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PATHOGENESIS, AGE DEPENDENCE AND MODERN DIAGNOSTIC METHODS OF
TREATMENT OF EUSTACHITIS
Gʻaybullayev Rasulbek Bahodir oʻgʻli
Hojiyev Azizjon
Baxrimurod oʻgʻli
Abdiarimov Bayramali Serobovich
Samarkand State Medical University, Department of Otorhinolaryngology No. 1, 1st year
clinical residents.
https://doi.org/10.5281/zenodo.15635502
Research objective:
Some researchers believe that damage to the auditory tube alone is
almost impossible: the middle ear, that is, the auditory tube, the tympanic cavity and the mastoid
process are usually involved in the inflammatory process in one way or another. Due to this
combination, eustachitis is also called secretory (exudative) otitis media. Other synonyms: tubo-
otitis, salpingo-otitis, otosalpingitis, catarrh of the eustachian tube and tubotympanitis [11].
Eustachitis is an inflammation of the mucous membrane of the auditory tube. It can be acute and
chronic, unilateral and bilateral. Eustachitis occurs in people of any age, but is more common in
children, since their auditory tube is shorter and wider.
Introduction
Typically, disturbances in the functioning of the auditory tube occur due to acute and
chronic diseases of the nose (sinusitis, pharyngitis, tonsillitis and laryngitis), as well as allergic
and vasomotor rhinitis. This inflammatory process is ascending.
Respiratory viruses play a major role in the development of acute rhinosinusitis:
rhinovirus, influenza virus, and parainfluenza virus. They are found in more than 50% of patients
with acute rhinosinusitis [1].
Bacterial rhinosinusitis is often a complication of viral infection. Common pathogens
include pneumococcus, Haemophilus influenzae, and Moraxella catarrhalis. Furthermore, the
first two agents account for approximately 75% of acute bacterial rhinosinusitis [2].
A descending path of damage is also possible, for example with otitis media. In this case,
the infection enters through an opening in the middle ear.
The cause of the development of Eustachitis can be neuromotor and vegetative-vascular
diseases, injuries, benign and malignant tumors (for example, polyps or nasal carcinomas),
foreign bodies in the auditory tubes and border structures, diseases of the temporomandibular
joint, enlarged adenoids, chronic infectious granulomas, hereditary diseases, deviation of the
nasal septum and gastroesophageal reflux (this is especially characteristic of people with low
pharyngeal openings of the auditory tubes). Also, tubo-otitis can develop with specific
inflammatory diseases ( tuberculosis, syphilis, diphtheria, scleroma and leprosy) [3].
Materials and Methods
Inflammation of the mucous membrane is accompanied by swelling and accumulation of
fluid (transudate), which closes the lumen of the tube. This can also lead to impaired
barofunction, that is, the pressure in the middle ear cavity decreases, leading to the appearance of
congestion - the main complaint when eustachitis is suspected.
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If the cause of Eustachitis is rhinitis or other inflammation of the upper respiratory tract,
symptoms may develop within a few hours or a few days after the onset of the underlying
disease. It all depends on the severity of the initial inflammation.
Pathogenesis of Eustachitis
The auditory tube, or Eustachian tube, is a cavity made partly of bone and partly of
fibrocartilage that connects the middle ear with the nasopharynx. Its main function is ventilation.
When atmospheric pressure changes, the auditory tube opens, which equalizes the pressure in the
middle ear. For example, when an airplane takes off and reaches a higher altitude, the
atmospheric pressure decreases. This decrease puts pressure on the eardrum, increasing the
volume of the middle ear. Air is drawn in through the auditory tube to equalize the pressure in
the middle ear. When the airplane descends, the atmospheric pressure increases, again displacing
the eardrum, thereby compressing the air in the middle ear.
When an infection or allergen enters the auditory tube, it damages the ciliary epithelial
cells, thereby disrupting its protective and drainage functions. Inflammation or mechanical
obstruction (for example, adenoiditis, nasal polyps, etc.) leads to a decrease in the patency of the
pharyngeal opening of the auditory tube and a decrease in air pressure in the middle ear. In this
case, the eardrum is pulled back, reducing its mobility and the mobility of the entire chain of
auditory ossicles.
Results
An effusion (fluid) forms in the middle ear, the outflow of which is difficult due to
impaired drainage function.
Classification and stages of development of eustachitis
According to the International Classification of Diseases, 10th edition (ICD-10), there
are:
H 68. Inflammation and blockage of the auditory (Eustachian) tube.
H 69.9 Disorder of auditory (Eustachian) tube, unspecified.
Depending on the course of the pathological process, eustachitis can be:
acute - characterized by sudden onset and pronounced symptoms, often associated with
infections;
chronic - develops over a long period of time and is often the result of untreated acute
inflammation or prolonged exposure to adverse factors.
Taking into account the characteristics of pathological changes, doctors distinguish the
following:
vasomotor eustachitis (neurovegetative, allergic form) - develops as a result of a disorder
of the autonomic nervous system, in some cases under the influence of allergic factors,
sometimes the disease occurs as a combination of both phenomena [3] ;
adhesive eustachitis - inflammatory changes lead to the formation of adhesions that
disrupt the patency of the auditory tube and the mobility of the auditory ossicles;
hypertrophic eustachitis - associated with an increase in mucous membrane;
Atrophic eustachitis - develops as a result of thinning of the mucous membrane.
Neglected, untreated eustachitis can lead to the following unpleasant consequences:
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Acute catarrhal otitis media is an inflammation of the mucous membrane of the middle
ear, which causes severe pain in the ear. It usually develops when viruses enter. In this case,
eustachitis is the initial stage of otitis media.
Acute exudative otitis media is a collection of mucus in the middle ear. Due to poor
ventilation and decreased pressure in the middle ear, the mucous membrane produces more
mucus. At the same time, the drainage function is also impaired. In this case, the fluid can
remain in the middle ear for a very long time (sometimes up to several months).
Acute purulent otitis media - the course and symptoms are similar to catarrhal otitis, but
the causative agent is usually bacteria. First of all, the otolaryngologist will clarify all the
patient's complaints and collect anamnesis (medical history). He will be interested in how long
ago and against what background the symptoms appeared, whether there were flights, deep
dives, inflammation of the upper respiratory tract, etc. If the patient took any medications before
going to the hospital, he must inform the doctor about this.
The main diagnostic method is a complete examination of the ENT organs. All other
examinations are individual, but they are often performed and prescribed.
Otoscopy (examination of the ears) with eustachitis shows a retracted eardrum, a blurred
(flattened) light contour, and visible dilation of blood vessels on its surface.
Subjective diagnostic methods:
Measuring spoken and whispered speech. Typically, a person can hear whispered speech
at a distance of 6 meters, and spoken speech at a distance of more than 6 meters. With
eustachitis, the whispering speed is usually reduced.
Valsalva maneuver and Toynbee maneuver. In the first case, the patient takes a deep
breath, pinches his nostrils, closes his mouth and tries to breathe through his nose. In the second,
the person first pinches his nose, then takes a sip. At this time, the doctor uses an otoscope or
endoscope to observe the mobility of the eardrum. If everything is normal, the patient will hear
an invisible crackling sound in the ears. If the auditory tubes are blocked, congestion, buzzing,
wheezing, noise and noise occur.
Politzer's ear canal inflation. The doctor inserts an olive from a balloon designed for
insufflation into the patient's nose (first from one side, then from the other) and presses the wing
on the nasal septum from the other side. The patient pronounces the word "vaporizer" in
syllables, and on the syllable "hod" the doctor squeezes the balloon, thereby starting the flow of
air through the nose [6]. If there is mucus in the nasal cavity, insufflation is not performed, since
under pressure it can enter the ear canal and aggravate the course of the disease.
Tuning fork study:
Weber's experiment - the leg of a bass tuning fork that produces sound is placed in the
middle of the crown: with normal hearing, the sound of the belt is detected in the middle of the
head or in both ears, with damage to the outer and one-sided middle ear, the diseased ear hears
well, with damage to the inner ear, the healthy ear hears well;
Rinne's experiment - the stem of the tuning fork is placed in the mastoid process (behind
the ear); when the patient stops perceiving vibrations, it is brought to the external auditory canal:
with normal hearing or damage to the inner ear, the tuning fork is still audible for some time,
with damage to the outer and middle ear - vice versa;
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Schwabach experiment - the leg of a sound-emitting plug is placed in the middle of the
crown or mastoid process and the duration of sound reception is checked (the method is intended
to diagnose conductive hearing loss, which is characteristic of eustachitis) [7].
Objective diagnostic methods:
Impedanceometry - shows changes in pressure in the tympanic cavity, fluid
accumulation, etc. (this is the main method for monitoring diagnostics and treatment in children);
audiometric examination - eustachitis is characterized by conductive hearing loss, that is,
it is associated with impaired sound conduction;
X-ray or computed tomography of the paranasal sinuses;
swabs from the nose and throat for flora and sensitivity to antibiotics (for purulent otitis,
swabs are also taken from the ears);
general blood test - helps determine the nature of the inflammation (allergen, virus or
bacteria).
Eustachitis treatment
Timely treatment of the disease is very important, since chronic eustachitis and its
changes in the middle ear gradually form permanent disturbances of sound conduction, which
become chronic after 3 months from the onset of the disease, so it is very difficult to completely
cure them. It is important to restore the ventilation function of the auditory tube as soon as
possible to prevent the development of hearing loss and eliminate the need for more serious
interventions [5].
The most important point in the treatment of Eustachitis is the elimination of acute and
chronic foci of infection of the ENT organs and the restoration of nasal breathing. If the cause of
Eustachitis is enlarged adenoids or other localized formations, they should be removed in a
timely manner. In case of deviation of the nasal septum, septum plastic surgery is performed
first.
Drug therapy includes vasoconstrictors and mucolytics. According to the indications,
antihistamines, anti-inflammatory, antibacterial, immunomodulatory and restorative agents, as
well as inhaled glucocorticosteroids and local warming agents for the ear (for example, turunda
with boric alcohol) can also be prescribed. Alcohol turundas are an effective tool for complex
treatment, but they can be used only as prescribed by a doctor, since their use can be dangerous
if there are certain contraindications.
Conclusion:
Surgical treatments include tympanopuncture, shunting, myringotomy, tympanotomy,
laser intervention, and balloon dilation of the auditory tube. They are performed for specific
indications (for example, with persistent exudative or purulent otitis media).
Balloon dilation of the auditory tube is a microsurgical method for the treatment of
tubular dysfunction and chronic middle ear pathology. The balloon is filled with saline and
inserted into the pharyngeal opening of the auditory tube using a syringe-manometer, after which
the balloon is inflated. The injection is maintained for 2 minutes. At this time, the cartilage of the
auditory tube becomes pale and its walls thicken. When the catheter and balloon are removed,
the mouth of the tube opens.
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