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.

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.

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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).
Medically Reviewed by a Doctor on 12/7/2016

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