Calcification of the cartilaginous Eustachian tube

Abstract

Dear Sir:We would like to present to your readers the first reported computed tomography (CT) findings of complete cartilaginous Eustachian tube calcification incidentally found on a trauma workup. An 89-year-old female with a past medical history significant for chronic atrial fibrillation rate controlled on diltiazem and digoxin and anticoagulated on coumadin and osteoporosis was brought in after a mechanical fall. A CT of the head was ordered as part of our institution's trauma protocol. No history of diabetes, renal insufficiency, or primary or secondary hyperparathyroidism was noted.On CT, there was no evidence of intracranial hemorrhage, midline shift, mass effect, or depressed skull fracture. Incidentally noted was complete calcification of the cartilaginous portions of both Eustachian tubes (ET) (Fig. 1). This case demonstrates, to the best of the authors' knowledge and after an extensive literature review, the first reported CT findings of complete calcification of the cartilaginous portions of the ETs. Calcium deposition can occur with aging and various pathologic processes [1] with cartilaginous ossification or calcification often found in the elderly, including bronchial cartilage [2], laryngeal cartilage [3], and various articular cartilages [4].Although CT findings of ET calcification have not been previously reported, there are histopathologic reports of this finding. These studies posit that ET calcification is closely associated with aging and may be a predisposing factor to ET dysfunction in the elderly, including otitis media [5]. Calcification of the cartilaginous portion of the ET has also been seen in chronic renal failure [6]. The anatomy of the ET may help understand the link between calcification and dysfunction.The ET extends from the anterior wall of the middle ear to the lateral wall of the nasopharyrnx approximately at the level of the inferior nasal concha, traversing an inverted S-shaped course posterior and lateral through the petrous temporal bone (Fig. 2a) [7]. The mucosal layer of the ET is a pseudostratified ciliated columnar epithelium, which functions to sweep material from the middle ear towards the nasopharynx. The ET serves in ventilation, clearance, and protection of the middle ear [8] and the shape and elasticity of the ET appear to allow these functions [9].The proximal third of the ET is made of bone and is attached by a junctional zone with the remaining two thirds composed of cartilage (Fig. 2a) which protrudes into the nasopharynx forming the torus tubarius. The osseous and cartilaginous portions of the ET are cone shaped in appearance with the broadest portion at the respective tympanic and nasopharyngeal openings and

Rare finding of Eustachian tube calcifications with cone-beam computed tomography

“… 7 Furthermore, calcification has been associated with fatty infiltration of the tensor veli palatini muscle, which may additionally contribute to Eustachian tube dysfunction. 13 The patient reported no positive signs of Eustachian tube dysfunction such as muffled hearing, tinnitus, popping sounds, ear pressure, or abnormal hearing; however, the patient had infrequent muscle soreness in the ear region, which could be attributed to failure of the Eustachian tube to provide proper clearance of middle ear secretions and pressure equalization. The cartilaginous portion of the Eustachian tube is elastic in nature and calcifications reduce its opening and closing effectiveness.…”

“… 11 Anatomically, the Eustachian tube is divided into osseous, junctional, and cartilaginous portions, with the osseous portion being nearest the middle ear and the cartilaginous portion running between the greater wing of the sphenoid and the petrous portion of the temporal bone. 15 The cartilage provides structural support to the Eustachian tube, while still allowing mobility, 13 and its function is intimately related to the structure, composition, and attachment of the cartilage. 12 The Eustachian tube has 3 physiologic functions: 1) pressure regulation, 2) protection of the middle ear from excessive sound pressure, and 3) drainage of nasopharyngeal secretions.…”

“…Although clinical evidence of Eustachian tube calcification is almost nonexistent, Morshedi and Mafee published the first and only documented case in 2011 13 and more recently Buch et al retrospectively reviewed torus tubarius calcifications. 8 Calcium deposition has been shown to occur with aging and various pathological processes, and is more frequently found in the elderly.…”

“…The cartilaginous portion of the Eustachian tube is elastic in nature and calcifications reduce its opening and closing effectiveness. 13 …”

“…However, a case diagnosed using multidetector CT was reported in the literature. 13 The purpose of this article is to present an unusual case of Eustachian tube calcification noted on CBCT imaging.…”