Eustachian Tube Dysfunction
Overview
The Eustachian tubes connect the middle ears to the nose. The tubes help drain fluid (mucus) from the middle ear. They also keep air pressure in the ears at the right level.
The Eustachian tube is normally closed. It opens in the back of the nose when you yawn or swallow.
Eustachian tube dysfunction (ETD) can occur if the tubes become obstructed or blocked. Also, if your condition gets worse, it can become chronic and lead to hearing loss.
Symptoms
Symptoms can be mild or severe. Mild ETD can cause:
- Off and on feeling of fullness – like having water in the ear
- Pressure
- Pain
- Popping or cracking
- Ringing
Often, one ear is worse than the other. Symptoms may get worse after a cold or change in altitude, such as during or after airplane travel.
Severe ETD can cause constant symptoms. This can lead to:
- Frequent ear infections.
- Perforations of the eardrum.
- Hearing loss.
- Inward withdrawal of the eardrum.
- Inward growth of skin into the middle ear. This is called a cholesteatoma.
Screening and Diagnosis
We’ll ask you about your medical history and examine your eardrums. If you have mild dysfunction, you may have a normal physical exam. With severe ETD we may see fluid or detect abnormal pressure behind the eardrum.
Additional tests
If the eardrum looks normal but you feel fullness and pressure of the ear, we may order an audiogram. This tests for actual loss of hearing in the inner ear. Sudden hearing loss is managed differently than ETD.
Causes
Several things prevent the tubes from equalizing pressure. These include:
- Colds.
- Hay fever.
- Chronic sinus problems.
- Some other blockage in the back of the nose.
- Ear infections.
- Narrow Eustachian tubes. Some people are born with smaller tubes. This can make ETD more likely.
- Rapid altitude changes. This can occur during diving, airplane travel, or mountain climbing.
Treatments
Most people have mild symptoms that come and go. Treatment may not be needed.
Other people have frequent, severe symptoms. Daily medications such as decongestants and nasal steroid sprays may be needed. We may recommend the following medications that are safe to use over time.
Oral decongestants
These decongestants include pseudoephedrine (Sudafed) or phenylephrine (Sudafed-PE).
Nasal decongestant sprays
These nasal sprays include oxymetazoline (Afrin) or phenylephrine (Neo-Synephrine). Don’t use these sprays for more than 3 days.
Nasal steroid spray
You can use nasal steroid spray every day for a few weeks to months. This may decrease allergy symptoms that make Eustachian tube problems worse.
You can buy nasal steroid spray over-the-counter or with a prescription. They don’t work as fast as decongestants but you can use them for longer than a few days. These include:
- Fluticasone (Flonase)
- Triamcinolone (Nasocort)
- Mometasone (Nasonex)
- Flunisolide (Nasalide/Nasarel)
Altitude changes, allergies, and colds can make ETD symptoms worse. If you’ve had ear problems, follow these tips:
- Don’t fly with a cold, if possible.
- Use an over-the-counter nasal decongestant spray if you must fly with a cold. Apply it 1 hour before the airplane takes off. On long flights use it again an hour before descent.
Surgery
Myringotomy
In some cases, we may recommend a minor surgical procedure called a myringotomy. This procedure relieves pressure caused by too much fluid behind the eardrum. It’s usually done in the office with a local anesthetic. Sometimes a general anesthetic may be needed.
During the procedure we:
- Make a small incision in the eardrum.
- Drain fluid from behind the eardrum.
- Insert a small plastic or metal tube into the incision, if needed. This is called a pressure equalizing (PE) tube. It’s left in place. The tube helps ventilate the middle ear. Tubes are not always needed.
As with any procedure, myringotomy involves some discomfort or risks. These include:
- Ear drainage. This may happen if there’s an infection.
- Tube loss. The tubes may fall out and need replacement.
- Perforation (a hole or rupture). In rare cases the eardrum may be perforated. Further surgery may be needed later to patch this.
- Restricted water-based activities. You’ll need to be careful around water, as it may cause an ear infection.
Eustachian tube balloon dilation procedure
Balloon dilation is a newer way of opening a blocked Eustachian tube. It works well for certain cases of mild to moderate ETD.
We usually perform this operation under general anesthesia. However, it can sometimes be done in the office with topical numbing medication.
During the procedure we will:
- Insert a balloon catheter through the nose until it reaches the opening of the Eustachian tube.
- Inflate the balloon. This dilates the opening.
Unblocking the tube allows air to circulate through the inner ear. This improves ETD symptoms.
Balloon dilation is not the best option for all ETD cases. If you’re a candidate, your head and neck surgeon will discuss the procedure in detail with you.
Disclaimer
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.