Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 8-04: Diseases of the Eustachian Tube + Key Features Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ Diagnostic Procedures ++ Clinical diagnosis + Treatment Download Section PDF Listen +++ +++ 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 is indicated And rarely, insertion of a ventilating tube is indicated (to reduce the outward stretch of the ear drum during phonation) +++ Therapeutic Procedures ++ Autoinflation should not be recommended to patients with active intranasal infection, because this maneuver may precipitate middle ear infection Balloon dilation of the eustachian tube Used in some centers However, which patients benefit and how long results last are still being determined + Outcome Download Section PDF Listen +++ +++ Prognosis ++ Following a viral illness, this disorder is usually transient, lasting days to weeks +++ Prevention ++ Avoid long-term decongestant use Avoid exacerbants of air travel, rapid altitudinal change, and underwater diving Control associated sinonasal disease +++ When to Refer ++ Refer to an otolaryngologist if symptoms persist despite medical therapy or if there is persistent hearing loss + References Download Section PDF Listen +++ + +Huisman JML et al. Treatment of eustachian tube dysfunction with balloon dilation: a systematic review. Laryngoscope. 2018 Jan;128(1):237–47. [PubMed: 28799657] + +Meyer TA et al. A randomized controlled trial of balloon dilation as a treatment for persistent Eustachian tube dysfunction with 1-year follow-up. Otol Neurotol. 2018 Aug;39(7):894–902. [PubMed: 29912819] + +Ward BK et al. Patulous eustachian tube dysfunction: patient demographics and comorbidities. Otol Neurotol. 2017 Oct;38(9):1362–9. [PubMed: 28796094]