Eustachian tube dysfunction: Causes, symptoms and treatments

What is eustachian tube dysfunction?

Eustachian tube dysfunction (ETD) is a condition that occurs when your eustachian tubes in your ear are blocked or do not open properly.

Your eustachian tubes are openings that connect the middle ear with the back of your throat. This helps to balance pressure in the middle ear (commonly felt as a popping sensation in the ear), drain fluid from the ears, and protect the ear from both hearing sounds your body causes (such as breathing) and any nasal drainage.

Typically, these tubes are closed. However, when you swallow, sneeze or yawn they open naturally and helps prevent air pressure and fluid from building up inside your ear. ETD can cause air pressure and fluid to build due to the tubes not opening as they should.

What causes eustachian tube dysfunction?

Eustachian tube dysfunction is extremely common and can be caused by a number of different factors.

These include:

• Altitude change (travelling by plane, driving high above sea level, or scuba diving, for example)
• Allergies
• Viruses, like the common cold
• Flu
• Glue ear
• Chronic acid reflux (GERD or GORD)
• Chronic sinusitis
• Chronic rhinitis
• Smoking-related changes to the nose and throat

What are the risk factors for eustachian tube dysfunction?

Many people experience ETD occasionally and will usually pass with minimal impact on your day to day. However, there are those who are at higher risk of getting ETD more regularly.

Children are often at high risk of developing ETD more regularly. This is because a child’s tubes are smaller than an adult, so germs, that can cause infection, reach the middle ear more easily. Also, a child’s immune system is not yet fully developed, which can mean they are more susceptible to developing infections.

Smokers are also at a higher risk of developing ETD regularly. This is because smoking can damage the tiny hairs that line the eustachian tubes and stops them from working properly. These tiny hairs help direct mucus from the middle ear into the back of the nose. If these hairs are damaged, they can cause mucus to build up in the tubes.

If you are often travelling through areas with high altitude, high above sea level, this can put you at risk of developing ETD.

Certain conditions can also increase your risk for eustachian tube dysfunction, like having a cleft palate.

How is eustachian tube dysfunction diagnosed?

If your symptoms don’t clear and persist for more than 2 weeks, it’s advised to see a doctor you trust about what may be bothering you.

During your consultation, your doctor will ask about your symptoms, health and family history, and any relevant information such as your day-to-day lifestyle to weigh up what may be troubling you. They may also perform a physical examination of your ear to check for any signs of infection or blockages.

If they suspect you may have ETD, your doctor may also recommend an audiogram, which shows the function of the eardrum. 

If your ETD is suspected to be caused by another condition, your doctor will assess what may need to be treated first to help alleviate your symptoms.

How is eustachian tube dysfunction treated?

In most cases, eustachian tube dysfunction typically clears up on its own without the need for treatment.

However, if it doesn’t clear up and you’ve been to a doctor about the issue, they may recommend the following treatments:

At home remedies

Minor ETD symptoms, such as those due to a change in altitude or air pressure, can be treated through at home treatments and techniques.

Sometimes, symptoms can be relieved by forcing a yawn, chewing, or swallowing - so drinking a beverage or having a snack may help. This works because these movements help open and close the eustachian tube and relieve the pressure in the ears.

Doing certain manoeuvres, such as the Valsalva manoeuvre, can also help. This manoeuvre is the act of pinching your nose closed while closing the mouth and blowing into the nose. This can also help relieve ear pressure.

Medications 

If your symptoms still don’t go away after trying these at home remedies, you can, depending on the cause, take some over-the-counter medications to help ease your symptoms.

These may include:

• Nasal or oral decongestants
• Antihistamines
• Nasal steroids, to help relieve nasal congestion and aid your eustachian tubes to open
• Pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDS)

Surgery

In severe cases, particularly if you have fluid build up behind the eardrum that can’t escape through your eustachian tubes, surgery may be recommended. The goal of surgical treatment is to bypass your eustachian tubes and combat the pressure ventilation problems in the middle of your ears.

Your options may include:

• Myringotomy – this involves making a small incision (cut) in your eardrum to help drain the fluid from your ear. The cut usually stays open long enough for the swelling in your eustachian tubes to resolve
• Ear tubes - sometimes, ear tubes are placed into the incisions during myringotomy. These tubes provide proper ear pressure ventilation for up to one year. Usually, ear tubes fall out over time and your eardrum heals
• Eustachian tuboplasty (eustachian tube balloon dilation) - this involves widening your eustachian tubes with a balloon. Your surgeon will perform a nasal endoscopy (a small, thin tube fed through your nose) to thread the balloon into your eustachian tubes. The balloon will be inflated for two minutes, then deflated and removed

Can eustachian tube dysfunction be prevented?

Eustachian tube dysfunction can’t always be prevented, but you can lower the risk by treating colds, allergies, and nasal congestion early, and by avoiding smoke and irritants. 

During flights, swallowing, yawning, or gently equalising the pressure in your ear may help.

If the problem is caused by a long-term condition or the shape of the ear tubes, ETD may not be fully preventable. In those cases, the focus will be on easing your symptoms and treating the underlying cause.

It’s important to see a doctor if your symptoms last for several weeks, keep coming back, or are linked to issues such as hearing loss, ear pain, or fluid coming from the ear.

Get help with Circle Health Group

If you are struggling to tackle symptoms of eustachian tube dysfunction and need help with a healthcare professional, you can book an appointment online and speak with one of our specialists.

Clinical sources and further reading

1. Eustachian tube dysfunction, Patient.info
2. What's to know about eustachian tube dysfunction?, MedicalNewsToday
3. Eustachian Tube Dysfunction, John Hopkins Medicine