Eustachitis

EUSTACHITIS, eustachiitis, a catarrhal disease of the Eustachian tube. The name E. is incorrect, and in modern specialized manuals this disease is designated as catarrh of the Eustachian tube (catarrhus tubae Eustachii). Catarrhs of the Eustachian tube are divided into acute and chronic, which in turn are subdivided into primary and secondary. In the acute stage, congestion (hyperemia) and swelling of the mucous membrane of the canal are noted, whereby its lumen narrows, the walls close more tightly than in the norm, and lose the ability to separate from each other under the action of the tubal muscles; from this ventilation of the tympanic cavity is disturbed, air is absorbed into it, pressure decreases, and as a result exudate accumulates. If, despite the exudate, the pressure does not equalize, the tympanic membrane is drawn inward. This process may gradually disappear or gradually pass into the chronic form. In the chronic form, persistent thickening of the mucous membrane of the Eustachian tube, concentric contraction, and consequently narrowing of the canal are noted. Most often, catarrh of the Eustachian tube is secondary in the spread of the catarrhal process from the mucous membrane of the nose or nasopharynx to the mucous membrane of the tube. Catarrh of the Eustachian tube is observed as a primary disease significantly less often. The causes of secondary catarrh are the most diverse diseases of the upper respiratory tract, pharynx, and tympanic cavity: rhinitis, angina, nasopharyngeal enlargements (adenoids), suppuration of the accessory cavities of the nose, ozaena. In schoolchildren, in 10% of cases, the presence of enlarged nasopharyngeal glands (adenoids) was established as the cause of catarrh of the Eustachian tube. Primary catarrh of the Eustachian tube depends on a special tendency of this canal to inflammation. Narrowness of the nasal passages or their excessive width and generally chronic diseases of the nasal and nasopharyngeal cavities predispose to primary diseases. The symptoms of acute catarrh of the Eustachian tube depend on the state of the lumen of the tube. Obstruction is expressed by retraction of the tympanic membrane, exudate, or both simultaneously. These phenomena can be seen with an ear funnel (mirror) during examination of the tympanic membrane (otoscopically). Subjectively, a decrease in hearing is felt in this disease, sometimes a feeling of fullness in the head, 'stuffiness in the ear,' noise in the ears, or only in one ear is added. A symptom indicating that there is accumulation of fluid in the tympanic cavity is the sensation of fluid shifting in the ear experienced by patients. With the disappearance of inflammatory changes in the upper respiratory tract (nose, nasopharynx), the phenomena of acute catarrh of the Eustachian tube disappear within 5–6 days without the application of local treatment. - The symptoms of chronic disease of the Eustachian tube are the same as those noted in acute catarrh, but they are more persistent. Improvement that occurs in such cases after the application of therapeutic measures does not last long. The result of treatment of chronic catarrh depends in the vast majority of cases on diseases in the nose and nasopharynx that caused the lesion of the canal. If there are diseases in the nose and nasopharynx that are amenable to successful treatment (adenoids, curvature of the nasal septum, excessive enlargement of the nasal turbinates, acute disease of the accessory cavities of the nose), then the prognosis must be considered favorable. After removal of the causes that caused chronic disease of the Eustachian tube in the upper respiratory tract, hearing is quickly restored after repeatedly performed catheterization or blowing (according to Politzer). In cases of stricture of the canal, bougienage is applied for treatment. Therapeutic measures in the acute stage of catarrh aim to reduce the swelling of the nasopharyngeal opening of the Eustachian tube to improve the outflow of catarrhal discharge. For this purpose, cocaine, adrenaline, menthol in the form of nasal drops and ointments (as in rhinitis) are applied. In those cases where exudate has accumulated in the middle ear, it usually absorbs after blowing; otherwise, it must be allowed to exit outward. For this purpose, a puncture of the tympanic membrane (paracentesis) is performed in the area of its lower posterior part. Then, to remove the exudate, the Eustachian tube is blown from the side of the external auditory canal with a Politzer balloon.