. Differential diagnosis
  6. SEROUS OTITIS MEDIA (OTITIS MEDIA WITH EFFUSION – OME)
  7. Classification of OME
  8. Clinical picture
  9. Paraclinical & Radiological examinations
  10. Complications

Eustachian tube dysfunction and serous otitis with effusion.

1. Eustachian tube dysfunction (ETD)

1. Definition: Eustachian tube dysfunction is the failure of the Eustachian tube to perform its primary functions: pressure equalization (ventilation), protection of the middle ear from nasopharyngeal sound/secretions, and clearance of secretions (mucociliary transport).This leads to negative middle ear pressure, retraction of TM, and may progress to serous otitis media.

2. Etiopathogenesis:

Obstructive (Most Common)

  • Inflammation/edema: Viral Upper respiratory infections, Allergic rhinitis, Adenoid hypertrophy in children and Chronic sinusitis causing mucosal swelling around the nasopharyngeal orifice
  • Mechanical: Adenoid hypertrophy in children, Tumors (nasopharyngeal carcinoma) or anatomical abnormalities (Cleft palate, Deviated nasal septum)

Other Causes

  • Patulous ETD: Tube remains abnormally open, Seen with weight loss, pregnancy, neuromuscular disorders
  • Baro-challenge–induced ETD: rapid changes in ambient pressure (flying/diving) overwhelm the tube’s ability to open

3. Classification

  1. 1. Dilatory/Obstructive ETD- failure of the tube to open adequately (most common)
  • Functional obstruction: due to mucosa edema
  • Dynamic Dysfunction: Due to muscular failure (tensor veli palatini).
  • Anatomical Obstruction: Due to extrinsic pressure (adenoids, tumor).
  1. 2. Patulous ETD: failure of the tube to close properly
  1. 3. Baro-challenge–induced ETD - Failure of ET to open during altitude/pressure changes

4. Clinical picture

A. Symptoms – due to pressure dysregulation in the middle ear

  • Ear fullness
  • Mild conductive hearing loss
  • Ear popping/clicking when swallowing or yawning
  • Autophony (in patulous ET)
  • Otalgia

B. Signs

  • Tympanosclerotic patches in chronic cases
  • In patulous ET: TM moves with respiration

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