Eustachian tube dysfunction (ETD) is a disorder where pressure abnormalities in the

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles (malleus, incus, and stapes), which transfer the vibrations ...

result in symptoms.

External links

Reliable Medical Journal Article on Eustachian Tube Dysfunction

Signs and symptoms

Symptoms include aural fullness, ears popping, a feeling of pressure in the affected ear(s), a feeling that the affected ear(s) is clogged, crackling, ear pain,

tinnitus Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it. Nearly everyone experiences faint "normal tinnitus" in a completely ...

, autophony, and muffled hearing.

Diagnosis

While Eustachian tube dysfunction can be hard to diagnose, due to the

Eustachian tube The Eustachian tube (), also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in diameter. It ...

s and the

nasopharynx The pharynx (: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs respectively). It is found in vertebrates and invertebrates, though its ...

not being easily visible, usually a

tympanometry Tympanometry is an acoustic evaluation of the condition of the middle ear eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal. Tympanometry is an objective test of middle-ear function. It ...

is indicated, along with findings on an

otoscopy An otoscope or auriscope is a medical device used by healthcare professionals to examine the ear canal and eardrum. This may be done as part of routine physical examinations, or for evaluating specific ear complaints, such as earaches, sense o ...

. For cases of baro-challenge induced Eustachian tube dysfunction, diagnosis usually relies on the history of the patient and their reported symptoms, as otoscopy and tympanometry is sometimes normal at normal ambient pressure. Opening pressure has been proposed as a method for preoperative and intraoperative evaluation of any obstructive process within the Eustachian tube. As well, Valsalva CT scanning using advanced 64 slice or higher machines has been proposed as a way of diagnosing and localizing anatomic obstruction within the Eustachian tube.

Types

Four subtypes have been described: #Anatomic obstruction within the proximal cartilaginous eustachian tube. #Dilatory Eustachian tube dysfunction: Functional, dynamic (muscle failure), or anatomical obstruction of the Eustachian tube #Baro-challenge induced Eustachian tube dysfunction: Eustachian tube dysfunction which generally features a normal

and normal

# Patulous Eustachian tube dysfunction

Causes

Eustachian tube dysfunction can be caused by a number of factors. Some common causes include the flu,

allergies Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

, a

cold Cold is the presence of low temperature, especially in the atmosphere. In common usage, cold is often a subjectivity, subjective perception. A lower bound to temperature is absolute zero, defined as 0.00K on the Kelvin scale, an absolute t ...

, and sinus infections. In patients with chronic ear disease such as

cholesteatoma Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of the ...

and chronic discharge, studies showed that they have obstructive pathology at the ear side of the Eustachian tube. Given that proximity of that part of the Eustachian tube to the tympanic cavity, the site of frequent infections during childhood, it is logical to conclude that this segment of the tube experiences fibrosis and stenosis from recurrent infections. This is a possible explanation for the increased frequency of chronic ear disease in disadvantaged populations who lack access to medical care including antibiotics and tympanostomy tubes.

Treatment

First-line treatment options are generally aimed at treating the underlying cause and include attempting to "pop" the ears, usually via the

Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be ...

, the use of oral or topical

decongestant A decongestant, or nasal decongestant, is a type of pharmaceutical drug that is used to relieve nasal congestion in the upper respiratory tract. The active ingredient in most decongestants is either pseudoephedrine or phenylephrine (the latter o ...

s, oral steroids, oral

antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides ...

s, and topical nasal steroid sprays, such as Flonase. If medical management fails,

myringotomy A myringotomy is a surgical procedure in which an incision is created in the eardrum (tympanic membrane) to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube may be inserted through th ...

, which is a surgical procedure in which an incision is made in the

eardrum In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit changes in pres ...

to drain pus from the

or to relieve pressure caused by a large buildup of fluid, is indicated, and usually accompanied by the insertion of a

tympanostomy tube Tympanostomy tube, also known as a grommet, myringotomy tube, or pressure equalizing tube, is a small tube inserted into the eardrum via a surgical procedure called myringotomy to keep the middle ear aerated for a prolonged period of time, typic ...

. Tentative evidence supports the use of balloon dilation of the

. In 2018, researchers published a prospective, multicenter, randomized, controlled trial demonstrating efficacy of this technique. Dilatation of the eustachian tube using

balloon catheter A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the Human body, body. The deflated balloon catheter is position ...

has gained attention as a method of treating eustachian tube obstruction. There are two methods of performing this procedure depending on the route of the catheter introduction and the area of the Eustachian tube to be dilated.

References

{{Diseases of the ear and mastoid process, state=collapsed Diseases of middle ear and mastoid