The Eustachian tube is a small narrow channel that connects the middle ear to the upper part of the throat, just above the palate. The Eustachian tube is about 1 to 1.5 inch in length. The Eustachian tube functions to equalize the pressure in the middle ear according to the atmospheric pressure in the surrounding; it also protects the middle ear from the nasopharyngeal secretion and drains the middle ear secretion into the nasopharynx. It maintains equal pressure on either side of the ear drum and prevents fluid accumulation in the middle ear. The middle ear is usually filled with air, in normal condition the Eustachian tube, also called the “pressure equalizing valve of the middle ear”, opens once every 3 minutes in response to swallowing or yawning. This opening allows the replacement of air from the middle ear for the air that is being absorbed by the middle ear mucus membrane; this is done to equalize the pressure change due to change in altitudes. If something impedes this basic function of the Eustachian tube it results in ear problem or Eustachian tube dysfunction.
About Eustachian tube dysfunction
When something blocks or obstructs the Eustachian tube, it fails to open sufficiently creating a difference in air pressure between the inner and outer middle ear. This results in ear discomfort, fullness, and pain in the ears with mild hearing loss, and may lead to conditions like barotitis media (blockage due to change in altitude), otitis media (infection), tinnitus (hearing ringing sounds), and vertigo (spinning sensation). If the blockage in the Eustachian tube is prolonged, then it results in fluid accumulation in the middle ear, a condition called as serous otitis media. Serous otitis media is very common in children and is mostly associated with hearing loss. Very rarely, blockage of the Eustachian tube results in continuous opening of the Eustachian tube, a condition called as abnormal patency of the Eustachian tube. As the Eustachian tube remains open the person does not have any hearing impairment, to the more he/she can hear his/her own breathing and hear his/her voice echoing, the feeling of fullness or blockage in the ear is common. This condition is very common in adults, and rare in children.
Causes and risk factors
There are many causes of Eustachian dysfunction, few causes and risk factors are listed below
- Excessive mucus and inflammation due to cold, flu, allergy, and sinus infection
- Upper respiratory tract infection
- Nasal congestion
- Children are at greater risk as they have small and straighter Eustachian tube through which the germs can easily reach the middle ear and also they have a weaker/developing immune system
- Smoking, damages the cilia (hair like structure, which pushes the mucus from the middle ear to the nose
- Obesity, as fat deposition around the tube can result in blockage
- Altitude change during air travel, scuba diving, and mountain trekking
- Swelling in throat
- By birth a narrow Eustachian tube
- Tumors in nasopharynx
- Enlarged adenoids
- Wax build up
- Loud sound or explosion
Symptoms
Eustachian dysfunction exhibits symptoms that might be intermittent, recurrent or progressive. There may be feeling of plugged or fullness in the ear, along with a popping or clinking sensation or tickling sensation. The person may complain of hearing muffled or ringing sounds in the ear. Some people may also have pain in the ear, and mild hearing loss. Eustachian dysfunction can also lead to difficulty in keeping balance, dizziness and vertigo (spinning sensation). Vertigo may cause a sensation of vomiting.
Diagnosis
Doctors can diagnose a Eustachian tube dysfunction by asking the person about the symptoms they are experiencing and by examining the ear canal, ear drum, nasal passage, and the back of the throat. During ear examination, a slight inward or outward bulge of the ear drum is seen. In severe cases, blood may be seen behind the eardrum. Observing the respiratory movement of the ear drum, while forcefully breathing through one nostril confirms the diagnosis. Hearing an amphoric sound using a diagnostic device also helps to detect the disorder.
Treatment
Most of the symptoms of the Eustachian dysfunction go away without any treatment. The doctor may ask the person to try swallowing or yawning or chewing a gum. In case of “full” ear, a deep breath should be taken, the nose should be pinched, and the air should be blown through the mouth. Scuba divers with Eustachian tube dysfunction, are advised to descend and ascend slowly. In babies, swallowing reflex should be encouraged by giving them a bottle or a pacifier.
If these simple things don’t seem to help, then the next option is visiting the doctor’s office. Doctor may prescribe a decongestant, to reduce the swelling in the tube lining. If allergy is the causative agent, then an antihistamine or a steroid nasal spray is prescribed to minimize the allergic response. Antibiotics may be given to prevent ear infection in severe condition. Surgical implantation of Pressure equalization tube (PET) in the ear drum may be done to correct the pressure difference. If there is fluid collection, suctioning of the fluid from the middle ear can be done by making a small incision in the ear drum. This puncture helps the Eustachian tube to shrink while the ear drum is healing. In case of Eustachian dysfunction along with tinnitus, doctor might prescribe antidepressants, anxiolytics, hearing aids etc.
Prevention
Few tips to prevent or avoid Eustachian dysfunction are
• Treat the underlying causes such as cold, flu, allergy etc that might cause Eustachian dysfunction
• Use nasal spray or decongestant before altitude change
• Avoid altitude change during upper respiratory tract infection and allergy
• Do not sleep during ascend and descend of air plane
• Use ear plugs, yawn and swallow often during ascend and descend of air plane
• Drink plenty of water as hydration will avoid irritation of the nasal passage and throat and ensures better functioning of the Eustachian tube
• Avoid alcohol and caffeine as they can dehydrate
Outlook
Eustachian tube dysfunction leads to multitude of problems like otitis media, vertigo, and tinnitus, therefore treating the condition at its early stage is better. In case of otitis media, the treatment option is changing continuously, in some over prescription of antibiotics results in antibiotic resistance and in patients where the treatment starts late leaves both patient and the doctor frustrated. Tinnitus and vertigo may be only due to Eustachian dysfunction but in many it might be lethal also. Proper initial care and taking steps to prevent Eustachian dysfunction helps a person to lead a normal life.
