Eustachian Tube Dysfunction

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

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

Diagnostic Procedures

• Clinical diagnosis

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

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