Eustachian Tube Dysfunction

Definition

The eustachian tube is a small canal that connects the middle ear to the back of the nose and upper throat (nasopharynx). Its purpose is to equalize the air pressure in the middle ear with the pressure outside it.

Eustachian tube dysfunction (ETD) occurs when the tube fails to open during swallowing or yawning. This results in a difference between the air pressure inside and outside the middle ear. It causes discomfort in the ear and temporary hearing problems.

Eustachian Tube

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Causes

The ear may feel blocked if the pressure outside the ear changes, but the pressure inside the ear does not change. When this happens, the eardrum cannot vibrate normally. It often occurs during altitude changes, like flying in an airplane, driving on steep hills, or scuba diving. Swallowing, yawning, or chewing usually make the symptoms go away.

ETD occurs if the tube is blocked or swollen, trapping air and fluids in the middle ear. This causes symptoms to continue beyond a few hours. Sometimes it can lead to ear damage.

Causes include:

• Nasal congestion from an allergy
• Cold other upper respiratory infection
• Ear or sinus infections
• Narrow eustachian tube
• Adenoid tissue blocking eustachian tube (in children)
• Tumors (in adults)

Risk Factors

A risk factor is something that increases your chance of getting ETD. Tell your doctor if you have any of these factors:

• Activities with large, rapid altitude changes, such as flying in an airplane or scuba diving
• Allergy, cold, or other upper respiratory infection
• Ear or sinus infection
• Narrow eustachian tube
• Presence of obstructing tumors in the nasopharynx
• Children with large adenoids
• Age: Children (Their eustachian tubes are narrower.)
• Environmental allergies

Symptoms

Symptoms can include:

• Feeling of fullness or clogging in the ear
• Discomfort or pain in the ear
• Hearing loss
• Ringing in the ear (tinnitus)
• Dizziness
• Symptoms cannot be relieved by swallowing, yawning, or chewing
• Pain if the blockage results in an infection

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. A lighted instrument, called an otoscope, will be used to look inside your ear. The doctor will check for a slight bulge around the eardrum, fluid, and swelling. If your case is severe, your may need to see an otolaryngologist, a doctor who specializes in ear disorders.

Other possible tests include:

• Tympanogram—to measure pressure in the ear canal and movement of the eardrum
• Audiogram—to measure hearing
• Examination of the nose and the back of the nose

Treatment

To deal with ear clogging, discomfort, or pain, you can try:

• Swallowing, yawning, or chewing gum to relieve the pressure
• Clearing your ears by breathing in and then gently breathing out while holding your nostrils and mouth closed

If the symptoms do not go away within a few hours or are severe, your doctor may recommend the following medications:

• Nasal or oral decongestants
• Oral antihistamines
• Nasal steroids to relieve nasal congestion and enable the eustachian tube to open
• Pain medications (eg, acetaminophen or ibuprofen)

In rare cases, a myringotomy may be necessary. The doctor makes an incision in the eardrum to allow the pressure to equalize and the fluid to drain.

Prevention

To help reduce your chances of getting ETD, take the following steps:

• Avoid flying in an airplane or going scuba diving if you have allergies or a cold.
• When flying:
  • Use decongestants or antihistamines if you have an allergy or a cold.
  • Yawn or chew gum. Encourage swallowing by sucking on hard candy or drinking water.
  • When taking off and landing, clear your ears by breathing in and then gently breathing out while holding your nostrils and mouth closed.
  • Try special earplugs that slowly equalize the pressure in your ear. These earplugs can be found at drugstores and airports.