Eustachian Tube Dysfunction

Eustachian tube (ET) connects our middle ear to the back of the nose and upper throat. It has three functions. It helps to ventilate middle ear and equalize pressure between middle ear and the atmosphere, protects ear from loud sounds and drains any fluid build up in the middle ear to the back of the nose.

Normally, at rest the tube is closed. It opens when we swallow, sneeze, burp or yawn. Any change in its structure or function of the tube can affect ears causing pain, fluid buildup, ringing of the ears, dizziness or hearing loss.

Types of Eustachian Tube Dysfunction

1. Blockage or Obstruction

The Eustachian tubes can become blocked by many things. In infants and young children, the tube is short and lies horizontally between the nose and the ear. This position affects the function of the tube and makes them more susceptible to ear infections (acute otitis media) or fluid without infection (serous otitis media). These 2 conditions are frequently related. Around 7 years of age, as the head undergoes further development, the tube gets longer and lies at an angle between the nose and ear thus decreasing susceptibility to ear infections. Enlarged adenoids, lymphatic tissue at the back of nose, colds, allergies, sinus problems, deviated septum, masses of the back of the nose, reflux of stomach acid and neurologic problems can all cause swelling and block the normal opening of the tube and impair the middle ear ventilation. This creates a vacuum effect in the middle ear which causes fluid accumulation in the middle ear and a sucking in of the eardrum. These conditions can lead to pain and infection, but without infection can cause the ears to feel plugged and hearing loss. In babies, the condition may be silent and cause hearing loss and speech problems.

Diagnosis is made by the medical history, physical exam of the nose and throat, microscopic examination of the ears and hearing tests. Immittance testing is important, but can inaccurate and not relied upon in all cases, especially in babies and young children. Blockage of tube in the nose can be checked by looking through a flexible endoscope passed through the nose called nasopharyngoscopy.

Eustachian tube dysfunction is common and treatment is successful. Treatment depends on the cause. In infants and young children, ventilation tube insertion helps to prevent fluid buildup during a cold and ear infection. (link to VT insertion) This is a temporary procedure until the child is older when ear infections are less common. If enlarged adenoids are the cause of frequent ear infections, they are surgically removed. Medical treatment of allergies is commonly sufficient to prevent ear infections in adults.

2. Patulous Eustachian Tube

This condition occurs when one or both Eustachian tubes stay open for prolonged periods of time. This may cause many annoying symptoms such as ear fullness and blockage, a feeling of being in a tunnel, hearing one's own breathing and voice reverberation. It does not cause hearing loss.

The exact cause is often difficult to determine. At times it develops following a loss in weight. It may develop during pregnancy, or while taking oral contraceptives or other hormones.

Treatment of this is often difficult. Nasal sprays, weight gain and some medications may be helpful.

3. Palatal Myoclonus

This is a rare condition in which muscles of the palate twitch rhythmically many times a minute, causing a clicking or snapping sound as the tube opens and closes. The cause is unknown. The condition frequently resolves without treatment. Sedatives or tranquilizers can help.

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