Relationship Between the Electromyographic Activity of the Paratubal Muscles and Eustachian Tube Opening Assessed by Sonotubometry and Videoendoscopy

Authors:
  • JSJ. Douglas Swarts
    J. Douglas Swarts
  • ASAlok Singla
    Alok Singla
  • JBJulianne Banks
    Julianne Banks
  • WDWilliam J. Doyle
    William J. Doyle
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Abstract
Otitis media (OM) is believed to be a spectrum of diseases characterized by inflammation of the middle ear (ME) mucosa and a concomitant accumulation of effusion in the ME cleft.1 A variety of factors have been implicated in the pathogenesis of OM, including in situ bacterial or viral infection, nasal allergy, and eustachian tube (ET) dysfunction. The ET is a biological tube that connects the anterior portion of the ME to the nasopharynx. That tube is usually closed by a periluminal pressure in excess of atmospheric and is opened intermittently by the active contraction of the tensor veli palatini muscles (mTVP) and, perhaps, the levator veli palatini muscles (mLVP).2 Muscle-assisted, active tubal opening during such activities as swallowing, yawning, and mandibular repositioning allows gradient-driven exchange of gas between the nasopharynx (atmospheric pressure) and ME that equilibrates any preexisting ME-atmospheric pressure differences.1 Failure to open the ET, or insufficiently frequent ET openings, are associated with the progressive development of ME underpressures that “at a critical” value of approximately −200 decapascals provokes ME effusion.3 The results of numerous studies showed that populations “at risk” for OM, or with tympanostomy tubes inserted for OM, are characterized by having a poor ET opening function related to structural variations in the ET and/or aberrant function of the mTVP, mLVP, or both.1,4,5

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