Eustachian dysfunction

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The Eustachian tube, also termed the pharyngotympanic or auditory tube, is vital in regulating middle ear homeostasis, with complex anatomy designed to achieve this function. It travels medially from the middle ear, directing down and forwards to open just posterior to the end of the inferior turbinate—the bony lateral third travels past both squamous and petrous portions of the temporal bone. The medial two-thirds is fibrocartilaginous, opening out into the nasopharynx as a mucosal elevation known as the torus tubarius. The tube opens on positive pressure, e.g., yawning, sneezing, swallowing, and the Valsalva maneuver, by contraction of the levator veli palatini and tensor veli palatini muscles.

Through the Eustachian tube's complex structure, it can carry out its three main functions:

Firstly, by having a patent and open Eustachian tube, the pressure of the middle ear is equalized to that of the nasopharynx (i.e., towards atmospheric pressure). This has assistance from active mucosal gas exchange within the middle ear. With the maintenance of middle ear pressure, tympanic membrane compliance is optimized for hearing.

Secondly, it contains tube mucociliary transport. This consists of ciliated cells that clear inflammatory products and secretions from the middle ear and Eustachian tube, transporting them towards the direction of the nasopharynx for elimination.

Lastly, a functioning Eustachian tube protects the middle ear from loud sounds and potential hazards, including pathogens and secretions from the nasopharynx.

Eustachian tube dysfunction (ETD) is the failure of the Eustachian tube in maintaining any of the three roles mentioned above. This categorizes as either acute (less than three months presentation) or chronic ETD (more than three months). ETD affects 1% of the population, with symptoms including aural fullness or 'popping sounds,' reduced hearing, tinnitus, autophony, otalgia, and imbalance. It can be broadly categorized into baro-challenged induced, patulous, and dilatory ETD.


People with ETD may experience a number of warning signs. Common eustachian tube dysfunction symptoms include:

Hearing problems.

Tinnitus, or ringing in your ears.

Clicking or popping sounds.

A feeling of fullness in your ears.

Pain that mimics an ear infection.

Dizziness, vertigo or balance problems.

A “tickling” sensation in your ears.

Eustachian tube dysfunction symptoms may get worse in higher altitudes. This is called barotrauma, and it can happen while scuba diving, flying in an airplane or driving in the mountains.


The most common cause of Eustachian tube dysfunction is when the tube become swollen (inflamed) and mucus or fluid builds up. This can be caused by a cold, the flu, a sinus infection, or allergies. Some people are at greater risk for Eustachian tube dysfunction. They include:

Children. Their tubes are shorter and straighter than those of an adult. This makes it easier for germs to reach the middle ear and for fluid to become trapped there. Also, children’s immune systems are not fully developed. This makes it harder for them to fight off infections.

People who smoke. Smoking damages the cilia (the tiny hairs that sweep mucus from the middle ear to the back of the nose). This can allow mucus to gather in the tubes.

People who are obese. Fatty deposits around the tubes can lead to Eustachian tube dysfunction.

too much earwax in the Eustachian tube.

water in your ear.

a change in altitude (you may have noticed problems when you fly)

sinus infections.

middle ear infections.


Risk factors

It is common to experience ETD occasionally, but some people have symptoms more often than others.

Lifestyle risks

Lifestyle risks include smoking and carrying excess body weight.

Smoking can damageTrusted Source the delicate hairs in the throat and middle ear.

Carrying excess body weight can lead to fatty tissue deposits to form around the eustachian tubes, causing fluid buildup in the ear.

However, significant weight loss can also lead to dysfunction when fat buildup in the tubes decreasesTrusted Source too quickly.

Engaging in certain activities may also put a person more at risk of pressure changes, which could trigger ETD symptoms. These activities include:

hiking at high altitudes

rock climbing

skiing or snowboarding

scuba diving

Medical risks

People with allergies may experience ETD more often, as allergies can cause increased mucus and congestion.

Children are also at higher risk of ETD, as their eustachian tubes are smaller and orient more horizontally than vertically. This makes the tubes more likely to become clogged by mucus or germs.

Furthermore, a child’s immune system is less able to fight off infections, as it is not fully developed. Children have more frequent colds and sinus infections, which are direct causes of ETD.

Enlarged adenoids can also cause eustachian tube obstruction and lead to bacterial growth, which can then result in ear infections.

The following medical conditions are risk factors as well:

Cleft palate: It commonly affects children from birth and almost always leads to ETD.

Trisomy 21: This is a type of Down syndrome that causes small and abnormally shaped tubes, poorTrusted Source muscle tone, and a decreaseTrusted Source in the cartilage density within the tube.

Generalized hypotonia: Also called poor muscle tone, this condition can occur for a number of reasons. It can impairTrusted Source the function of a muscle in the soft palate in the mouth and lead to a eustachian tube collapse.

Laryngopharyngeal reflux: This condition can obstruct the eustachian tubes.

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ETD can cause complications such asTrusted Source:

ear infection

middle ear atelectasis, which is a retraction of the eardrum

chronic otitis media, which is when there is persistent fluid in the ear

cholesteatoma, which is an abnormal skin growth in the middle ear

Any of these conditions can lead to dysfunction that causes hearing loss.


A common course of treatment for Eustachian tube dysfunction is the use of decongestants or antihistamines. In some cases, this treatment may make the condition worse. If decongestants or antihistamines do not provide relief, contact your doctor. You may need to see an ear, nose and throat specialist for treatment.