My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Eustachian Tube Dysfunction

Overview

The Eustachian tubes connect the middle ears to the nose. The tubes help the ears drain fluid (mucus) from the middle ear. They also keep air pressure in the ears at the right level. The tubes are each about 35 millimeters long, the length of the side of a teabag.

The Eustachian tube is normally closed, but it opens from time to time in the back of the nose, for example when you yawn or swallow. When you pinch your nose in an effort to "pop" the ears open, air is forced up the Eustachian tube to equalize pressure in the middle ear space. 

However if these tubes become obstructed or blocked, you might have Eustachian tube dysfunction (ETD). If your condition gets worse, it can become chronic and lead to hearing loss.

Normal and Blocked Eustachian tube


Symptoms

A spectrum of symptoms from mild to severe can be associated with ETD. Mild ETD in the affected ear can result in:

  • Intermittent fullness
  • Pressure
  • Pain
  • Popping
  • Cracking
  • Ringing
  • Dizziness or imbalance
  • A sense of water in the ear

Usually these symptoms are mild. It is common for one ear to be affected more than the other. These symptoms may worsen following a cold or with changes in altitude, such as an airplane trip.

Those more severely affected with ETD will have constant symptoms with recurrent episodes of:

  • Ear infections
  • Perforations of the ear drum
  • Hearing loss
  • Inward retraction of the eardrum
  • Inward growth of skin into the middle ear (called a cholesteatoma) 

Screening and Diagnosis

The diagnosis is usually made by obtaining a careful history and performing a physical exam of the eardrums. If you have a mild dysfunction, you may have an entirely normal physical exam. However, if you have a more severe dysfunction, there may be fluid or abnormal pressure behind your eardrum..

Causes

As a result of colds, hay fever, chronic sinus problems, or some other blockage in the back of the nose, the Eustachian tubes cannot equalize pressure adequately. What little air enters the ear passes up the Eustachian tube and into the middle ear where it is absorbed into the surrounding tissue. This creates a low pressure area (a vacuum) that can then pull the eardrum inward or pull fluid from the surrounding tissues into the middle ear. If bacteria travel up the Eustachian tube from the nose and infect this fluid, an ear infection can develop.

Rapid changes in altitude such as diving, airplane travel, and mountain climbing are also possible causes of ETD.

Some people are born with a smaller or thinner Eustachian tube, and this can cause more frequent ear infections or problems with the Eustachian tubes.

Treatments

Generally, most patients who suffer from ETD have mild symptoms that wax and wane, require no specific intervention, and resolve on their own. Some patients benefit from the daily use of nasal saline sprays, oral decongestant tablets, or nasal steroid spray. Patients who often have allergy symptoms may be treated with nasal steroid sprays or oral antihistamine tablets that are safe to use over time. 

More severely affected patients may benefit from the daily use of oral and topical medications. Rarely is surgery indicated. 

All patients with ETD should be aware that their symptoms might worsen with altitude changes that occur while diving, flying, or driving into or out of the mountains. Use oral and topical nasal decongestants before airplane travel or driving in the mountains, especially if you also have a cold or allergies. If you must fly with a cold, use an over-the-counter nasal decongestant spray 1 hour before the airplane takes off to equalize air pressure in the ears. Some patients have found relief by using earplugs available at airports or at the Kaiser Permanente pharmacy or Hearing Aid Center.

Medications

In some instances, medications may be appropriate to help the Eustachian tubes equalize pressure. If so, here are some over-the-counter options:

  • Take an over-the-counter oral decongestant, such as pseudoephedrine (Sudafed) or phenylephrine (Sudafed-PE).
  • If you prefer, use an over-the-counter nasal decongestant spray, such as oxymetazoline (Afrin) or phenylephrine (Neo-Synephrine). Do not use these sprays for more than 3 days.
  • If you must fly, it can be helpful to take a decongestant 1 hour prior to takeoff and 1 hour prior to landing.
  • If you must dive, take the decongestant 1 hour before scuba diving.
Myringotomy Procedure

If your case is more severe, a myringotomy, a minor surgical procedure, may be appropriate. It is used to relieve pressure caused by the excess build-up of fluid. 

Myringotomy involves creating a small incision or hole in the eardrum. Fluid that has accumulated behind the eardrum from the infection drains out through the incision. A small plastic or metal tube called a pressure equalizing (PE) tube is inserted through the incision and is left in place. The tube provides a ventilation hole in the eardrum, which allows the ear to heal.

This can be performed in the office with a local anesthetic, although in some cases a general anesthetic is used for difficult cases. As with any procedure, placement of tubes involves some discomfort or risks. These include: 

  • The tendency of the ear to drain during times of infection.
  • Natural extrusion of the tubes, and the need to replace them in 6 to 18 months.
  • The risk of perforation (causing a hole in the eardrum) that may need to be patched later with a separate surgery.

Additional References:

Related Health Tools:

Prepare for Your Procedure

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.