Eustachian Tube Problems

The cause of any ear infection is some type of blockage of the Eustachian tube. Connecting the middle ear to the rear of the nose by the soft palate, this tube is just over an inch in length in adults. Tissues in the Eustachian tube may respond to stimuli inside of the nasal cavity, as is often the case when you have a cold or allergies that affect your ears.

• While these tubes are normally closed, a feeling of “fullness” in the ear can result if they are unable to open as needed
• A blocked tube creates an ideal environment for bacteria, which is just one of several potential problems that may involve the Eustachian tube

E-tubes normally open to regular middle ear pressure, help with ventilation and ear fluid drainage, and prevent fluids from the throat and nose from getting into the middle ear. If these tubes aren’t functioning as expected, pressure imbalances and infections can result in symptoms that may include:

• Temporary ringing in the ears (tinnitus)
• Dizziness or vertigo
• Headaches
• Nausea or vomiting
• Headaches
• Popping and crackling sensations
• Mild hearing loss

Other than an upper respiratory infection due to the common cold, tube problems may be caused by chronic sinus infections and seasonal allergies. Some individuals have tubes locked in an open position, a condition known as patulous Eustachian tube (PET). Patients with PET often report persistent ear fullness and hear echoes or their own voice in the affected ear.

Eustachian tube problems are sometimes experienced because of post-nasal drainage that flows down the back of throat to the end point of the tubes. Children with infected, inflamed, or enlarged adenoids (lymph tissues) may have clogged tubes. Some people also experience tube problems due to:

• Damage to hair-like structures in Eustachian tubes (cilia) from smoking or secondhand smoke exposure
• Altitude changes
• Excessively small Eustachian tubes
• Skull base tumors (in rare cases)

Children with upper respiratory infections often have ear infections because of bacteria that transfers from the nose to the middle ear. If ear infections become chronic, mucus may accumulate in Eustachian tubes. This makes it difficult for the ear to properly drain, which may result in higher-than-normal pressure in the middle ear. Sometimes this pressure causes eardrum deformities or ruptures.

Issues involving Eustachian tubes are typically diagnosed with a physical exam and a detailed evaluation of the affected ear. Movements of the eardrum when air pressure is applied can be observed with a bulb syringe attached to an otoscope (instrument used to look inside of ears). A device called a tympanogram may be used to measure eardrum movement.

When there’s discharge from the affected ear, laboratory tests may be done to identify if there’s a bacterial infection in the middle ear. Diagnosis of damage to an eardrum involves examination of the ear that is done with a microscope or an otoscope. It may also involve a tuning fork evaluation to detect hearing loss.. The eardrum is sometimes further evaluated with tympanometry, a procedure involving the use of a device called a tympanometer that’s inserted into the ear canal to detect movement of the ear drum with changes in air pressure. Nearly all patients with a tympanic membrane perforation will benefit from a full audiological exam.

Tube problems due to a cold or changes in altitude often go away with little or no treatment. If Eustachian tube problems are due to allergies, patients may benefit from aggressive efforts to manage allergies better. Patients with chronic allergies or sinus irritations causing ear problems are sometimes referred to an allergist for further treatment.

When ear infections are causing tube issues, antibiotics delivered orally or with ear drops or ventilation tubes to improve circulation may be recommended. Decongestants and nasal corticosteroids may be a beneficial solution for some people with occasional problems. PET-related issues might be treated with a special type of estrogen nasal spray.

Surgery may become an option if abnormalities of the Eustachian tube are contributing to persistent and serious ear issues. A common procedure is the insertion of a pressure equalization tube into the eardrum to create a better pressure balance. This is often recommended for children. With a procedure known as a myringotomy, a small slit is made in the eardrum to drain fluid and create a temporary source of ventilation. The slit will heal on its own.

Problems with Eustachian tubes can be minimized by being cautious in situations where ear pressure is likely to change, as is often the case when traveling by airplane. Yawning, chewing gum, and making swallowing motions can help keep your e-tubes open in situations like this, as can gently blowing your nose. See your doctor about any lingering or recurrent ear infections. You may be referred to an ear, nose, and throat specialist if your problems may be related to some type of deformity or abnormality, or if an infection has caused issues with parts of your middle ear.