Eustachian Tube Dysfunction

What is eustachian tube dysfunction?

Eustachian tube dysfunction (ETD) is when your eustachian tubes don’t open and close as they should. These tubes connect your middle ears to the back of your throat. The tubes equalize air pressure and help drain fluid from your ears. Eustachian tube dysfunction is when these tubes become clogged.

Eustachian tube dysfunction can affect anyone, but it’s more common in children. Only 1% of the general adult population has ETD.

Types of eustachian tube dysfunction

There are three types of ETD:

• Patulous eustachian tube dysfunction: Your eustachian tubes stay open all the time. Sound travels from your nasal cavity to your ears, changing the sound of your voice.
• Obstructive eustachian tube dysfunction: Your eustachian tubes don’t open like they should. Fluid builds up and causes ear pain or pressure.
• Baro-challenge-induced eustachian tube dysfunction: You eustachian tubes don’t open like they should. Ear pain and pressure only occur when you experience altitude changes.

What are the symptoms of eustachian tube dysfunction?

The most common ETD symptom is muffled hearing, almost like you’re underwater.

Additional eustachian tube dysfunction symptoms may include:

• A feeling of fullness in your ears.
• Clicking or popping sounds.
• Dizziness, vertigo or balance problems.
• Ear pain.
• Tinnitus (ringing in your ears).
• Hearing loss.

What causes eustachian tube dysfunction?

The following conditions may cause inflammation that leads to eustachian tube dysfunction:

• Allergies.
• Chronic acid reflux (GERD).
• Viruses like the common cold.
• Flu.

Eustachian tube dysfunction symptoms may get worse in different altitudes. This is called barotrauma, and it can happen while scuba diving, flying in an airplane or driving in the mountains.

Certain conditions can also increase your risk for eustachian tube dysfunction, like cleft palate.

What are the complications of ETD?

In rare cases, untreated eustachian tube dysfunction can cause hearing loss and permanent damage to your eardrum and middle ear. That’s why it’s important to tell your healthcare provider about symptoms that don’t go away after a couple of weeks.

How is eustachian tube dysfunction diagnosed?

Your healthcare provider will ask about your symptoms and do a physical examination. They’ll check your ear canals, eardrums, nasal passages and the back of your throat.

They may also need to run these tests:

• Tympanometry: This tells your healthcare provider how well your middle ear works.
• Hearing tests: These tests can tell you if have hearing loss and if so, what type.

How is eustachian tube dysfunction treated?

ETD can go away on its own, so treatment isn’t always necessary. But you might need treatment if your symptoms linger for more than two weeks.

Eustachian tube dysfunction treatment depends on the cause and the severity of your condition. Treatments may include home remedies, medications or, in severe cases, surgery.

Home remedies

Sometimes, simple home remedies can help with mild cases of eustachian tube dysfunction. To try and clear the blockage, you can:

• Chew gum.
• Yawn.
• Swallow.
• Try the Valsalva maneuver (breathing out forcefully while closing your mouth and pinching your nostrils).
• Use a saline spray to clear out nasal passages.
• Use a device that can help you pop your ears, like an Otovent^®.

If you think your baby has ETD, give them a pacifier or a bottle. The sucking motion may help clear the blockage.

Medications

When allergies cause eustachian tube dysfunction, over-the-counter (OTC) medications can help. You can try:

• Antihistamines like cetirizine or diphenhydramine.
• Nasal sprays like fluticasone (Flonase^®) or azelastine (Astelin^®).
• Pain relievers like acetaminophen or ibuprofen.

When an infection causes ETD, your healthcare provider may prescribe antibiotics. They may also give you corticosteroids to help with inflammation.

Ask your healthcare provider before using decongestants like pseudoephedrine (Sudafed^®). While these medications can help with congestion, they can make eustachian tube dysfunction worse, in some cases.

Surgery

Chronic ETD may require surgery. The goal of this treatment is to bypass your eustachian tubes and address ventilation problems in your middle ears. This restores hearing issues and other symptoms. Surgical options for eustachian tube dysfunction include:

• Myringotomy. Your surgeon makes a small incision (cut) in your eardrum to drain the fluid from your middle ear. In adults, the incisions usually stay open long enough for the swelling in your eustachian tubes to resolve.
• Ear tubes. Sometimes, surgeons place ear tubes into the incisions during myringotomy. These tubes provide proper middle ear ventilation for up to one year. Typically, the tubes fall out over time and your eardrum heals.
• Eustachian tuboplasty (eustachian tube balloon dilation). This involves expanding your eustachian tubes with a balloon. Your surgeon uses nasal endoscopy and small instruments to thread the balloon through your nasal passages and into your eustachian tube. They inflate the balloon for two minutes, then deflate and remove it.

How soon after treatment will I feel better?

It depends on the type of treatment you have. It takes about three to four weeks to heal after myringotomy. People who receive eustachian tuboplasty generally recover in about 24 hours.

If you have ear tubes for eustachian tube dysfunction, they should remain in place for 12 to 18 months.

Can eustachian tube dysfunction be prevented?

While you can’t prevent ETD altogether, there are things you can do to reduce your risk. For example:

• Wear ear plugs when you fly to reduce your risk of airplane ear.
• Avoid extreme temperatures, which can make ear-related issues worse.
• Drink plenty of water to thin out mucus.

What’s the outlook for eustachian tube dysfunction?

The good news is that ETD usually isn’t serious, and it typically goes away on its own. But the associated symptoms can be annoying and inconvenient. Talk to your healthcare provider to learn how to manage the condition.

How long does ETD last?

Eustachian tube dysfunction usually goes away in one to two weeks. People with chronic eustachian tube dysfunction may have lingering symptoms for weeks, months or even years.

When should I see my healthcare provider?

If eustachian tube dysfunction causes severe pain, or if symptoms last longer than a couple of weeks, make an appointment with your healthcare provider.

What questions should I ask my doctor?

If you have eustachian tube dysfunction, here are some questions you might want to ask your healthcare provider:

• What caused ETD in my case?
• Are there things I can do to reduce my risk of ETD?
• Will I need antibiotics or other prescription medications?
• How can I make myself more comfortable?