Narrowest (isthmus) portion of eustachian tube: a computer-aided three-dimensional reconstruction and measurement study.

Nine normal human temporal bones from persons 16 to 88 years old were studied by computer aided three-dimensional reconstruction and measurement. The length of the eustachian tube (ET) lumen in three portions (from pharyngeal orifice to tympanic orifice: cartilaginous, junctional, and bony) averaged 23.6 +/- 4.3 mm, 3.0 +/- 1.9 mm, and 6.4 +/- 2.6 mm. The narrowest portion of the ET lumen was in the cartilaginous portion in all cases: 20.5 +/- 4.2 mm from the pharyngeal orifice and 3.1 +/- 1.6 mm from the pharyngeal margin of the junctional portion. The cross-sectional area of the narrowest portion was 0.65 +/- 0.2 mm2. The tendon of the tensor veli palatini muscle (TVPM) inserted into the lateral lamina in the narrowest portion of the ET lumen in five of nine cases. These results suggest that contraction of the TVPM opens the narrowest portion of the ET lumen to ventilate the middle ear and that this portion also plays a role in protecting the middle ear.