Timothy C. Hain, MD. Page last modified: December 26, 2007
The eustachian tube connects the middle ear to the throat. Its normal function is illustrated on the diagram above. Its purpose is to equalize middle ear pressure with environmental pressure. When your ear "pops" on a high-speed elevator or in an airplane, the reason is that the eustachian tube has opened and equalized pressure.
Occasionally people develop symptoms when the eustachian tube does not equalize pressure. In other words, it is closed when it should be open. This may involve pain or fullness. It may be a particular problem and source of severe pain when flying on airplanes, ascending tall buildings, or diving. In many cases, however, this may be alleviated by use of special ear plugs. Fullness in the ears can be a very troublesome symptom that can also arise from TMJ (jaw joint) disturbances, migraine, and Meniere's disease.
Another variant of eustachian tube dysfunction is when the eustachian tube is chronically open, called a "Patulous" eustachaian tube. This causes a "man in a barrel" sensation when one talks.
Finally, sometimes the eustachian tubes opens and closes rhythmically, causing a clicking noise. This is usually due to palatal myoclonus, which is discussed elsewhere.
Disturbances of eustachian tube function are generally called "ET" dysfunction or ETD.
Diagnosis is generally made from history. Someone who reports that they have fullness in their ears, which clears when they swallow or "pop" them, has ETD of the most common kind -- the ET is not opening when it should. One can prove that the ET opens or not, using tympanometry. This is simply a method of recording pressure in the ear.
The patulous (open too much) eustachian tube is also diagnosed by noting that people have autophony (hear their own voice in their ear), an abnormal resonance to the voice (due to the tube being open), or the simple expediant of watching the ear drum move while the person breathes. The Japanese recently described another method involving testing hearing with masking noises inserted into the nose (Hori et al, 2006). While clever, diagnosis is generally so easy that procedures are unnecessary.
Treatment of ETD is not very sophisticated or effective.
For the usual type of ETD (closed), medications for allergy such as decongestants, systemic or local antihistamines and nasal topical steroids are commonly tried. We are particularly fond of using "Astelin", which is a prescription antihistamine nasal spray, as well as kits that involve irrigation of the nose with salt water.
Occasionally, people with severe symptoms due to ET dysfunction may have a ventilation tube placed in their ear drum. This relieves the symptoms of ET dysfunction but creates a perforation in the eardrum which reduces hearing to a small extent as well as provides a potential entry point for infection. However, in most cases, it is worth it to find out if symptoms respond to ventilation of the ear.
|A ventilation tube being placed in the ear drum.|
Methods of treatment aimed at "patulous" (abnormally open) eustachian tubes include Premarin nose drops or nasal spray (compounded 25 mg in 30 cc NS), and insufflation of boric acid and salicylate powder as described by Bezold. These agents are intended to close eustachaian tubes, and would not be appropriate for persons who have plugged eustachian tubes rather than abnormally open ones.
As a last resort, a patulous eustachian tube may be closed surgically and a perforation created in the eardrum. However, it is difficult to imagine a situation where this would be desirable.
Graphics are courtesy of Northwestern University, and are used with permission.
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