Finally, the air cushion, according to the flask model of C. The surfactant acts both as a surface-tension reducer and as an antibacterial substance. A manifestation of its protective role is the inhibition of pathogen-laden secretions and sounds created in the nasopharynx from entering the middle ear. The ET prevents pathogens from ascending to the ear by remaining mostly closed it also features a mucosal surface coated with surfactant. A third role of the ET is the protection of the middle ear. Simultaneously, the muscles surrounding the tube exert a pumping action from proximal to distal, propelling mucus to the nasopharynx. An additional role includes the clearance of secretions, as the middle ear clears its mucus towards the nasopharynx with the aid of the ciliated respiratory epithelium of the ET. In this way, the tympano-ossicular system remains at the state of least impendence, transmitting, consequentially, the mechanical wave of sound to the inner-ear lymph in the most effective way. The eustachian tube (ET) is not merely a canal that connects the tympanic cavity with the nasopharynx but is a distinct organ that plays a fundamental role in the physiology of the middle ear. Its first role is to aerate the middle ear, creating a condition of equal air pressure on both sides of the tympanic membrane. In the current review, we aim to provide background information on the anatomy, physiology, and pathophysiology of the ET and to present the progress of the balloon dilation technique with emphasis on pediatric patients. Growing international experience indicates that this promising technique is safe and effective. An emerging interventional approach that intends to restore the function of the tube is the transnasal balloon dilation of the cartilaginous part of the ET. Moreover, the established surgical approaches, like grommets and adenoidectomy, deal only indirectly with the problem since they are not addressing the dysfunctional ET itself. Medical therapy is not practically effective for the treatment of effusion. Otitis media with effusion, apart from being a burden for hearing, with direct consequences for speech development, may also be implicated in cholesteatoma formation. Children are more vulnerable to pathologies of the middle ear, primarily due to the immature development of their eustachian tubes. Thus, any condition that renders the tube dysfunctional is directly implicated with middle ear pathophysiology, like in the case of acute otitis media and otitis media with effusion. The tensor veli palatini does not contribute to the fold, because the origin of tensor veli palatine is deep to the cartilaginous opening.The eustachian tube (ET) has a crucial role in the physiology of the middle ear. It includes some fibers of muscle, called salpingopalatine muscle and stretches from the superior border of lateral lamina of the cartilage, anteroinferiorly, to the back of the hard palate. The Anterior Fold is the second and smaller fold which is also called the salpingopalatine fold and is smaller than the salpingopharyngeal fold. It stretches from the lower part of the torus tubarius and includes the Salpingopharyngeus muscle which emerges from the superior border of the medial lamina of the cartilage of the auditory tube and passes downward and then blends with the posterior fasciculus of the palatopharyngeus muscle. The posterior fold is the vertical fold of mucous membrane which is also called the salpingopharyngeal fold. From the inferior portion of the torus tubarius, two mucosal folds are extended which are named anterior fold and posterior fold.
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