Eustachian Tube Problems (Ear Tube Dysfunction, Blockage)

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

Tips for Treating Ear Infections

Eustachian tube definition and facts

  • The Eustachian tube originates in the rear of the nose adjacent to the soft palate, runs a slightly uphill course, and ends in the middle ear space.
  • The Eustachian tube connects the middle ear space to the rear of the nose near the soft palate. The middle ear space is the hollowed out portion of the skull bone that contains the hearing apparatus and is covered on one side by the eardrum.
  • Cartilage provides the supporting structure for the first two-thirds of the Eustachian tube, with the last third (the part closest to the middle ear space) being made of bone.
  • In adults, the Eustachian tube is approximately 35 mm long (1.3 inches) and approximately 3 mm in diameter (less than 1/10 inch).
  • The tissue that lines the Eustachian tube is similar to that inside the nasal cavity and may respond the same way (swelling and mucous production) when presented with similar stimuli.
  • Normally, the Eustachian tube is closed, but it can become partially or completely blocked as a consequence of common colds or allergies.
  • Partial or complete blockage of the Eustachian tube can cause sensations of popping, clicking, and ear fullness.
  • Altitude changes can cause symptoms in persons with Eustachian tube problems.
  • Several maneuvers can be done to improve Eustachian tube function.
  • The Eustachian tube was named in honor of the 16th century Italian anatomist Eustachius. Sources credit Almaceon of Sparta as the first to describe the structure in approximately 400 BC.

What is the function of the Eustachian tube?

The primary function of the Eustachian tube is to ventilate the middle ear space, ensuring that its pressure remains at near normal environmental air pressure. The secondary function of the Eustachian tube is to drain any accumulated secretions, infection, or debris from the middle ear space. Several small muscles located in the back of the throat and palate control the opening and closing of the Eustachian tube. Swallowing and yawning cause contractions of these muscles located in the back of the throat and help regulate Eustachian tube function. If it were not for the Eustachian tube, the middle ear cavity would be an isolated air pocket inside the head that would be vulnerable to every change in air pressure and lead to unhealthy middle ear space function.

Normally, the nasal opening of the Eustachian tube is closed, which helps prevent the inadvertent contamination of the middle ear space by the normal secretions found in the back of the nose. A dysfunctional Eustachian tube that is always open is called a "patulous" Eustachian tube. Patients with this rare condition are plagued by chronic ear infections. A much more common problem is a failure of the Eustachian tube to effectively regulate air pressure. Partial or complete blockage of the Eustachian tube can cause sensations of popping, clicking, and ear fullness and occasionally moderate to severe ear pain. Such intense pain is most frequently experienced during sudden air pressure changes during airplane travel, particularly during take-off and landing. Young children may describe the popping sensation as "a tickle in my ear" or "my ears are itching."

If the Eustachian tube function worsens, air pressure in the middle ear falls, and the ear feels full and sounds are perceived as muffled. Eventually, a vacuum is created which can then cause fluid to be drawn down the Eustachian tube into the middle ear space (termed serous otitis media). If the fluid becomes infected, the common ear infection (suppurative otitis media) develops.

Picture of the Stuctures of the Inner Ear
Picture of the Structures of the Inner Ear

What causes Eustachian tube dysfunction or blockage?

Eustachian tube problems and the associated ear infections are among the most common problems seen by health-care professionals. Many people have chronic problems regulating middle ear pressure.

The Eustachian tube can be blocked, or obstructed, for a variety of reasons.

  • The most common cause is a "cold" (upper respiratory infection).
  • Sinus infections and allergies may also cause swelling of the tissue lining the Eustachian tube. Simply put, a stuffy nose leads to stuffy ears.
  • Children are particularly prone to Eustachian tube blockage because their tubes are narrower in diameter, more horizontal in orientation, and closer at the nasal opening of the Eustachian tube to the adenoids.
  • Adenoid tissue in the back of the nose near the Eustachian tube can act as a reservoir for bacteria, contributing to recurrent ear infections. Enlarged adenoids obstructing the opening of the Eustachian tube may also be present. Adenoid removal (adenoidectomy) is frequently recommended in children with chronic ear infections (chronic otitis media).
  • Rarely, masses or tumors in the skull base or nasopharynx can lead to Eustachian tube obstruction.
  • Excessively small Eustachian tubes (as may afflict children with Down Syndrome)
  • Smoking is associated with damage to the cilia that sweep mucus and debris from the middle ear space via the Eustachian tube to the back of the nose where it may be expelled.
Causes range from allergies to excessively small Eustachian tubes (as may afflict children with Down Syndrome).

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Middle Ear Infection Symptoms

In general, adults with an ear infection may have one or more of these symptoms and signs:

  • Ringing in ears
  • Dizziness
  • Fever
  • Headache
  • Nausea and/or vomiting.

What are the signs and symptoms of Eustachian tube dysfunction or blockage?

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People with some Eustachian tube dysfunction may experience signs and symptoms of:

What home remedies help clear Eustachian tube blockage?

Several maneuvers may be done to improve Eustachian tube function and thus aid in equalization of air pressure.

  • The simple act of swallowing activates the muscles in the back of the throat that help open the Eustachian tube. Any activity that promotes swallowing can help open the Eustachian tube, for example, chewing gum, drinking, or eating.
  • Yawning is even more effective because it is a stronger muscle activator.
  • If the ears still feel full, the person can try to forcibly open the Eustachian tube by taking a deep breath and blowing while pinching your nostrils and closing the mouth. When a "pop" is felt, you know you have succeeded. If problems persist despite trying to forcibly open the tubes you may need to seek medical attention. If you feel dizzy performing this maneuver, then stop and discuss this with your doctor.
  • If you have a cold, sinus infection, ear infection, or suffering from allergies, it may be advisable to postpone air travel.
  • Similarly, individuals with Eustachian tube problems may find such sports as scuba diving painful, and in some situations quite dangerous.
  • Babies traveling on airplanes cannot intentionally pop their ears, but may do so if they are sucking on a bottle or pacifier. Crying, similar in function to yawning, will also enable equalization of air pressure.

What is the medical treatment for clearing Eustachian tube dysfunction or blockage?

Many people with Eustachian tube blockage or dysfunction that travel use a decongestant pill or nasal spray an hour prior to takeoff, and if necessary, prior to descent. The decongestant acts to shrink the membranes lining the nose and throat, allowing the ears to equalize more easily. Similarly, people experiencing chronic daily problems with Eustachian tube dysfunction can benefit by aggressive control of allergies (with antihistamines, decongestants, and prescription nasal sprays).

Acid reflux control may be help some people if their reflux is irritating the lining in the back of the nose and Eustachian tube opening.

An evaluation with an allergy specialist or Allergist may be helpful in diagnosing the cause of the Eustachian tube dysfunction or blockage.

What about Eustachian tube surgery?

In severe situations, a "pressure equalization tube" (PET) can be surgically placed in the eardrum, replacing the role of a functioning Eustachian tube, and thus guaranteeing equalization of middle ear pressure. This procedure is most commonly seen in young children who experience recurrent ear infections as a consequence of a poorly functioning Eustachian tube.

How do changes in altitude or air travel affect Eustachian tube dysfunction or blockage?

A rapid change in altitude, and thus air pressure is equalized across the eardrum by a normally functioning Eustachian tube. A healthy tube opens frequently and widely enough to equalize these changes in air pressure. With altitude changes during the descent of an airplane, air pressure increases as the plane lowers. The air pressure change pushes the eardrum inward (retraction). Persons with Eustachian tube blockage can develop fullness of the ear, dulled hearing, and possibly pain when this occurs. Those with poorly functioning Eustachian tubes may experience similar symptoms when riding in elevators, driving through the mountains, or diving to the bottom of a swimming pool. Scuba divers learn tricks to equalize their ear pressures.

REFERENCE: MedscapeReference.com. Eustachian Tube Function.

Last Editorial Review: 12/7/2016

Reviewed on 12/7/2016
References
REFERENCE: MedscapeReference.com. Eustachian Tube Function.

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