Gaping tube

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Classification according to ICD-10
H69.0 Extended tuba auditiva
ICD-10 online (WHO version 2019)

Gaping tube , open tube or expanded tuba auditiva denotes a functional disorder of the Eustachian tube ( tuba auditiva ) in which the tube remains open on both sides or only on one side, permanently or temporarily. Normally, the tube is closed under the influence of the surrounding tissue, especially the tube cartilage and the so-called Ostmann fat body, and only opens briefly under the action of a number of muscles, above all the tensor veli palatini muscle (tendon muscle of the soft palate).

Symptoms

The main symptom of the gaping tube is autophony , which means that the body's own sound is fed to the middle ear unhindered through the tube. Your own voice is perceived as very loud and booming, the ambient noise as too quiet in comparison. Your own breathing is also perceived comparatively loud, sometimes a breathing-synchronous fluttering or flapping is described. Often the patients also complain of a dull pressure in their ears. Typically, the symptoms disappear with increasing venous pressure in the head area, e.g. B. lying down or by applying pressure to the neck veins. It is not uncommon for patients with a gaping tube to show the subjective compulsion to inhale sharply through the nose (so-called sniffing ), which creates a negative pressure in the nasopharynx, which is transferred to the middle ear via the open tube, which leads to a temporary closure of the tube . Compared to the frequency of the gaping tube (approx. Six to seven percent), however, the number of patients with serious complaints is noticeably low, and the gaping tube is usually symptom-free. However, there can be considerable suffering, especially with autophony.

causes

According to the current state of knowledge, a number of causes for the gaping tube are discussed. These include a previous strong decrease in body weight, hormonal factors (pregnancy, contraceptives ), scars in the nasopharynx, for example after adenotomy, or tumor irradiation of the nasopharynx. More complex causes such as desynchronization of the act of swallowing and contraction of the tensor veli palatini muscle, which keeps the tube open when the food passes from the throat into the esophagus, are also described. A connection between craniomandibular dysfunction and tube occlusion disorder is also discussed.

diagnosis

In addition to the typical symptoms (autophony, disappearance of symptoms when lying down or when the venous pressure increases), a breath-synchronous movement of the eardrum can often be seen under the microscope. Breath- synchronous impedance changes can be shown tympanometrically . However, depending on the severity of the tube disorder, these changes cannot always be detected. Usually, however, the tube function tests ( Valsalva experiment or similar) show that the tube is abnormally easy to open. Attempts to detect a gaping tube with imaging means ( magnetic resonance tomography ) are not yet satisfactory.

Treatment methods

In view of the symptoms that are often absent, therapy is often not necessary. In asthenic patients, weight gain may occur. U. eliminate the symptoms, in women discontinuing or changing the ovulation inhibitor can be successful. Occasionally, the use of a nasal ointment shows improvement. Decongestant nasal drops or sprays should be avoided, as should the frequent use of the Valsalva test .

Various surgical methods for narrowing the tube entrance, such as the injection of silicone or collagen or the implantation of gelatin sponges or pieces of cartilage in the tube bulge, are not regularly successful.

literature

  • HH Naumann among others: Oto-rhino-laryngology in clinic and practice. Part 1; Edited by Jan Helms. Georg Thieme Verlag, Stuttgart 1996, ISBN 3-13-676501-X .

Individual evidence

  1. ↑ B. Magnuson, B. Falk: Physiology of the Eustachian tube and middle ear pressure regulation. In: AF Jahn, Santos-Sacchi (Ed.): Physiology of the ear. Raven, New York 1988, pp. 81-101.
  2. ↑ R. Leuwer et al.: New aspects on the mechanics of the tuba auditiva. In: ENT. 2003, 51, pp. 431-438.

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