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From catheterization to crenotherapy: historical and functional perspective on the Eustachian tube

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Received: 2 September 2025
Published: 26 September 2025
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The Eustachian tube has played a surprisingly central role in the development of modern otology. Although often overshadowed by the clinical study of the inner ear and tympanic cavity, it was the Eustachian tube, and its treatment, that led to the establishment of Otology as an independent medical discipline in the early 19th century. This article aims to retrace this evolution, beginning with the historical, anatomical, and physiological background of catheterization techniques, continuing with the functional anatomy of the peritubal muscles, and concluding with a discussion of the most common middle ear pathologies. It also highlights the modern rediscovery of thermal therapy as a potential ally in the management of Eustachian tube dysfunction.

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1. Feldmann H. The Eustachian tube and its role in the history of otology. Images from the history of otorhinolaryngology, presented by instruments from the collection of the Ingolstadt German History Museum. Laryngo Rhino Otologie 1996;75:783-92. DOI: https://doi.org/10.1055/s-2007-997676

2. Hage R, Andrew K. To hear One's breath: Unveiling the eponymous quartet – A historical exploration of the eustachian tube. Transl Res Anat 2024;36:100311. DOI: https://doi.org/10.1016/j.tria.2024.100311

3. Martini S. Il senso dell’udito nel Corpus Aristotelicum. Europäische Hochschulschriften / European University Studies / Publications Universitaires Européennes, Volume 735. Bern: Peter Lung; 2011. DOI: https://doi.org/10.3726/978-3-0351-0189-8

4. Stangerup SE. Autoinflation: historical highlights and clinical implications. Ear Nose Throat J 1998;77:737-42. DOI: https://doi.org/10.1177/014556139807700910

5. Hee-Young K. The history of Eustachian tube catheterization. J Otolaryngol ENT Res 2016;4:00084. DOI: https://doi.org/10.15406/joentr.2016.04.00084

6. Feldmann H. Tympanic membrane massage, origin and decline of a promising therapeutic concept. Laryngo Rhino Otologie 1996;75:491-8. DOI: https://doi.org/10.1055/s-2007-997621

7. Bluestone CD, Bluestone MB. Eustachian tube: structure, function, role in otitis media. Hamilton: BC Decker; 2005.

8. Makibara RR, Fukunaga JY, Gil D. Eustachian tube function in adults with intact tympanic membrane. Braz J Otorhinolaryngol 2010;76:340-6. DOI: https://doi.org/10.1590/S1808-86942010000300012

9. Helwany M, Arbor TC, Tadi P. Embryology, Ear. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

10. Bluestone CD, Doyle WJ. Anatomy and physiology of eustachian tube and middle ear related to otitis media. J Allergy Clin Immunol 1988;81:997-1003. DOI: https://doi.org/10.1016/0091-6749(88)90168-6

11. Alper CM, Luntz M, Takahashi H, et al. Anatomy (Eustachian tube, middle ear, and mastoid-anatomy, physiology, pathophysiology, and pathogenesis). Otolaryngol Head Neck Surg 2017;156:S22-40. DOI: https://doi.org/10.1177/0194599816647959

12. Ostfeld EJ, Silberberg A. Gas composition and pressure in the middle ear: a model for the physiological steady state. Laryngoscope 1991;101:297-304. DOI: https://doi.org/10.1288/00005537-199103000-00014

13. Mertes IB. Detection of middle-ear muscle reflex activation using changes in otoacoustic emission stimulus amplitude versus absorbance: an initial investigation. Hear Bal Commun 2022;20:272-8. DOI: https://doi.org/10.1080/21695717.2022.2083872

14. Loukzadeh Z, Houshang Mehrparvar A, Razmjooei Z, et al. Effect of noise and organic solvents on acoustic stapedial reflex. Hear Bal Commun 2023;21:275-80. DOI: https://doi.org/10.1080/21695717.2023.2172271

15. Llewellyn A, Norman G, Harden M, et al. Interventions for adult Eustachian tube dysfunction: a systematic review. Health Technol Assess 2014;18:1-180. DOI: https://doi.org/10.3310/hta18460

16. Zarei M, Hosseini Dastgerdi Z, Momeni A, Nouri NS. Assessment of auditory processing in children with non-syndromic cleft lip and/or palate. Hear Bal Commun 2021;20:32-8. DOI: https://doi.org/10.1080/21695717.2021.1933317

17. Yurdakul Çınar F, Polat Z. Assessment of auditory processing skills in adolescents with cleft lip and palate. Hear Bal Commun 2023;21:262-8. DOI: https://doi.org/10.1080/21695717.2023.2203558

18. Smith ME, Tysome JR. Tests of Eustachian tube function: a review. Clin Otolaryngol 2015;40:300-11. DOI: https://doi.org/10.1111/coa.12428

19. Kaya B, Çiftçi HN, Çelebi Z, Yılmaz O, Şerbetçioğlu MB. Evaluation of the effect of the menstrual cycle on hearing. Hear Bal Commun 2022;21:281-5. DOI: https://doi.org/10.1080/21695717.2022.2148991

20. Tailor BV, Smith ME, Hutchinson PJA, Tysome JR. Outcome measures for baro-challenge-induced Eustachian tube dysfunction: a systematic review. Otol Neurotol 2018;39:138-49. DOI: https://doi.org/10.1097/MAO.0000000000001666

21. Alper CM, Swarts JD, Singla A, et al. Relationship between the electromyographic activity of the paratubal muscles and eustachian tube opening assessed by sonotubometry and videoendoscopy. Arch Otolaryngol Head Neck Surg 2012;138:741-6. DOI: https://doi.org/10.1001/archoto.2012.1293

22. Meyer MF, Korthäuer C, Jansen S, et al. Analyzing eustachian tube function in patients with symptoms of chronical Eustachian tube dysfunction by pressure chamber measurements. Eur Arch Otorhinolaryngol 2018;275:1087-94. DOI: https://doi.org/10.1007/s00405-018-4938-z

23. Liu S, Ni X, Zhang J. Assessment of the Eustachian tube: a review. Eur Arch Otorhinolaryngol 2023;280:3915-20. DOI: https://doi.org/10.1007/s00405-023-08026-5

24. Yücetürk AV, Unlü HH, Okumuş M, et al. The evaluation of eustachian tube function in patients with chronic otitis media. Clin Otolaryngol Allied Sci 1997;22:449-52. DOI: https://doi.org/10.1046/j.1365-2273.1997.00029.x

25. McCoul ED, Anand VK, Christos PJ. Validating the clinical assessment of eustachian tube dysfunction: The Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Laryngoscope 2012;122:1137-41. DOI: https://doi.org/10.1002/lary.23223

26. Keller S, König V, Mösges R. Thermal water applications in the treatment of upper respiratory tract diseases: a systematic review and meta-analysis. J Allergy 2014;2014:943824. DOI: https://doi.org/10.1155/2014/943824

27. Simões JF, Castro H, Martins MJ, Miguéis A. Thermal waters in otorhinolaryngology. In: Martins MJ, editor. Mineral Water. New York: Nova Science Publishers; 2022.

28. Passali D, De Corso E, Platzgummer S, et al. Spa therapy of upper respiratory tract inflammations. Eur Arch Otorhinolaryngol 2013;270:565-70. DOI: https://doi.org/10.1007/s00405-012-2024-5

29. Mirandola P, Gobbi G, Malinverno C, et al. Impact of sulphurous water politzer inhalation on audiometric parameters in children with otitis media with effusion. Clin Exp Otorhinolaryngol 2013;6:7-11. DOI: https://doi.org/10.3342/ceo.2013.6.1.7

30. Ciprandi G, Cristofolini M, Mira E. Comano thermal water inhalations in the treatment of allergic rhinitis: preliminary results. Eur Ann Allergy Clin Immunol 2016;48:220-3.

31. Ottaviano G, Marioni G, Staffieri C, et al. Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomised, double-blind, clinical, and cytological study. Am J Otolaryngol 2011;32:235-9. DOI: https://doi.org/10.1016/j.amjoto.2010.02.004

32. Califano L, Salafia F, Mazzone S, et al. A comparative randomised study on the efficacy of a systemic steroid therapy vs. a thermal therapy in otitis media with effusion in children. Minerva Pediatr 2016;68:241-9.

33. La Mantia I, Andaloro C. Effects of salso-bromo-iodine thermal water in children suffering from otitis media with effusion: a randomised controlled pilot study. Clin Ter 2018;169:e10-13.

34. Cantone E, Marino A, Ferranti I, et al. Nasal cytological assessment after crenotherapy in the treatment of chronic rhinosinusitis in the elderly. Int J Immunopathol Pharmacol 2014;27:683-7. DOI: https://doi.org/10.1177/039463201402700427

35. Sokrateva TD, Roussev BH, Nashar MA, et al. Effects of sulphur-containing mineral water intake on oxidative status and markers for inflammation in healthy subjects. Arch Physiol Biochem 2019;126:278-87.

36. Fontana M, Vitali M, Del Prete J, et al. Beneficial effects of thermal waters on respiratory diseases: a systematic review. Int J Biometeorol 2025;69:915-46. DOI: https://doi.org/10.1007/s00484-025-02865-z

37. Hermelingmeier KE, Weber RK, Hellmich M, et al. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy 2012;26:e119-25. DOI: https://doi.org/10.2500/ajra.2012.26.3787

38. Casale M, Moffa A, Cassano M, et al. Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update. Int J Immunopathol Pharmacol 2018;32:2058738418802676. DOI: https://doi.org/10.1177/2058738418802676

39. Chong LY, Head K, Hopkins C, Philpott C, Glew S, Scadding G, et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev 2016;4:CD011995. DOI: https://doi.org/10.1002/14651858.CD011995.pub2

40. Fermo S, Frosolini A, Parrino D, et al. Eustachian tube insufflation with thermal water: Effectiveness in the treatment of pediatric otitis media with effusion. Am J Otolaryngol 2022;43:103504. DOI: https://doi.org/10.1016/j.amjoto.2022.103504

How to Cite



1.
Spinato G, Martini A. From catheterization to crenotherapy: historical and functional perspective on the Eustachian tube. Eur J Transl Myol [Internet]. 2025 Sep. 26 [cited 2026 Apr. 27];35(4). Available from: https://www.pagepressjournals.org/bam/article/view/14300