Eustachian Tube Dysfunction (ETD)
The Eustachian tube is a small passageway that connects your throat to your middle ear. When you sneeze, swallow, or yawn, your Eustachian tubes open. This keeps air pressure and fluid from building up inside your ear. But sometimes a Eustachian tube might get plugged. This is called Eustachian tube dysfunction. When this happens, sounds may be muffled, and your ear may feel full. You may also have ear pain.
The most common causes of eustachian tube dysfunction are diseases associated with edema of the tubal lining, such as viral upper respiratory tract infections and allergy. The patient usually reports a sense of fullness in the ear and mild to moderate impairment of hearing. When the tube is only partially blocked, swallowing or yawning may elicit a popping or crackling sound. Examination may reveal retraction of the tympanic membrane and decreased mobility on pneumatic otoscopy. Following a viral illness, this disorder is usually transient, lasting days to weeks.
Common colds and other nasal, sinus, ear or throat infections
- By far the most common cause of ETD is the common cold (upper respiratory tract infection).
- The blocked nose or thick mucus that develops during a cold or other infections, may block the Eustachian tube.
- An infection may also cause the lining of the Eustachian tube to become inflamed and swollen.
- Most people have had a cold when they haven’t been able to hear so well – this is due to ETD.
- Symptoms may last for a week or so (sometimes longer) after the other symptoms of the infection have gone. This is because the trapped mucus and swelling can take a while to clear even when the germ causing the infection has gone.
- Sometimes the infection that sets it off is very mild but even so, in some people, ETD can still develop.
- Glue ear is a condition where the middle ear fills with glue-like liquid.
- It is a common condition in children.
- The Eustachian tube becomes congested and prevents the free flow of air into the middle ear, causing the difference in air pressure mentioned above. The eardrum becomes tight, reducing its ability to vibrate. This results in dulled hearing. The situation is made worse by the glue-like fluid damping down the vibrations of the drum even further.
- It clears by itself in most cases but some children need an operation to solve the problem.
Allergies that affect the nose, such as persistent rhinitis and hay fever, can cause extra mucus and inflammation in and around the Eustachian tube and lead to having symptoms for several months.
- Smoking can stop the tiny hairs that line the Eustachian tube from working.
- Smoking can also cause tissues at the back of the nose and throat (including the adenoids) to enlarge, blocking the Eustachian tube.
- If you smoke and are having problems with long-term (chronic) ETD you should try to stop smoking.
- Anything that causes a blockage to the Eustachian tube can cause muffled hearing – for example, enlarged adenoids in children.
- Rarely, a tumour behind the eardrum or at the back of the nose (the nasopharynx) can mimic the symptoms of ETD. These types of tumours are very uncommon and usually cause other symptoms in addition to ETD, such as headache, a hoarse voice and a constantly blocked nose.
Symptoms of ETD may include:
- fullness in the ears
- feeling like your ears are “plugged”
- changes to your hearing
- ringing in the ear, also known as tinnitus
- clicking or popping sounds
- ticklish feelings in the ears
The length of time that ETD symptoms last depends on the initial cause. Symptoms from altitude changes, for example, may resolve once you get back to the altitude you’re used to. Illnesses and other causes of ETD may result in longer-lasting symptoms.
Treatment with systemic and intranasal decongestants (eg, pseudoephedrine, 60 mg orally every 4–6 hours; oxymetazoline, 0.05% spray every 8–12 hours) combined with autoinflation by forced exhalation against closed nostrils may hasten relief. Autoinflation should not be recommended to patients with active intranasal infection, since this maneuver may precipitate middle ear infection. Allergic patients may also benefit from intranasal corticosteroids (eg, beclomethasone dipropionate, two sprays in each nostril twice daily for 2–6 weeks). Air travel, rapid altitudinal change, and underwater diving should be avoided until resolution
Conversely, an overly patent eustachian tube (“patulous eustachian tube”) is a relatively uncommon, though quite distressing problem. Typical complaints include fullness in the ear and autophony, an exaggerated ability to hear oneself breathe and speak. A patulous eustachian tube may develop during rapid weight loss, or it may be idiopathic.
In contrast to eustachian tube dysfunction, the aural pressure is often made worse by exertion and may diminish during an upper respiratory tract infection. Although physical examination is usually normal, respiratory excursions of the tympanic membrane may occasionally be detected during vigorous breathing.
Treatment includes avoidance of decongestant products, insertion of a ventilating tube to reduce the outward stretch of the eardrum during phonation and, rarely, surgery on the eustachian tube itself.