What is Eustachian Tube Dysfunction?

The eustachian tube connects from your middle ear to your nasal-sinus cavity. The tube helps to drain fluid from your middle ear, balance the pressure in the middle ear, and helps to block certain noises from inside your body. Eustachian tube dysfunction occurs when the valve does not function appropriately and causes a buildup of fluid in the ear.

This buildup can cause pain, discomfort or pressure in the ear, and hearing difficulties. If the valve stays too open, it may cause you to feel constant pressure in the ear or hear unusual sounds such as hearing your voice too loudly or being able to hear yourself breathing. ETD is the leading cause of ear infections.

The most common eustachian tube disorders include:

• Patulous Eustachian tube dysfunction
• Obstructive Eustachian tube dysfunction
• Baro-challenge-induced Eustachian tube dysfunction (obstructive Eustachian tube dysfunction when on airplanes or when SCUBA diving)

Eustachian tube dysfunction is more common in children but can be diagnosed in adults. About 70% of children before age 7 will be diagnosed with ETD and about 1% of adults will be diagnosed. Fortunately, the condition usually resolves on its own in a few days. If symptoms do not resolve in a few days, consult with your healthcare provider.

Signs and Symptoms

Eustachian tube dysfunction has several signs and symptoms. Symptoms include:

• Hearing issues
• Tinnitus (ringing in your ears)
• Clicking or popping in the ears
• Sensation of pressure or fullness in the ears (sensation like your ears are plugged)
• Pain in the ears
• Dizziness, vertigo, or balance issues
• Tickling sensation in the ears

Symptoms may occur or get worse at higher altitudes (flying or driving in the mountains) and while scuba diving.

Causes

The most common causes for eustachian tube dysfunction are allergies, the common cold, the flu, or a sinus infection. Allergies and viruses can cause inflammation and mucus to buildup, which can lead to blockages in the ear. Additionally, people with GERD or chronic acid reflux are more likely to develop ETD. This occurs when stomach acid backs up into the throat and causes inflammation. Changes in altitude can also cause symptoms of ETD to develop.

Risk Factors

There are several risk factors that may put you at a greater risk of developing ETD. The most common risk factors include:

• Obesity can cause fatty tissue deposits to accumulate around the eustachian tubes, which increases the risk for blockages
• Smoking can damage the cilia (protective hairs in the middle ear that keep mucus from building up)
• Allergies may cause more inflammation, which can lead to a buildup of mucus and congestion
• Being a child increases risk because the eustachian tubes are smaller and are positioned more horizontally than vertically (this position changes in adulthood), which increases the likelihood of something getting stuck. Children also have weaker immune systems and are more likely to get colds or viruses that increase the risk of developing ETD.
• Being at higher altitudes also increases your risk of developing ETD
• Having enlarged adenoids

Diagnosis

ETD is typically diagnosed after a physical exam. Your doctor will ask questions about your symptoms, including the frequency, duration, and intensity. You will also be asked questions about your medical history, which may help to rule out other conditions. Additionally, your doctor will examine your ear and check the ear canals and passages into the nose and throat.

Treatment

In most cases, ETD resolves on its own. If symptoms persist for more than two weeks, consult your healthcare provider to discuss an appropriate treatment plan. The course of treatment you and your doctor will decide upon depends upon the cause and severity of your condition. There are effective home remedies your doctor may recommend. Depending on the effectiveness of the home remedies or cause and severity of your condition, your doctor may also recommend medications or surgery.

Home Remedies

• Chewing gum
• Swallowing
• Yawning
• Valsalva maneuver (forcefully breathing out while closing your mouth and pinching your nostrils)
• Using a saline solution or spray to clear out your nasal passages
• If you suspect your baby has ETD, give them a bottle or pacifier to suck on, as the sucking may help to clear any blockages

Medications

• Antihistamines (helps reduce allergy symptoms)
• Acetaminophen (pain reliever)
• Ibuprofen (pain reliever)
• Antibiotics (fights infection)
• Corticosteroids (reduces inflammation)

Surgery

If you have chronic eustachian tube dysfunction, it may require surgery. The goal of surgery is to avoid the eustachian tubes and just focus on the ventilation issues in your middle ear. Surgery should be able to correct any hearing issues and reduce or eliminate any other symptoms. The different types of surgery include:

• Myringotomy. In this procedure, a small incision is made in the eardrum, which helps to drain fluid from the middle ear. In adults, the incision is left open long enough to reduce the swelling in the eustachian tubes.
• Pressure equalization tubes. This procedure places tubes into the eardrums through the incision. The tubes provide appropriate ventilation to the middle ear for up to a year. The tubes usually come out over time, but sometimes if they don’t stay in long enough, the procedure will need to be repeated.
• Eustachian tuboplasty (eustachian tube balloon dilation). In this procedure, a balloon is inserted through the nasal cavity and into the eustachian tubes. The balloon is inflated once into the eustachian tubes and then deflated and removed after 2 minutes.

Prevention

There are a few things you can do to try and prevent ETD, although it cannot be prevented all together. Prevention strategies you can incorporate include:

• Wearing specialized earplugs to decrease the risk of “airplane ears”
• Drink plenty of water to help keep your mucus thin
• Avoiding extreme temperatures, which can make ETD symptoms worse

Complications

The most common complication from ETD is ongoing or recurring symptoms. Additional complications include:

• Chronic otitis media (middle ear infection)
• Otitis media with effusion (“glue ear;” fluid buildup in the middle ear that can last for weeks and sometimes causes permanent hearing damage)
• Eardrum retraction (the eardrum retracts further back into the ear canal)