The eustachian tube measures approximately 31 to 38 mm in overall length in the normal adult and about 21 mm in an infant. The eustachian tube reaches its full length at about 7 years of age. The eustachian tube originates from the anterior aspect of the middle ear cavity at its proximal end and extends to the nasopharynx, where it terminates distally. The eustachian tube is composed of two portions: a proximal
osseous one third that is contained within the skull base, and a distal two thirds that is the cartilaginous portion. It has a slightly S-shaped course and passes generally posterosuperially and laterally from the nasopharynx. At the nasopharyngeal orifice, its cross section is triangular in shape, measuring 2 to 3 mm vertically and 3 to 4 mm in the horizontal base. The narrowest portion of the eustachian tube, the isthmus, which is located in the cartilaginous portion, is a vertical slit measuring 2 mm in height and 0.6 to 0.9 mm in width. The segment in which the cartilaginous and osseous portions connect has been termed the junctional portion by Sudo et al. The osseous portion opens funnel-like into the middle ear, and it remains fixed and patent under normal circumstances; in contrast, the cartilaginous portion of the eustachian tube is dynamic
(particularly the most nasopharyngeal portion), closed at rest and opened when active. Within the cartilaginous superior and middle portion, the mucosal surfaces of the anterolateral and posteromedial walls meet in apposition, closing the lumen in the resting position. This roughly 8- to 15-mm-long section serves as a functional “valve” and is composed of the mucosa, submucosa, lateral cartilaginous lamina, the Ostmann’s
fat pad, and the relaxed bulk of the tensor veli palatini muscle. The bony portion is lined by a layer of cuboidal respiratory epithelium and the cartilaginous portion is lined by pseudostratified columnar respiratory epithelium that is taller, more densely ciliated, and abundant in secreting goblet cells. The eustachian tube orifice can be identified just posterior to the inferior turbinate. The fossa of Rosenmüller is located posterior
to the torus tubarius and courses laterally toward the internal carotid artery, which lies just deep to the apex of the fossa. The torus tubarius, also known as the posterior cushion, contains the medial cartilaginous lamina, which is the mobile portion of the eustachian tube orifice. The lateral cartilaginous lamina (an-
terolaterally located) is smaller and immobile. The entire cartilaginous skeleton is shaped like an inverted J in cross section.
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