The eustachian tube is a small canal that connects the middle ear to the back of the nose and upper throat. Its purpose is to equalize the air pressure in the middle ear with the pressure outside it.

Eustachian tube dysfunction (ETD) occurs when the tube fails to open during swallowing or yawning, which results in a difference between the air pressure inside and outside the middle ear. It causes discomfort in the ear and temporary hearing problems.

Causes

If the pressure in the environment changes without a change in middle ear pressure, the ear may feel blocked and the eardrum cannot vibrate normally. This can cause temporary hearing problems and discomfort in the ear. It often occurs when you experience altitude changes from events like flying in an airplane, driving on steep hills, riding in a fast moving elevator, or scuba diving. The symptoms can usually be relieved by swallowing, yawning, or chewing. ETD occurs if the tube is blocked or swollen, trapping air and fluids in the middle ear. This causes symptoms to continue beyond a few hours and can sometimes lead to ear damage.

ETD is usually caused by nasal congestion from an allergy, cold, or other upper respiratory infection and sometimes by ear or sinus infections. Some people develop ETD because they have a narrow eustachian tube. Sometimes the Eustachian tube can be mechanically blocked by adenoid tissue in young children, or by tumors in adults.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chances of developing ETD:

• Activities with large, rapid altitude changes, such as flying in an airplane and scuba diving

• Allergy, cold, or other upper respiratory infection

• Ear or sinus infection

• Narrow eustachian tube

• Presence of obstructing tumors in the nasopharynx

• Children with large adenoids

• Children have a higher chance of developing ETD because their eustachian tube is narrower than that of adults

Symptoms

Symptoms of ETD can include:

• Feeling of fullness or clogging in the ear

• Discomfort or pain in the ear

• Hearing loss

• Ringing in the ear (tinnitus)

• Dizziness

• Symptoms cannot be relieved by swallowing, yawning, or chewing

• Pain if the blockage results in an infection

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. A lighted instrument called an otoscope is used to look inside your ear. The doctor will check for a slight bulge outward or inward of the eardrum, as well as fluid and inflammation. If your case is severe, your doctor may refer you to a doctor who specializes in ear disorders (otolaryngologist).

Other possible tests include:

• Tympanogram–measures pressure in the ear canal and movement of the eardrum

• Audiogram–measures hearing

• Examination of the nose and the back of the nose with a telescope

Treatment

To deal with ear clogging, discomfort, or pain, first try to open the eustachian tube by swallowing, yawning, or chewing gum to relieve the pressure. You can also try clearing your ears by breathing in and then gently breathing out while holding your nostrils and mouth closed.

If the symptoms do not go away within a few hours or are severe, talk with your doctor about the best treatment for you. Nasal or oral decongestants, oral antihistamines, or nasal steroids may be used to relieve nasal congestion and enable the eustachian tube to open. If pain relief is needed, you can use medications such as acetaminophen or ibuprofen.

In rare cases, if the eustachian tube does not open with other treatments, a myringotomy may be necessary. The doctor makes an incision in the eardrum to allow the pressure to equalize and the fluid to drain.

Prevention

To help reduce your chances of getting ETD, take the following steps:

• When you have an allergy attack, a cold, or other upper respiratory condition, try not to fly in an airplane unless necessary, and do not scuba dive.

• When flying you can do the following:

• • Use decongestants or antihistamines before flying if you have an allergy, cold, or other upper respiratory condition.

• • When experiencing an altitude change, yawn, chew gum, or encourage swallowing by sucking candy or drinking water

• • When taking off and landing, clear your ears by breathing in and then gently breathing out while holding your nostrils and mouth closed

• • Try special earplugs that slowly equalize the pressure in your ear when taking off and landing. They can be purchased at drugstores and airports.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org

American Hearing Research Foundation
http://www.american-hearing.org

References:

Airplane ear. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00472. Accessed September 26, 2005.

Barotrauma. American Hearing Research Foundation website. Available at: http://www.american-hearing.org/name/barotrauma.html. Accessed September, 26, 2005.

Eustachian tube dysfunction. McKinley Health Center, University of Illinois at Urbana-Champaign website. Available at: http://www.mckinley.uiuc.edu/handouts/eusttube/eusttube.html. Accessed September 26, 2005

Eustachian tube dysfunction. University Health Services, University of Wisconsin-Madison website. Available at: http://www.uhs.wisc.edu/display_story.jsp?id=652&cat_id=38. Accessed September 26, 2005.

Meek RB. Middle ear, eustachian tube, inflammation/infection. eMedicine website. Available at: http://www.emedicine.com/ent/topic207.htm. Accessed September 26, 2005.