The morphometry and three-dimensional structure of the adult eustachian tube: implications for function.

An accurate description of the functioning Eustachian tube (ET) requires a thorough knowledge of the anatomic relationships of its components. To this end, 15 "normal" adult ETs were obtained, sectioned, and stained with hemotoxylin-eosin. Descriptive and quantitative data of ET structures and their relationships were obtained. Eustachian tube length was normalized and comparisons between specimens made. This analysis suggests (1) in its midsection the cartilage is loosely attached to the cranial base; (2) the deep portion of the tensor veli palatini (TVP) originates from the lateral lamina and the fibrous portion of the lateral membraneous wall; and (3) the levator veli palatini (LVP) can interact with the ET primarily via the elongated medial lamina in the anterior portion of the ET. These observations suggest the ET is opened by a medial rotation of cartilage effected primarily by the TVP, but aided anteriorly by the LVP.

Fetal development of the auditory tube and paratubal musculature.

The purpose of this study was to describe the prenatal development of the human auditory tube and paratubal musculature. Twenty prenatal specimens, 8 to 36 weeks of age postconception were embedded in celloidin, sectioned, and stained with hemotoxylin eosin. Qualitative data on the initial appearance and development were obtained using light microscopy (Plates I-VI). Linear and angular measurements were obtained from traced sections. The analysis showed the following: morphological differentiation of this area occurs between 8 and 16 weeks menstrual age; tubal structures develop in anterior-posterior and medial-lateral gradients; the tubal lumen of the perinatal fetus is cylindrical and lacks an isthmus; the allometric growth of the cartilaginous portion of the lumen between 16 and 28 weeks is responsible for the greatest increase in the tubal length during the fetal period.

Androgen stimulation and laryngeal development.

Androgen-induced changes in laryngeal growth patterns were studied using a sheep animal model. Forty-eight lambs were divided into eight treatment groups. Lambs in seven of the groups were castrated at birth, while lambs in the eighth group served as an intact (noncastrated) control. Six groups were then treated with varying doses of testosterone and dihydrotestosterone, while the seventh served as a castrated, nontreated control. All animals were killed and gross dissections of the larynges were performed. Thirty-four linear and angular measurements were obtained from each larynx. The mean superior thyroid horn separation showed the most dramatic androgen-induced effect (p = 0.023). Laryngeal anterior-posterior diameter, superior thyroid horn height, posterior thyroid cartilage width, thyroid cartilage angle, and vocal process to arytenoid base distances all demonstrated positive dose-response relationships. Hypoandrogenic levels appeared to have an inhibitory effect upon laryngeal growth when compared to castrated controls.

Effect of certain head and neck tumors and their management on the ventilatory function of the eustachian tube.

A prospective study was carried out which tested three hypotheses: 1) certain tumors of the head and neck that originate in sites other than the nasopharynx may cause middle ear effusion; 2) middle ear effusion is a predictable sequela of radical maxillectomy as well as total or partial resection of the soft palate; and 3) middle ear effusions that follow surgery to remove head and neck lesions are due to disturbances in palatal function, specifically to tensor veli palatini muscle dysfunction. Our results indicate that one fourth of all subjects had some evidence of middle ear abnormality prior to entering into treatment although they were asymptomatic. The treatment process influenced the function of the middle ear, as 79% of the subjects experienced middle ear-eustachian tube dysfunction following treatment, and 23% were found to have developed a perforation of the tympanic membrane or required myringotomy and tube insertion to relieve middle ear effusion. The results of these studies indicate that surgery that is adequate to remove cancer of the maxilla, tonsil, or palate in most cases interferes with the function of the tensor veli palatini muscle, resulting in functional eustachian tube obstruction. The need for attention to and the treatment of middle ear effusion in such patients is emphasized in light of other sensory deficits in this patient population.

Barium sulphate coating of the nasopharynx in lateral view videofluoroscopy.

There is disagreement regarding the usefulness of barium nasopharyngeal coating for clinical velopharyngeal evaluation. One hundred and thirty lateral videofluoroscopic studies performed both with and without barium at the same sitting were reviewed to evaluate multiple structural and functional characteristics of velopharyngeal valving behavior during speech production. Clinical ratings of hypernasality were also available for 105 of the patients studied by x-ray. Agreement between ratings of hypernasality and radiographic evidence of VP incompetency did not differ with respect to the presence or absence of barium. However, velopharyngeal incompetence was generally judged to be greater when the barium coating was used. The barium coating also provided more information as to the presence or absence of Passavant's ridge, generalized posterior pharyngeal wall movement, and palatal asymmetry. However, because the barium may produce artifacts or occasionally obscure structures, we recommend that lateral videofluoroscopy be performed both with and without barium.

Otolaryngology and deafness.

Results of a survey of 113 departments of otolaryngology chairmen indicated that, in general, otolaryngologists are inexperienced in treating deaf children. Moreover, the education of residents is marginal in some topics related to deafness. We conclude that didactic work in these deficient areas should be included in the curriculum of otolaryngology residents so that the needs of patients with such problems will be better met. This study was stimulated by the results of a survey of schools for the deaf regarding the otologic care of deaf children. Questions arose as to what extent otolaryngology residents are instructed in topics related to deafness.

Pharyngeal wall motion in prosthetically managed cleft palate adults.

Fiberoptic nasoendoscopy was used to evaluate the activity in the lateral and posterior pharyngeal walls of five adults with cleft palate, each of whom had worn a prosthetic speech appliance for more than 20 years. Activity during speech was greatest in the area of the levator veli palatini muscle and Passavant's ridge, while no gross activity was observed in the area of the auditory tube superiorly. Activity was variable within and between subjects. Apparent medial movement of the auditory tube seemed to be secondary to the influence of the levator muscle on the pharyngeal wall soft tissues.

Abnormalities in and around the ear: congenital, traumatic, inflammatory, and neoplastic.

Lesions on or about the auricle may be of congenital, traumatic, inflammatory, or neoplastic origin. For congenital lesions, appropriate treatment and correction of hearing loss are important concerns. The most common traumatic lesions, subperichondral hematomas and keloids, require accurate diagnosis and appropriate treatment to prevent development of further problems. Inflammatory lesions are usually easy to diagnose from the patient's complaints of recent onset of pain, erythema, and edema. Neoplasms, especially squamous cell carcinoma, should be considered in differential diagnosis of a sore that does not heal. When treatment of a periauricular abnormality involves surgery, biopsy, or incision and drainage, care should be taken not to jeopardize the facial nerve.

Examination for cervical masses.

Identification of cervical masses requires careful systematic examination of the head and neck. Important landmarks and major glands and muscles should be palpated and the upper aerodigestive tract examined with a mirror. If a mass is found and the cause is unclear, certain factors should be considered: the patient's age and history, the physical findings, and the location of the mass. Any mass of unknown cause that fails to respond to treatment within two to three weeks requires endoscopic evaluation of the mucosa of the upper aerodigestive tract and subsequent open biopsy. Such an aggressive approach will spare the patient inappropriate delays in determining definitive diagnosis and avoid inappropriate biopsy of a metastatic node containing squamous cell carcinoma primary to the aerodigestive tract. This results in optimum care of a patient with a cervical mass.

The nasopharyngeal orifice of the auditory tube: implications for tubal dynamics anatomy.

This is the first part of a study designed to clarify the relationship between auditory tube dilation and observed movement of the nasopharyngeal orifice of the tube. This report seeks to delineate the anatomical parameters of the system, whereas, the second will report on findings of torus "movement" observed during simultaneous tympanometric measurements of tubal function during swallowing. The disposition of the paratubal musculature, relation between the tubal cartilage and the cranial base, relations between the cartilage and the medial pyterygoid plate, relation between the two cartilaginous laminae, and the presence of a heavy coat of soft tissue over the torus were findings felt to indicate that movement of the tubal cartilage in swallowing cannot occur. Nasopharyngoscopic reports of "cartilage" movement during swallowing may be observations of soft tissue sliding over the torus and not torus movement itself.

Management of buccal space masses.

Lesions in the substance of the cheek--the buccal space--may present diagnostic and management difficulties. The buccal space, that potential fascia space lying within the bulk of the cheek, is anatomically described. While the history and physical characteristics of the buccal mass and selected radiographic and special procedures may suggest a specific cause, the diagnosis is often elusive and requires removal of the mass for histologic evaluation. The surgical approach to a mass in the cheek is governed by its location within the buccal space and by the index of suspicion of malignancy. The preauricular, submandibular approach is the authors' choice for most buccal space lesions. Five case reports are presented to illustrate features in the diagnosis and management of a buccal space mass.

Comparison of the anatomy of the eustachian tube in the rhesus monkey (Macaca mulatta) and man: implications for physiologic modeling.

The primate nasopharynx-eustachian tube-middle ear complex is being used to model both the normal and pathologic functions of the human eustachian tube by several researchers. An extensive search of the literature has indicated little detailed information on the primate eustachian tube/middle ear system. This study was undertaken to define the anatomical characteristic of the system in the Rhesus monkey (Macaca mulatta) and to determine the limits on the use of the monkey as a model of human eustachian tube function. Although the direct application of morphologic data to explain the function of a system is tenuous, the data on the Rhesus monkey eustachian tube appears to be consistent with that published for other mammals. The tensor veli palatni muscle appears to be the only muscle to act directly on the tube and effect tubal dilation. The muscle is attached to the lateral membranous tubal wall along its extrabullar extension. The muscle has an inferior attachment to the posterior hard palate and thus possesses a vector directed inferolaterally; contraction would appear to pull the membranous wall inferiorly and laterally, resulting in the tubal dilation. The eustachian tube relationships of the salpingopharyngeus, levator veli palatini, and internal pterygoid muscles are described. Their possible role in primate tubal function is minimal at best.