What is the Eustachian Tube?
The eustachian tube is a narrow, one-and-a-half-inch-long channel connecting the middle ear with the nasopharynx, the upper throat area just above the palate, and the back of the nose.
The eustachian tube functions as a pressure-equalizing valve to keep the air that usually fills the middle ear at the same pressure as the air in the external ear. When the air pressure in the external ear canal and the middle ear chamber are the same, the eardrum can vibrate freely. When these pressures are not the same, the eardrum movement or vibration is dampened, and hearing loss results.
When functioning properly, the eustachian tube opens for a fraction of a second periodically (about once every three minutes) in response to swallowing or yawning. In doing so, it allows air into the middle ear to replace the air that has been absorbed by the middle ear lining (mucous membrane) and to equalize pressure changes that occur during altitude changes. Anything interfering with this periodic opening and closing of the eustachian tube may result in hearing impairment (conductive hearing loss) or other ear symptoms.
Common Eustachian tube disorders include
- Obstructive Eustachian tube dysfunction (Eustachian tube does not open properly)
- Patulous Eustachian tube dysfunction (Eustachian tube is too open)
- Barochallenge-induced Eustachian tube dysfunction (obstructive Eustachian tube dysfunction when on airplanes, driving to increased elevation, or SCUBA diving)
Obstructive Eustachian Tube Dysfunction
This is the most common type of Eustachian tube dysfunction. Obstructive Eustachian tube dysfunction occurs when the valve of the Eustachian tube does not open properly. This prevents pressure from balancing and keeps fluids from draining out of the ear.
Symptoms and Causes of Obstructive Eustachian Tube Dysfunction
- Pressure and/or pain in the ears
- A sense of fullness in the ears
- Popping/crackling sounds in the ear
- Muffled hearing
- Environmental allergies
- Acid reflux
- Neoplasms (abnormal growth of tissue)
- Impaired muscle coordination or muscular deficiency, for example, in patients with a cleft palate
Diagnosing Obstructive Eustachian Tube Dysfunction
Over time, negative pressure can build up in the ear, causing pain, ear fullness and muffled hearing. When this occurs, sometimes your doctor can see the ear drum (tympanic membrane) change shape due to this pressure and become concave. An audiogram (hearing test) allows for the measurement of middle ear pressure, providing an objective means of detecting negative pressure or fluid behind the ear drum. Additionally, the structure and function of the eustachian tube may be directly visualized using a small, flexible camera.
Obstructive eustachian tube dysfunction can be chronic, intermittent, or short term. This is commonly felt during flights, when you have a cold or when SCUBA diving.
Following evaluation and diagnosis, your doctor will determine the best course of treatment. This may include medication or surgery, and a doctor may recommend avoiding triggers.
Medical treatments include:
- Nasal sprays and nasal saline irrigations
- Oral antihistamines (e.g., Claritin)
- Autoinsufflation (“popping” your ears)
Devices are available to facilitate autoinsufflation
- Immunotherapy (allergy shots)
Surgical treatments include:
- Tympanostomy tubes (ear tubes)
- Balloon dilation of the eustachian tube
- Adenoidectomy (removal of adenoids in the back of the nose)
The physicians at Shohet Ear Associates have completed specialized training in the application and performance of balloon dilation of the Eustachian tube. This safe and effective procedure may be performed in the office and has been demonstrated to improve symptoms in the majority of patients.
Patulous Eustachian Tube Dysfunction
Patulous Eustachian tube dysfunction is a disorder in which the valve of the Eustachian tube is too open. Inappropriate opening of this valve allows sound to travel from the sinonasal cavity to the ears, allowing you to hear your own voice or your own breathing too loudly. You may even hear the sound of blood pumping. Interestingly, patulous Eustachian tube dysfunction can also alternate with obstructive Eustachian tube dysfunction.
Symptoms of Patulous Eustachian Tube Dysfunction
- A sense of fullness in the ears
- The ability to hear your own voice, breathing or bodily functions very loudly
- Pulsation in the ears
Causes of Patulous Eustachian Tube Dysfunction
- Weight loss
- Chronic neuromuscular or immunological disease
- Chronic nasal allergy
- A history of acid reflux disease
- Stress and anxiety
- Prolonged standing
Diagnosing Patulous Eustachian Tube Dysfunction
Your doctor may use a variety of techniques to diagnose patulous Eustachian tube dysfunction while viewing your eardrum (tympanic membrane). Your doctor may ask you to breathe deeply and swallow to see how the eardrum responds. Your doctor may also measure the pressure inside your ear using specialized tools.
Treatment for Patulous Eustachian Tube Dysfunction
- Limiting decongestants and caffeine
- Drinking more water
- Medicated nasal drops
- Grafts or fat transfers
Baro-Challenge-Induced Eustachian Tube Dysfunction
When obstructive Eustachian tube dysfunction is only felt during airplane flights or SCUBA diving, this is known as baro-challenge-induced Eustachian tube dysfunction.