What is Eustachian Tube Dysfunction (ETD)
The Eustachian tubes are very small, narrow passageways that connect the middle ear to the back of the nose and upper throat. The tubes purpose is to regulate the balance of pressure between the ear and the outside. It enables fluid and secretions to be cleared from the middle ear and also protects the middle ear from infections, sounds and secretions from the back of the nose.
The Eustachian tube is normmaly closed however when you yawn, swallow or sneeze the tubes open enabling fluid to be cleared and the air pressure to be equalised.
Eustachian tube dysfunction or commonly known as ETD is when the tube or tubes become blocked thereby its function is impaired. The tube is unable to equalise the pressure and the ventilation of the middle ear. When this occurs, hearing can sound muffled. It is often accompanied by a feeling of fullness in your ear as well as ear pain occassionally.
How we hear and what part does the Eustachian tube play?
Sound waves from outside your ear travels down your ear canals to your eardrum, the vibrations from the sound pass on to the ossicles (tiny bones) in the middle part of your ear. The ossicles transmit these vibrations to the cochlea in the middle ear and from there sound signals are sent to the ear nerve, where they are transported to the brain.
Your middle ear is constantly filled with air which is absorbed into the middle ear. Fresh air is replaced from the back of the nose when your Eustachian tube opens from normal movement such as chewing, yawing. Air cannot does not pass through your ear drum due it to being a solid cover.
When there is equal air pressure on each side of the eardrum – and the middle ear is free of mucus it allows the eardrum to vibrate. This vibration is needed for us to hear properly. With ETD the air is not able to get into the middle ear section, therefore the air pressure on the outside of your ear drum (in the ear canal) is greater than the air pressure in the middle ear. This causes pressure which pushes the eardrum inwards (retracted) and stretched. The retracted eardrum inhibits vibration completely, thereby impacting the soundwaves that hit your ear drum and the subsequent sounds you hear.
What are the Symptoms of ETD?
- Sensation of fullness or blocked ears
- Popping or crackling sounds (described often like a radio channel not tuned in)
- Pain/discomfort in one or both ears that comes and goes. Ear pain can be due to a pressure difference causing the drum to over stretch.
- Reduced or muffled hearing (described as having water in ear or cotton wool in it)
- Ringing in the ears (tinnitus), Buzzing
- Abnormal sound of your own voice
- A feeling of spinning when standing still
- Hearing not eased with swallowing, yawning or from chewing
- Visible retracted eardrum, where the eardrum is sucked in towards the middle ear
Symptoms of ETD are often increased during changes in altitude. For example, pressure changes from flying diving or driving through mountains/hills.
What Causes ETD?
Eustachian tube dysfunction is commonly caused by an inflammation of the tube. This causes mucus and fluid to build up such as:
- With a recent cold or viral respiratory illness,
- Chronic nasal inflammation
- Hay fever
- Sinus infections
- Smokers – Smoking is shown to cause damage to the tiny hairs (cilia) which sweep mucus away from the middle ear and towards the back of the nose. When these hairs are damaged, mucus can gather in the Eustachian tubes more easily.
- Blockage at the back of the nose (i.e. enlarged adenoid (children), tissue or scarring from radiotherapy to head and neck, tumours in adults.
- Narrow tubes – Children’s Eustachian tubes are straighter and shorter than adults. This enables germs and bacteria to reach the middle ear as well as easier for fluid to become trapped in the middle ear.
How is ETD diagnosed?
Your doctor will discuss your symptoms and examine your eardrums, ear canals and the back of your throat and nasal passages. A hearing test may also need to be done. Possibly you may need to be referred to an Ear Nose and Throat (ENT) Specialist.
How to treat ETD?
Usually with mild symptoms ETD will resolve on its own. Treatment for ETD depends on the severity and cause of the condition. Treatment options may include OTC (over-the-counter) medications, prescriptions from your GP or natural/home remedies. Please check with your doctor before using any medications or supplements in case they may interact with medications you are normally taking.
Natural
- Yawning, eating and drinking, chewing gum may also move the Eustachian tubes to allow air to travel through the tube
- Valsalva manoeuvre – This can be done by pushing some air into middle ear. Take a deep breath, pinch your nostrils and close your mouth, and gently (not forcefully) pop your ears
- Steam inhalations with menthol, eucalyptus, or other oils in boiling water in the sink with a towel over the head or any other kind of inhalation device to open nasal passages
- Sucking menthol or eucalyptus lollies to unblock the nose.
Over-the-counter (OTC)
- Nasal decongestants over the counter may be used if there is some blockage Talk to your pharmacist as to which one would be right for you. Your GP may prescribe steroid nasal sprays for persistent inflammation
- Taking antihistamines if the swelling is caused by allergies
- Nasal sprays unmedicated or medicated may help
- Saline salt water nasal rinses
- Antihistamines to reduce the allergic response, talk to your Pharmacist
For symptoms that persist over 2 weeks, or symptoms increasing in severity please contact your GP for further investigations.