If you’ve ever felt your ears “pop,” you’ve felt your Eustachian tubes at work. The Eustachian tube is a narrow passageway from the back of the throat to the middle ear (the area right behind the eardrum). The Eustachian tubes, one on each side of the head, are there to make sure the pressure in the middle ear is the same as the surrounding air pressure. Unfortunately, if this passageway isn’t working right, it results in a condition called Eustachian tube dysfunction.

Normal Eustachian Tube Function

It is a common experience; the feeling of pressure in the ears when changing altitude or air pressure (e.g. driving over a mountain, flying in an airplane, scuba diving, etc.). When the pressure in the middle ear is substantially different than the outside world, you can feel it. The greater the difference in pressure, the more uncomfortable the sensation. If the pressure difference between the middle ear and the outside world is large enough, it can be quite painful.

Most know from experience that yawning or chewing gum or even exhaling against a pinched nose can usually relieve that pressure. The pressure is relieved through the Eustachian tube—the tube opens to allow air in or out of the middle ear, matching the air pressure of the throat. Once the pressure is equalized, the pain goes away.

Under normal circumstances, the Eustachian tube is closed. It usually only opens when muscles in the neck pull it open. While it is closed, the Eustachian tube protects the middle ear from substances in the mouth/throat and creates a barrier to infection. While it is open, it normalizes pressure and helps secretions in the middle ear drain into the throat.

Eustachian tube dysfunction: Abnormal Eustachian tube function

Eustachian tube dysfunction is the condition that arises when the Eustachian tube loses its ability to open and close properly. The Eustachian tube may not open properly, a condition called obstructive dysfunction (“always closed”). Likewise, the Eustachian tube may not close properly, a condition called patulous dysfunction (“always open”). Not every patient with a Eustachian tube has only one or the other problem. In fact, many patients with Eustachian tube dysfunction may experience both issues over time.1

Symptoms of Eustachian tube dysfunction

People with Eustachian tube dysfunction feel like their “ears won’t pop.” There is a sensation of fullness, pressure, or even pain in the affected ear. People may have trouble hearing through the affected ear as if they were hearing underwater. Cracking, ringing, and hearing one’s voice is the ear (autophony) are also common symptoms of Eustachian tube dysfunction.

Causes of Eustachian tube dysfunction

Interestingly, Eustachian tube dysfunction symptoms are similar in people with obstructive (i.e. “always closed”) and patulous (i.e. “always open”) dysfunction. However, the cause of Eustachian tube dysfunction differs between the two conditions. Most people with the “always closed” form of Eustachian tube dysfunction first have an upper respiratory infection, middle ear infection (i.e. otitis media), or a severe case of allergies (i.e. allergic rhinitis). Conversely, the “always open” form of the condition may be caused by a recent weight loss. In most cases, however, the precise cause of patulous dysfunction is never identified.

Medical treatment for Eustachian tube dysfunction

Unfortunately, there are few effective medical treatments for Eustachian tube dysfunction. When Eustachian tube dysfunction is caused by sinusitis, directly treating sinusitis can be effective overall. However, most medical Eustachian tube dysfunction treatments such as oral or nasal decongestants and oral or nasal steroids are usually not effective.2 Good hydration and nasals saline drops (along with some rather complicated head movements) may provide relief for people with “always open” Eustachian tube dysfunction3; however, these require patients to be motivated to learn and perform the treatments at home.

Surgical treatment for Eustachian tube dysfunction

Tympanostomy (i.e. “tubes in the ears”) is used to treat children with Eustachian tube dysfunction, specifically those who have had ear infection symptoms for more than 90 days.4 In tympanostomy, tubes are placed across the eardrum, which evens the pressure between the middle and outer ear. Tympanostomy can treat the current middle ear infection and also reduce the risk of recurrent ear infections in children.4

In adults, some otolaryngologists perform a procedure called balloon dilation of the Eustachian tube (BDET). As the name implies, a small empty balloon is placed in the Eustachian tube and inflated, which dilates (widens) the tube. BDET can be quite effective in treating Eustachian tube dysfunction in adults5 and may also be useful for children if tympanostomy fails.6

Tympanostomy and BDET are used to treat the “always closed” form of the condition. The “always open” form may be treated with intraluminal catheter placement, cartilage grafts, or complete occlusion surgery. Your ENT specialist can help you decide what treatment is right for you.

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