Eustachian Tube Dysfunction

• Eustachian tube dysfunction


  When the tube between the middle ear and throat is not functioning properly
• Eustachian tube

  • Present mainly to equalise the air pressure in the middle ear and drain fluid from the middle ear
• Eustachian tube not functioning correctly or becomes blocked

  Air pressure cannot equalise properly and fluid cannot drain freely from the middle ear
• Air pressure between the middle ear and the environment becomes unequal


  The middle ear can fill with fluid
• Causes of Eustachian tube dysfunction

  • Viral upper respiratory tract infection (URTI)
  • Allergies (e.g., hayfever)
  • Smoking
• Symptoms of Eustachian tube dysfunction

  • Reduced or altered hearing
  • Popping noises or sensations in the ear
  • A fullness sensation in the ear
  • Pain or discomfort
  • Tinnitus
• Symptoms tend to get worse

  When the external air pressure changes and the middle ear pressure cannot equalise to the outside pressure, for example, flying, climbing a mountain or scuba diving
• Otoscopy may appear normal, but it is important to exclude other causes (e.g., otitis media)
• Investigations for Eustachian tube dysfunction

  • Tympanometry
  • Audiometry
  • Nasopharyngoscopy (an endoscopic camera through the nose to the throat to inspect the Eustachian tube openings)
  • CT scan to assess for structural pathology
• Tympanometry


  Inserting a device into the external auditory canal (ear canal), creating different air pressures in the canal, sending a sound in the direction of the tympanic membrane, and measuring the amount of sound reflected back off the tympanic membrane
• Tympanogram

  Graph of the sound absorbed (admittance) at different air pressures
• Normally, sound is absorbed best when the air pressure in the ear canal matches the ambient air pressure
• In Eustachian tube dysfunction, the air pressure in the middle ear may be lower than the ambient air pressure


  The tympanogram will show a peak admittance (most sound absorbed) with negative ear canal pressures
• Treatment options for Eustachian tube dysfunction

  • No treatment, waiting for it to resolve spontaneously (e.g., recovering from the viral URTI)
  • Valsalva manoeuvre (holding the nose and blowing into it to inflate the Eustachian tube)
  • Decongestant nasal sprays (short term only)
  • Antihistamines and a steroid nasal spray for allergies or rhinitis
  • Surgery may be required in severe or persistent cases
  • Otovent (an over the counter device where the patient blows into a balloon using a single nostril, which can help inflate the Eustachian tube, clear blockages and equalise pressure)
• Surgical options for Eustachian tube dysfunction

  • Treating any other pathology that might be causing symptoms, for example, adenoidectomy (removal of the adenoids)
  • Grommets
  • Balloon dilatation Eustachian tuboplasty