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The nasopharynx, eustachian tube and otitis media

Published online by Cambridge University Press:  29 June 2007

Jacob Sadé
Jacob Sadé*
Affiliation:
Sackler School of Medicine, Ear Research Laboratory. The Bio-Engineering Programme, Dumont Chair of Hearing Research. Tel Aviv University, Israel.
*
Professor J. Sadé, 14 Hagefen Street, 47254 Ramat Hasharon, Israel. Fax: 972-3-5700924.
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Abstract

It has been classically hypothesized that a mass in the nasopharynx causes an obstacle to air flow through the eustachian tube, thereby creating a negative pressure in the middle ear followed by an effusion. However, examination of the relevant data concerning the supposed obstruction of the eustachian tube by nasopharyngeal carcinomas, choanal polyps and adenoids does not seem to support this cause and effect relationship. Evidence points to other more sophisticated mechanisms which cause negative pressure and an effusion in pathological middle ear conditions. While the hypothesis of a nasopharyngeal mass as the usual obstructive cause of middle ear effusion is hard to maintain, evidence does exist to support the origin of middle ear infection, as seen in acute and secretory otitis media, as being associated, at times, with an ascending infection from the nasopharynx.

Keywords

Otitis media with effusionOtitis mediaEustachian tubeAdenoidsAtelectasisCholesteatomaNasopharyngeal neoplasmsNasopharynx
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 108 , Issue 2 , February 1994 , pp. 95 - 100
Copyright
Copyright © JLO (1984) Limited 1994

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Footnotes

Lecture presented at the 14th Congress of the European Rhinological Society, Rome, October 1992.

References

Bernstein, J. M, Dryja, D. M., Loos, B. G., Dickinson, D. P. (1989) Restriction fragment mapping of nontypable Haemophilus influenzae: a new tool to study this middle ear pathogen. Otolaryngology - Head and Neck Surgery 100: 200–206.CrossRefGoogle ScholarPubMed
Buckingham, R. A. (1982) The clinical appearance and natural history of cholesteatoma. In Cholesteatoma and Mastoid Surgery (Sadé, J., ed.), Kugler, Amsterdam, pp 18–21.Google Scholar
Casselbrandt, M. L., Cantekin, E. I., Dirkmaat, D. C, Doyle, W. J., Bluestone, C. D. (1988) Experimental paralysis of tensor veli palatini muscle. Acta Otolaryngologica (Stockholm) 106: 178–185.CrossRefGoogle Scholar
Chonmaitree, T., Howie, V. M., Truant, A. L. (1986) Presence of respiratory viruses in middle ear fluids and nasal wash specimens from children with acute otitis media. Pediatrics 77: 698–702.CrossRefGoogle ScholarPubMed
Cundy, L. R., Sando, I., Hemingway, W. G. (1973) Middle ear extension of nasopharyngeal carcinoma via eustachian tube. Archives of Otolaryngology 98: 131–133.CrossRefGoogle ScholarPubMed
Dawes, J. D. K. (1970) The aetiology and sequelae of exudate otitis media. Journal of Laryngology and Otology 84: 583–610.CrossRefGoogle ScholarPubMed
Dawes, P. J. D., Bingham, B. J., Rhys, R., Griffiths, I. (1991) Aspirating middle ear effusions when inserting ventilation tubes: does it influence post-operative otorrhoea, tube obstruction or development of tympanosclerosis? Clinical Otolaryngology 16: 457–161.CrossRefGoogle ScholarPubMed
Freijd, A., Bygdeman, S., Rynnel-Dagoo, B. (1984) The nasopharyngeal microflora of otitis-prone children, with emphasis on H. influenzae. Acta Otolaryngology 97: 117–126.CrossRefGoogle ScholarPubMed
Gates, G. A., Avery, C. A., Prihoda, T. J., Cooper, J. C. (1987) Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. New England Journal of Medicine 317: 1444–1451.CrossRefGoogle ScholarPubMed
Gerwat, J. (1975) The structure and function of the nasopharyngcal lymphoid tissue with special reference to the aetiology of secretory otitis. Journal of Laryngology and Otology 89: 169–174.CrossRefGoogle Scholar
Goodhill, V. (1979) Ear Diseases, Deafness and Dizziness (Goodhill, V., ed.), Harper and Row, Maryland, USA, pp 248–249.Google Scholar
Hinchcliffe, R. (1972) Epidemiological aspects of otitis media. In Otitis Media (Glorig, A., Gerwin, K. D., eds.), Charles C. Thomas, Springfield, pp 36–43.Google Scholar
Hilding, A. C. (1944) Role of ciliary action in production of pulmonary atelectasis. Transaction of the Academy of Ophthalmology and Otolaryngology 80: 835–837.Google Scholar
Honjo, I., Tashima, K., Mitoma, T., Hamada, E. (1985) Effects of adenoidectomy on eustachian tube function. Auris Nasus Larynx 12(Suppl. 1): 231–233.CrossRefGoogle ScholarPubMed
Honjo, I. (1988) Nasopharyngeal Carcinoma on Otitis Media with Effusion in Eustachian Tube and Middle Ear Diseases, Springer- Verlag, Tokyo-Berlin-Heidelberg-New York-London-Paris, pp 91–111.Google Scholar
Kokko, E. (1974) Chronic secretory otitis media in children - a clinical study. Acta Otolaryngologica (Stockholm) (Suppl. 327): 7–24.Google ScholarPubMed
Lim, D. (1979). Microbiology and Cytology of Otitis Media with Effusion in Secretory Otitis Media and its Sequelae. (Sadé, J., ed.), Churchill-Livingstone, New York-Edinburgh-London, pp 125–143.Google Scholar
Loos, B. G., Bernstein, J. M., Dryja, D. M., Murphy, T. F., Dickinson, D. P. (1989) Determination of epidemiology and transmission of nontypeable hemaphilus influenza in children with otitis media by comparison of total fenomic DNA restriction fingerprints. Infection and Immunity 57: 2751–2757.CrossRefGoogle ScholarPubMed
Magnan, J., Bremond, G. A., Chays, A., Gignac, D. (1989) Experience in tubo-tympanic endoscopy. In Basic Aspects of the Eustachian Tube and Middle Ear Diseases, (Sadé, J., ed.), Kugler and Ghendini, Amsterdam-Milan-New York, pp 175–176.Google Scholar
Maw, A. R., Parker, A. (1988) Surgery of the tonsils and adenoids in relation to secretory otitis media in children. Acta Otolaryngologica, (Stockholm) 454 (Suppl.): 202–207.CrossRefGoogle ScholarPubMed
Mawson, S. R., Fagan, P. (1972) Tympanic effusions in children: long-term results of treatment by myringotomy, aspiration and indwelling tubes (grommets). Journal of Laryngology and Otology 86: 105–119.CrossRefGoogle ScholarPubMed
McKee, W. J. E. (1963) A controlled study of the effects of tonsillectomy and adenoidectomy in children. British Journal of Preventive Social Medicine 17: 49–69.Google Scholar
Murphy, D. (1979) Negative pressure in the middle ear by ciliary propulsion of mucus through the eustachian tube. Laryngoscope 89: 954–961.CrossRefGoogle ScholarPubMed
Myers, E. M., Beery, Q. C., Bluestone, C. D., Rood, S. R., Sigler, B. A. (1984) Effect of certain head and neck tumours and their management on the ventilatory function of the eustachian tube. Annals of Otology and Laryngology 19: 3–16.CrossRefGoogle Scholar
Paradise, J. L., Bluestone, C. D., Rogers, K. D., Taylor, F. H., Calborn, D. H., Bachman, R. Z., Bernard, B. S., Schwarzback, R. H. (1987) Efficacy of adenoidectomy for recurrent otitis media results from parallel random and nonrandom trials. Pediatric Research 21: 286A.CrossRefGoogle Scholar
Politzer, A. (1903). Diseases of the Ear, Lea Bros, Philadelphia, p 279.Google Scholar
Roydhouse, N. (1980) Adenoidectomy for otitis media with mucoid effusion. Annals of Otology, Rhinology and Laryngology 89 (Suppl. 68): 312–315.CrossRefGoogle ScholarPubMed
Sadé, J., Carr, C. D., Senturia, B. H. (1959) Middle ear effusions produced experimentally in dogs. I. Microscopic and bacteriologic findings. Annals of Otology, Rhinology and Laryngology 58: 1017–1027.CrossRefGoogle Scholar
Sadé, J. (1966 a) A middle ear mucosa. Archives of Otolaryngology 84: 137–143.CrossRefGoogle ScholarPubMed
Sadé, J. (1966 b) Pathology and pathogenesis of secretory otitis media. Archives of Otolaryngology 84: 297–305.CrossRefGoogle Scholar
Sadé, J., Halevy, A., Hadas, E. (1976) Clearance of middle ear effusion and middle ear pressures. Annals of Otology, Rhinology and Laryngology 85: 58–62.CrossRefGoogle ScholarPubMed
Sadé, J., Biran, R. (1977) The relationship of adenoids and adenoidectomy to secretory otitis media. In Eleventh World Congress on Otolaryngology, (Tato, M., Aranz, A., eds.), Buenos Aires, pp 166–168.Google Scholar
Sadé, J. (1979 a) Treatment of secretory otitis media. In Secretory Otitis Media and its Sequelae, (Sadé, J., ed.), Churchill-Livingstone, New York, p 65.Google Scholar
Sadé, J. (1979 b). Middle Ear Effusions: Animal Experiments in Secretory Otitis Media and its Sequelae. (Sadé, J., ed.) Churchill- Livingstone, New York-Edinburgh-London, pp 276–284.Google Scholar
Sadé, J., Fuchs, C. (1986) Adenoids, adenoidectomy and middle ear disease. A re-evaluation. In Acute and Secretory Otitis Media, (Sadé, J., ed.), Kugler, Amsterdam, pp 519–528.Google Scholar
Sadé, J., Luntz, M. (1989) Eustachian tube lumen: comparison between normal and inflamed specimens. Annals of Otology, Rhinology and Laryngology 98: 630–634.CrossRefGoogle ScholarPubMed
Sadé, J. (1992) The correlation of middle ear aeration with mastoid pneumatization. European Archives of Oto-Rhino-Laryngology 249: 301–304.CrossRefGoogle ScholarPubMed
Sadé, J., Luntz, M. (1993) Dynamic measurements of gas composition in the middle ear. II: Steady state values. Acta Otolaryngologica 113: 253–257.CrossRefGoogle ScholarPubMed
Sato, H., Kurata, K., Yen, Y. H., Hsieh, T. (1988) Extention of nasopharyngeal carcinoma and otitis media with effusion. Archives of Otolaryngology, Head and Neck Surgery 114: 866–867.CrossRefGoogle Scholar
Sham, J. S. I., Weis, I., Lau, S. K., Yau, C. C, Choy, D. (1992) Serous otitis media and paranasopharyngeal extension of nasopharyngeal carcinoma. Head and Neck 14: 19–23.CrossRefGoogle ScholarPubMed
Stenfors, L. E., Raisanen, S. (1991) Is the attachment of bacteria to epithelial cells of the nasopharynx the key to otitis media? International Journal of Pediatric Otorhinolaryngology 22: 1–8.CrossRefGoogle ScholarPubMed
Takahara, T., Sando, I., Bluestone, C. D., Myers, E. M. (1986) Lymphoma invading the anterior eustachian tube. Annals of Otology, Rhinology and Laryngology 95: 101–105.CrossRefGoogle ScholarPubMed
Van Hasselt, A. C., Gibb, A. G. (1991). Nasopharyngeal Carcinoma, Chinese University Press, Hong Kong, pp 105–144.Google Scholar
Vered, J., Eliezer, H., Sade, J. (1972) Biochemical characterization of middle ear effusion. International Journal of Pediatric Otorhinolaryngology 81: 394–400.Google Scholar
Wei, W. L., Lund, V. J., Howard, D. J. (1988) Serious otitis media in malignancies of the nasopharynx and maxilla. Journal of Laryngology and Otology 102: 129–132.CrossRefGoogle Scholar
Youngs, R. P., Gatland, D. J. (1988) Is aspiration of middle ear effusions prior to ventilation tube insertion really necessary? Journal of Otolaryngology 17: 204–206.Google ScholarPubMed
Zöllner, F. (1942) Anatomie, Physiologie, Pathologie and Klinik der Ohrtrompete, Springer-Verlag, Berlin, pp 188–207.Google Scholar