The ototubaritis is an inflammatory process of the Eustachian tubes that is accompanied by a transient and reversible obstruction of said tubes. It can be the consequence of infectious processes of the upper respiratory tract or of allergic rhinitis and it can be frequently complicated by otitis media.
The surface of the air cavities of the middle ear is covered with a mucosa of ciliated columnar epithelium (respiratory mucosa) with secretory glands. This mucosa is found covering and in contact with the periosteum of the temporal bone where the middle ear is sculpted.
Structure of the middle ear (Source: BruceBlaus / CC BY (https://creativecommons.org/licenses/by/3.0) via Wikimedia Commons)
The Eustachian tube is a tube that has a bony portion (posterior third) within the temporal bone and an anterior chondromembranous portion (two-thirds) that empties into the nasopharynx. Therefore, this osteochondromembranous tube communicates the tympanic cage with the nasopharynx.
The lumen of the tubes is opened by contraction of the muscles of the soft palate (peristaphylline muscles). The Eustachian tube performs functions of vital importance to the function of the middle ear. It allows balancing the pressures between the environment and the middle ear when ventilating the tympanic cage.
Another function of these tubes is to eliminate secretions from the middle ear towards the oropharynx, and prevent the entry of bacteria and foreign elements, protecting the structures contained therein.
Gas is permanently absorbed in the middle ear. If the Eustachian tube is swollen, blocked, and not working properly, the tympanic cage cannot be ventilated. This generates a decrease in the pressure of the middle ear with respect to the ambient pressure, that is, a negative pressure within the tympanic cage.
Normally, the Eustachian tube allows the pressure to be balanced so that the pressure in the tympanic cage equals the ambient pressure. When negative pressure is generated in the middle ear, the mucous glands are stimulated, the production of secretions increases and this predisposes to the development of otitis media.
Symptoms of ototubaritis
The most frequent symptoms are:
- Earache
- Itching or itching sensation and edema of the ear
- Appearance of tinnitus (whistling)
- Increased sensitivity to noise
- Increased secretions in the middle ear that can result in bulging of the tympanic membrane and the appearance of a fluid level that is observed when doing an otoscopy.
Transient hearing loss can occur. If the process is complicated by an acute infection of the middle ear, yellowish secretions and redness of the tympanic membrane appear. Sometimes vertigo, dizziness, nausea, vomiting and fever may occur.
Image by Ulrike Mai at www.pixabay.com
Tinnitus is characteristic of ototubaritis. Tinnitus is the presence of a noise that the patient perceives but does not respond to any external auditory stimulus.
Causes
Viral or bacterial processes of the upper respiratory tract, allergic rhinitis and the presence of adenoid tissue in the vicinity of the mouth of the Eustachian tubes in the oropharynx, predispose to inflammation and temporary closure of said ducts and the establishment of the ototubaritis.
In young children under three years of age, ototubaritis is very common and is usually complicated by otitis media. This is due, on the one hand, to the lack of development of the immune system in children and, on the other, to the particular characteristics of these ducts in children that facilitate their closure and inflammation.
These characteristics of children's Eustachian tubes that differentiate them from those of adults are as follows:
- The bony portion of the Eustachian tube in children is longer than that of adults.
- The angle between the membranous portion and the bony portion is much smaller, approximately 10 degrees. Therefore, children's tubes are much straighter than adults.
- The isthmus is longer with a 4 to 5mm nasopharyngeal orifice, much smaller than that of the adult.
The bacteria most commonly found in middle ear infections are M. catarrhalis, H. influenzae, and S. pneumoniae (pneumococcus). However, this may vary depending on the vaccination rate of the referenced population, the age of the patients and the underlying primary causes.
Aftermath
Complications of ototubaritis are otitis media which, in some cases, can be recurrent. When otitis media are infectious, they can be complicated by mastoiditis, labyrinthitis, meningitis, and rarely with brain abscesses. These complications can generate sequelae of the infectious process.
However, the most frequent complications of recurrent infectious otitis media are spontaneous perforations of the tympanic membrane, due to the accumulation of purulent secretions and increased pressure in the middle ear.
Tympanic membrane perforations usually heal spontaneously without leaving sequelae. But when the treatment is not administered properly, the germs are resistant and very virulent or the patient is immunosuppressed for some reason. These processes can become chronic.
In these cases, sequelae related to unresolved tympanic perforations, stiffness of the eardrum due to inflammatory and infectious processes or damage to the ossicular chain may appear.
Atelectasis vera or tympanic atelectasis is one of the sequelae of serous otitis. It consists of an invagination and collapse of the tympanic membrane classified into seven degrees and which may or may not include the ossicle chain.
Eardrum-sclerosis, atelectasis or alteration of the ossicular chain interfere with the transmission of sound from the external ear. All these facts lead to the development of hearing loss, which may be permanent or needs to be resolved surgically.
Treatments
The treatment of ototubaritis requires anti-inflammatories, analgesics, antihistamines, mucolytics and the correction or treatment of the initial cause, that is, of allergic rhinitis if present, of upper respiratory tract infections or of adenoiditis. Nasal washes and sprays are also included.
In case of an infectious process that includes the Eustachian tubes or the middle ear, antibiotics are included. On some occasions, surgical tympanic drainage and the placement of a small tube are required to facilitate temporary transtympanic drainage.
Surgical treatments for complicated ototubaritis problems include placement of ventilator tubes, eardrum reconstruction, and Tuboplasties.
References
- Bluestone, CD, & Klein, JO (2003). Otitis media and eustachian tube dysfunction. Pediatric otolaryngology, 4, 474.
- Fireman, P. (1997). Otitis media and eustachian tube dysfunction: connection to allergic rhinitis. Journal of allergy and clinical immunology, 99 (2), s787-s797.
- McBride, TP, Doyle, WJ, Hayden, FG, & Gwaltney, JM (1989). Alterations of the eustachian tube, middle ear, and nose in rhinovirus infection. Archives of Otolaryngology – Head & Neck Surgery, 115 (9), 1054-1059.
- McBride, TP, Doyle, WJ, Hayden, FG, & Gwaltney, JM (1989). Alterations of the eustachian tube, middle ear, and nose in rhinovirus infection. Archives of Otolaryngology – Head & Neck Surgery, 115 (9), 1054-1059.
- Palomar Asenjo, V., Borràs Perera, M., & Palomar García, V. (2014). Inflammatory pathology of the middle ear. pathophysiology of the eustachian tube. ototubaritis. acute otitis media. recurring oma. Libr. virtual Form. at ORL, 1-20.
- Payá, APH, & Jiménez, PJ (2003). Ear, nose and throat examination in Primary Care. SEMERGEN-Family Medicine, 29 (6), 318-325.
- Todd, NW (1983). Otitis media and eustachian tube caliber. Acta Oto-Laryngologica, 96 (sup404), 1-17.