1. Otitis media and eustachian tube dysfunction: Connection to allergic rhinitis 
Philip Fireman, MD 
Journal of Allergy and Clinical Immunology 
Volume 99, Issue 2, Pages s787-s797 (February 1997)
DOI: /S (97)
Copyright © 1997 Mosby, Inc. Terms and Conditions

2. FIG. 1
A, The upper respiratory tract. The insert shows the eustachian tube as an airway that provides anatomic communication between the nasopharynx and the middle ear. B, Enlargement of the insert from A shows the role of the eustachian tube in ventilation of the middle ear. Tubal function is governed, in part, by the tensor veli palatini (TVP) muscle. With the muscle at rest, the tube is almost always closed. C, The tube opens when the TVP muscle contracts during swallowing, yawning, crying, or sneezing. Obstruction of the tube plays a central role in the pathogenesis of otitis media (From Atlas of Allergies. 2nd ed. P. Fireman and R. Slavin, editors, St. Louis, Mosby–Year Book, 1996.)
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions

3. FIG. 1
A, The upper respiratory tract. The insert shows the eustachian tube as an airway that provides anatomic communication between the nasopharynx and the middle ear. B, Enlargement of the insert from A shows the role of the eustachian tube in ventilation of the middle ear. Tubal function is governed, in part, by the tensor veli palatini (TVP) muscle. With the muscle at rest, the tube is almost always closed. C, The tube opens when the TVP muscle contracts during swallowing, yawning, crying, or sneezing. Obstruction of the tube plays a central role in the pathogenesis of otitis media (From Atlas of Allergies. 2nd ed. P. Fireman and R. Slavin, editors, St. Louis, Mosby–Year Book, 1996.)
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions

4. FIG. 1
A, The upper respiratory tract. The insert shows the eustachian tube as an airway that provides anatomic communication between the nasopharynx and the middle ear. B, Enlargement of the insert from A shows the role of the eustachian tube in ventilation of the middle ear. Tubal function is governed, in part, by the tensor veli palatini (TVP) muscle. With the muscle at rest, the tube is almost always closed. C, The tube opens when the TVP muscle contracts during swallowing, yawning, crying, or sneezing. Obstruction of the tube plays a central role in the pathogenesis of otitis media (From Atlas of Allergies. 2nd ed. P. Fireman and R. Slavin, editors, St. Louis, Mosby–Year Book, 1996.)
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions

5. FIG. 2
Function of the eustachian tube as related to the middle ear. A, Ventilation of the middle ear regulates and equilibrates middle-ear pressure with atmospheric pressure. B, The tube allows drainage and clearance of middle ear secretions and C protects the middle ear from nasopharyngeal secretions. These functions are analogous to those of the bronchial tree. Like other respiratory tract mucosa, the lining of the eustachian tubes contains mast cells, lymphocytes, macrophages, and plasma cells. (From Atlas of Allergy. 2nd ed. P. Fireman and R. Slavin, editors. St. Louis, Mosby, 1996.)
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions

6. FIG. 2
Function of the eustachian tube as related to the middle ear. A, Ventilation of the middle ear regulates and equilibrates middle-ear pressure with atmospheric pressure. B, The tube allows drainage and clearance of middle ear secretions and C protects the middle ear from nasopharyngeal secretions. These functions are analogous to those of the bronchial tree. Like other respiratory tract mucosa, the lining of the eustachian tubes contains mast cells, lymphocytes, macrophages, and plasma cells. (From Atlas of Allergy. 2nd ed. P. Fireman and R. Slavin, editors. St. Louis, Mosby, 1996.)
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions

7. FIG. 2
Function of the eustachian tube as related to the middle ear. A, Ventilation of the middle ear regulates and equilibrates middle-ear pressure with atmospheric pressure. B, The tube allows drainage and clearance of middle ear secretions and C protects the middle ear from nasopharyngeal secretions. These functions are analogous to those of the bronchial tree. Like other respiratory tract mucosa, the lining of the eustachian tubes contains mast cells, lymphocytes, macrophages, and plasma cells. (From Atlas of Allergy. 2nd ed. P. Fireman and R. Slavin, editors. St. Louis, Mosby, 1996.)
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions

8. FIG. 3
Diagram of proposed interactions among infection, eustachian tube obstruction, allergy, and host defense defects in pathogenesis of otitis media with effusion.
Journal of Allergy and Clinical Immunology  , s787-s797DOI: ( /S (97) )
Copyright © 1997 Mosby, Inc. Terms and Conditions