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For further information, see CMDT Part 8-04: Diseases of the Eustachian Tube

Key Features

Essentials of Diagnosis

  • Aural fullness

  • Fluctuating hearing

  • Discomfort with barometric pressure change

  • At risk for serous otitis media

General Considerations

  • The tube that connects the middle ear to the nasopharynx—the eustachian tube—provides ventilation and drainage for the middle ear cleft

  • The eustachian tube is normally closed, opening only during the act of swallowing or yawning

Hypofunctioning (narrowed) eustachian tube

  • When eustachian tube function is compromised, air trapped within the middle ear becomes absorbed and negative pressure results

  • The most common causes are diseases associated with edema of the tubal lining, such as viral upper respiratory tract infections and allergy

Overly patent (patulous) eustachian tube

  • A relatively uncommon problem that may be quite distressing

  • May develop during rapid weight loss or may be idiopathic

Clinical Findings

Symptoms and Signs

Hypofunctioning eustachian tube

  • Usually there is a sense of fullness in the ear and mild to moderate impairment of hearing

  • When the tube is only partially blocked, swallowing or yawning may elicit a popping or crackling sound

  • Examination reveals retraction of the tympanic membrane and decreased mobility on pneumatic otoscopy

Overly patent (patulous) eustachian tube

  • As with hypofunctioning eustachian tube, there is often a sensation of fullness in the ear

  • But, in contrast to a hypofunctioning eustachian tube, sensation of aural pressure

    • is often made worse by exertion

    • may diminish during an upper respiratory tract infection

  • Autophony, an exaggerated ability to hear oneself breathe and speak, occurs

  • Although physical examination is usually normal, respiratory excursions of the tympanic membrane may occasionally be detected during vigorous breathing

Differential Diagnosis

  • Cerumen (ear wax) impaction

  • Acute or chronic otitis media

  • Temporomandibular joint dysfunction

  • Paget disease

  • Head trauma

Diagnosis

Diagnostic Procedures

  • Clinical diagnosis

Treatment

Medications

Hypofunctioning eustachian tube

  • Systemic and intranasal decongestants (eg, pseudoephedrine, 60 mg every 4–6 hours orally; oxymetazoline, 0.05% spray every 8–12 hours) combined with autoinflation by forced exhalation against closed nostrils may hasten relief

  • Allergic patients may also benefit from intranasal corticosteroids (eg, beclomethasone dipropionate, two sprays in each nostril twice daily for 2–6 weeks)

Overly patent (patulous) eustachian tube

  • Avoidance of decongestant products

Surgery

Hypofunctioning eustachian tube

  • In medically refractory tube hypofunction, insertion of a tympanostomy tube is often helpful

Overly patent (patulous) eustachian tube

  • Rarely, surgical treatment of the eustachian tube ...

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