Eustachian Tube Problems – ENT Doctor | Ear and Tinnitus Specialist

The cause of any ear infection is some type of blockage of the Eustachian tube. Connecting the middle ear to the rear of the nose by the soft palate, this tube is just over an inch in length in adults. Tissues in the Eustachian tube may respond to stimuli inside of the nasal cavity, as is often the case when you have a cold or allergies that affect your ears.

• While these tubes are normally closed, a feeling of “fullness” in the ear can result if they are unable to open as needed
• A blocked tube creates an ideal environment for bacteria, which is just one of several potential problems that may involve the Eustachian tube

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Causes of Eustachian Tube Problems

E-tubes normally open to regular middle ear pressure, help with ventilation and ear fluid drainage, and prevent fluids from the throat and nose from getting into the middle ear. If these tubes aren’t functioning as expected, pressure imbalances and infections can result in symptoms that may include:

• Temporary ringing in the ears (tinnitus)
• Dizziness or vertigo
• Headaches
• Nausea or vomiting
• Headaches
• Popping and crackling sensations
• Mild hearing loss

Other than an upper respiratory infection due to the common cold, tube problems may be caused by chronic sinus infections and seasonal allergies. Some individuals have tubes locked in an open position, a condition known as patulous Eustachian tube (PET). Patients with PET often report persistent ear fullness and hear echoes or their own voice in the affected ear.

Eustachian tube problems are sometimes experienced because of post-nasal drainage that flows down the back of throat to the end point of the tubes. Children with infected, inflamed, or enlarged adenoids (lymph tissues) may have clogged tubes. Some people also experience tube problems due to:

• Damage to hair-like structures in Eustachian tubes (cilia) from smoking or secondhand smoke exposure
• Altitude changes
• Excessively small Eustachian tubes
• Skull base tumors (in rare cases)

How Do Childhood Ear Infections Affect Eustachian Tubes?

Children with upper respiratory infections often have ear infections because of bacteria that transfers from the nose to the middle ear. If ear infections become chronic, mucus may accumulate in Eustachian tubes. This makes it difficult for the ear to properly drain, which may result in higher-than-normal pressure in the middle ear. Sometimes this pressure causes eardrum deformities or ruptures.

Diagnoses

Issues involving Eustachian tubes are typically diagnosed with a physical exam and a detailed evaluation of the affected ear. Movements of the eardrum when air pressure is applied can be observed with a bulb syringe attached to an otoscope (instrument used to look inside of ears). A device called a tympanogram may be used to measure eardrum movement.

Diagnosis of Eardrum Ruptures

When there’s discharge from the affected ear, laboratory tests may be done to identify if there’s a bacterial infection in the middle ear. Diagnosis of damage to an eardrum involves examination of the ear that is done with a microscope or an otoscope. It may also involve a tuning fork evaluation to detect hearing loss. . The eardrum is sometimes further evaluated with tympanometry, a procedure involving the use of a device called a tympanometer that’s inserted into the ear canal to detect movement of the ear drum with changes in air pressure. Nearly all patients with a tympanic membrane perforation will benefit from a full audiological exam.

Treatment Options

Tube problems due to a cold or changes in altitude often go away with little or no treatment. If Eustachian tube problems are due to allergies, patients may benefit from aggressive efforts to manage allergies better. Patients with chronic allergies or sinus irritations causing ear problems are sometimes referred to an allergist for further treatment.

When ear infections are causing tube issues, antibiotics delivered orally or with ear drops or ventilation tubes to improve circulation may be recommended. Decongestants and nasal corticosteroids may be a beneficial solution for some people with occasional problems. PET-related issues might be treated with a special type of estrogen nasal spray.

When Is Surgery Recommended?

Surgery may become an option if abnormalities of the Eustachian tube are contributing to persistent and serious ear issues. A common procedure is the insertion of a pressure equalization tube into the eardrum to create a better pressure balance. This is often recommended for children. With a procedure known as a myringotomy, a small slit is made in the eardrum to drain fluid and create a temporary source of ventilation. The slit will heal on its own.

Problems with Eustachian tubes can be minimized by being cautious in situations where ear pressure is likely to change, as is often the case when traveling by airplane. Yawning, chewing gum, and making swallowing motions can help keep your e-tubes open in situations like this, as can gently blowing your nose. See your doctor about any lingering or recurrent ear infections. You may be referred to an ear, nose, and throat specialist if your problems may be related to some type of deformity or abnormality, or if an infection has caused issues with parts of your middle ear.

Eustachian tube dysfunction: Causes, symptoms, and treatment

Infections and blockages can disrupt the eustachian tubes, leading to discomfort and hearing problems. Any of these symptoms can count as eustachian tube dysfunction (ETD).

The eustachian tube runs from the middle ear to the back of the nose and throat. It helps drain fluid from the middle ear, which is the space behind the eardrum. Infection and blockages can disrupt this process and lead to complications.

In this article, we discuss the the symptoms, causes, and treatments for ETD

There are a few different causes of ETD, and certain factors may increase a person’s likelihood of developing it.

• The eustachian tubes help regulate ear pressure and drain excess fluid from the middle ear.
• When they are blocked, symptoms can include pain, popping sounds in the ears, or fluid in the ears.
• The treatment depends on the underlying cause.

A person can often easily manage ETD at home. However, persistent symptoms may require contacting a doctor for treatment.

The eustachian tubes are canals that run from the back of the nose and upper throat to the middle ear, helping keep the air pressure behind the eardrum the same as the pressure outside. They remain closed most of the time but will open as a person swallows, chews, or yawns.

Some people can have a condition that health experts refer to as patulous eustachian tube, where tubes stay open when they should be closed. This causes a person to experience autophony, which is when they can hear their own breathing and voice inside their head.

In addition, these canals are so tiny that blockages can happen for many reasons. Blocked eustachian tubes can cause discomfort and lead to hearing problems. Any of these symptoms can count as ETD.

ETD covers a variety of symptoms and has a range of potential causes. Season allergies and illnesses that create inflammation in the area, such as the flu or cold, are common causes of ETD.

Sinus infections can also trigger ETD, as a sinus infection causes the eustachian tubes to become inflamed or filled with mucus. More serious infections can cause ETD as well.

Moreover, ETD may stem from simple changes in altitude or air pressure. For instance, driving up a mountain or sitting in a plane can cause ETD. Even just riding the elevator in a tall building may be enough for some people to develop unpleasant symptoms.

It is common to experience ETD occasionally, but some people have symptoms more often than others.

Lifestyle risks

Lifestyle risks include smoking and carrying excess body weight.

Smoking can damage the delicate hairs in the throat and middle ear.

Carrying excess body weight can lead to fatty tissue deposits to form around the eustachian tubes, causing fluid buildup in the ear.

However, significant weight loss can also lead to dysfunction when fat buildup in the tubes decreases too quickly.

Engaging in certain activities may also put a person more at risk of pressure changes, which could trigger ETD symptoms. These activities include:

• hiking at high altitudes
• rock climbing
• skiing or snowboarding
• scuba diving

Medical risks

People with allergies may experience ETD more often, as allergies can cause increased mucus and congestion.

Children are also at higher risk of ETD, as their eustachian tubes are smaller and orient more horizontally than vertically. This makes the tubes more likely to become clogged by mucus or germs.

Furthermore, a child’s immune system is less able to fight off infections, as it is not fully developed. Children have more frequent colds and sinus infections, which are direct causes of ETD.

Enlarged adenoids can also cause eustachian tube obstruction and lead to bacterial growth, which can then result in ear infections.

The following medical conditions are risk factors as well:

• Cleft palate: It commonly affects children from birth and almost always leads to ETD.
• Trisomy 21: This is a type of Down syndrome that causes small and abnormally shaped tubes, poor muscle tone, and a decrease in the cartilage density within the tube.
• Generalized hypotonia: Also called poor muscle tone, this condition can occur for a number of reasons. It can impair the function of a muscle in the soft palate in the mouth and lead to a eustachian tube collapse.
• Laryngopharyngeal reflux: This condition can obstruct the eustachian tubes.

Yet another risk factor is having a ciliary disorder, such as primary ciliary dyskinesia, which is an inherited condition where the cilia in the airway do not work properly.

Symptoms of ETD can vary from mild to severe and may be different for each person.

Common symptoms include:

• a plugged feeling in the ears
• the ears feeling as if they are filled with water
• tinnitus, or ringing in the ear
• muffled hearing or partial hearing loss
• ticking or popping sounds
• pain and tenderness around the ear
• a tickling or tingling sensation
• trouble with balance

The length and severity of ETD symptoms depend on their cause. For instance, if ETD results from a change in altitude, these symptoms will often go away as the body adjusts to the pressure or reaches a lower altitude.

By contrast, ETD that is due to an illness or infection can last much longer. Anyone with ETD symptoms that last more than 2 weeks should seek guidance from a doctor.

Children with symptoms of ETD should receive medical help sooner, as the symptoms of ETD are similar to an ear infection.

When people experience dysfunction due to a nonviral cause, they are more likely to experience symptoms that persist for longer.

ETD can cause complications such as:

• ear infection
• middle ear atelectasis, which is a retraction of the eardrum
• chronic otitis media, which is when there is persistent fluid in the ear
• cholesteatoma, which is an abnormal skin growth in the middle ear

Any of these conditions can lead to dysfunction that causes hearing loss.

Doctors usually diagnose ETD based on a physical examination and a person’s symptoms.

A doctor may ask about hearing changes, pain in the ears, or feelings of pressure. They will also look inside the eardrum and the middle ear using an otoscope, checking for any signs of infection or blockages.

A doctor may need to look at an audiogram. This shows the results of a hearing test, or a tympanogram, which shows the function of the eardrum.

If there are cholesteatomas in the ear, or if there are concerns about skin migration into the middle ear, the doctor may order additional imaging tests.

If ETD occurs as a result of another condition, the doctor may ask questions about that as well in order to determine the correct treatment.

The symptoms of ETD will usually clear up on their own. If another condition is causing the symptoms, however, they will resolve once a person receives treatment for the underlying cause.

Home remedies

If the symptoms of ETD are bothersome, some simple home remedies may help. A person can address minor ETD symptoms, such as those due to a change in altitude or air pressure, by chewing gum or forcing a yawn.

Many people also find that the symptoms of minor ETD can go away as they swallow, so drinking a beverage or having a snack may help. These remedies help open and close the eustachian tube and relieve the pressure.

Doing the valsalva maneuver can also help. This means pinching the nose closed while closing the mouth, and blowing into the nose. This can also help relieve ear pressure on an airplane.

Children experiencing minor or temporary ETD symptoms can eat a snack or chew a piece of gum. Giving an infant a bottle or pacifier may help relieve the symptoms.

A person can relieve minor to moderate symptoms by using a saline nasal spray or irrigation system. Sometimes, dried mucus or other particles can get stuck in or near the eustachian tube and cause symptoms. Clearing the passageways can help eliminate anything clogged in the passage.

Over-the-counter medication

Depending on the cause, some over-the-counter drugs may help with ETD symptoms.

Someone who experiences ETD due to allergies may find relief using antihistamines, such as cetirizine (Zyrtec), diphenhydramine (Benadryl), or loratadine (Alavert, Claritin), or nasal steroid sprays.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, may help with pain and swelling. A person should check with a doctor to make sure these medications will not interact with any other medication they are taking.

Medical treatments

If the symptoms of ETD are due to a bacterial ear infection, a doctor will likely prescribe antibiotics. This may be a topical treatment or an oral antibiotic.

In severe cases of ETD, a doctor may prescribe oral steroids as well.

Surgery

Sometimes, fluids build up behind the eardrum and cannot escape through the dysfunctional eustachian tubes. In such cases, doctors may make a small cut in the eardrum to help with fluid drainage.

People who experience frequent severe ETD may need pressure equalization (PE) tubes. These are implants that balance the pressure in the ears and help reduce the likelihood of middle ear infections. It is a common procedure for children, but it can be suitable for adults as well.

Other surgical procedures include:

• eustachian tube balloon dilation, which uses a saline-filled balloon catheter to dilate the tubes
• transtubal application of fluids, in which a surgeon uses a nasal microendoscope to pass fluids to the middle ear and regulate ear pressure
• eustachian tuboplasty, which uses a laser or rotary cutting tool to clear obstructions from mucous membranes or cartilage in the eustachian tube

Most often, doctors use these procedures in adults. Children usually get PE tubes and will typically not need them as they get older.

A big part of any prevention strategy for ETD involves:

• leading a healthy lifestyle
• maintaining good hygiene to avoid cold- or flu-causing germs
• practicing good management of any allergies or asthma

This can help prevent common triggers that can cause the condition.

ETD and flying

When people fly, they may experience a common sensation in their ears known as airplane ear, ear barotrauma, barotitis media, or aerotitis media. It is a sensation of pressure, sometimes also pain, in the ears as the plane ascends and descends.

The cause is a quick change in altitude and pressure. When this happens, and the eustachian tube does not ventilate properly, a dysfunction occurs.

Since flying can put a person at risk of the condition, it may help to do the following when on a plane:

• swallowing repeatedly, for example, by drinking water, chewing gum, or eating candy as a way to help the process
• doing the valsalva maneuver
• yawning repeatedly to cause a popping sensation that can equalize pressure
• wearing earplugs during take off and landing to reduce the impact of the pressure change
• using a nasal decongestant for acute discomfort before, during, or after flying. However, a person should not use this for more than 3 days.

ETD is common, but most cases resolve with little or no help. Treating the underlying cause is the best way to treat and prevent recurring symptoms of ETD.

Children and adults who get symptoms that interfere with their daily lives, as well as those with chronic ETD symptoms, should contact a doctor to consider more thorough treatments.

Purulent otitis: symptoms, complications, diagnosis, treatment

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Purulent otitis media is an inflammatory process that occurs when pathogenic agents enter the ear canal. In most cases, it develops in the middle and inner parts of the ear against the background of a protracted, long-term inflammatory process and a decrease in the body’s immune defenses, when a bacterial infection joins the inflammation. Children are more susceptible to this disease, but it is also diagnosed in adults quite often.

Symptoms

Types of otitis media

Causes

Complications

Inflammation is accompanied at first by mild and then by severe throbbing pain radiating to the temple, head or jaw. The ear is blocked, there is tinnitus. With the development of inflammation, body temperature rises, swelling of the ear and the appearance of purulent exudate. Then there is a rupture of the membrane and the release of purulent discharge. With proper and timely treatment, the symptoms of the disease are reduced.

The course of chronic otitis has a less pronounced pain syndrome, suppuration is prolonged and recurrent. The eardrum does not regenerate, which can cause temporary or permanent hearing loss.

External purulent otitis is quite rare and is treated much easier than internal damage to the organ of hearing. The most common cause is trauma to the organ.

Purulent otitis media occurs in two forms – mesotympanitis and epitympanitis. In the first case, the inflammatory process is localized within the mucous membrane of the auditory tube and the tympanic membrane, without affecting the ossicular structures. Epitympanitis is characterized by involvement of bone tissues in the inflammatory process. With a long course of the disease, inflammation can affect the entire organ of hearing and bone tissue.

In many ways, the tendency to inflammatory diseases of the organ of hearing often has a hereditary predisposition. Children are more susceptible to otitis due to the anatomical features of the development of the children’s organ of hearing.

If we consider purulent otitis media, then in most cases it is a complication of acute inflammation resulting from improper or poor-quality treatment.

Purulent otitis can also be caused by an infection in the ear. Among the main pathogenic agents are pneumococci, staphylococci, Proteus, Klebsiella, Pseudomonia, and in some cases fungi. Often, pathogens enter the ear with mucus from the nasopharynx, through the blood during an infectious disease (measles, rubella, influenza), or from the outside when the hearing organ is injured.

Various immunodeficiency conditions, endocrine disorders and improper antibiotic treatment often contribute to the development of the disease.

In the absence of adequate therapy, purulent otitis media can provoke various complications:

• tympanic membrane rupture;
• chronic hearing loss;
• reduction or complete loss of hearing;
• inflammation or paresis of the facial nerve;
• brain abscess, etc.

Diagnosis of purulent otitis media

In the diagnosis of purulent otitis media, it is important to determine the degree of damage to the organ of hearing and the presence of various complications in the course of the disease. To do this, endoscopy of the organ, a study of the auditory analyzer, CT or MRI of the skull, and a study of the level of hearing are performed.

At the first stage, it is important to determine the causative agent of the infection (bacteriological analysis of purulent exudate is carried out) and prescribe adequate antibiotic therapy. It is also recommended to take anesthetics to relieve pain. To remove the accumulated pus, the eardrum is punctured.

Treatment of suppurative otitis

It is recommended to wash the ear with antibiotic solutions and instill it. The course of treatment is supplemented by physiotherapy: UHF, laser therapy, UFO. If during the examination bone destruction, disorders of the vestibular apparatus, paresis of the facial nerve and other disorders are detected, then surgical treatment is performed. During the operation, pus and altered tissues are removed; in especially severe cases, reconstruction of damaged areas is necessary.

The prognosis for the treatment of the disease depends on the stage of the disease and the presence of complications. It is important to start therapy as early as possible, in this case, it will be possible to save hearing. When the first symptoms of purulent otitis appear, you need to make an appointment with an otolaryngologist at the Gaide medical centers for a fee. Specialists of the centers are engaged in the treatment of purulent otitis at any stage of the development of the pathological process. The clinics are equipped with the necessary equipment, and our specialists have extensive experience in the treatment of complex and severe inflammation of the hearing organ.

Otitis

Do people often have earaches?
Inflammation of the middle ear – acute otitis media (AOM) already in the first year of life is suffered by up to 62% of children!!! During the first five years of life in the US and Western Europe, more than 90% of children suffer at least once NCA, which means we need to know how to help ourselves and our children with the development of such a frequent and unpleasant disease.

What is the reason?
None of the doctors will tell you with certainty what the cause of otitis media is. It is believed that this is more often an infectious disease that can be caused by a virus, bacterium or fungus. It can also be a manifestation of an allergic reaction and occur for other reasons. Otitis is a frequent companion of acute respiratory infections, especially with a severe cold. Snot, flowing down the back wall of the pharynx, transfers the infection to the auditory tubes, and through them it enters the middle ear. This is how inflammation occurs.

Is your ear inflated?
It is widely believed that the ear can get sick if it is inflated! Can’t inflate into the ear. Otitis is not a contagious disease, and does not occur from wind and cold. It cannot be prevented by regularly wearing a hat or covering the ear. The middle ear is completely isolated from the external environment by the tympanic membrane, which does not allow air or bacteria to pass through. The infection enters the middle ear from the nasopharynx, since the middle ear is connected to the nasal cavity by a hollow cartilaginous tube – the Eustachian tube.

Miscellaneous otitis media: AOM or EOM?
Normally, the Eustachian tube opens when swallowing, and through it the mucus from the inner ear flows into the nasopharynx (have you heard how it clicks in the ears when swallowed? – the tube opens!). When there is inflammation in the nose, the mucous membrane of this tube swells and clogs the exit of mucus from the middle ear, the ear bursts with accumulated mucus and there are sharp pains, dizziness, vomiting, high (up to 40) temperature and even hearing loss. But this is not yet acute otitis media, it is called acute exudative otitis media (ESO), sometimes such otitis media is called tubootitis or eustacheitis. It lasts, on average, 48 hours. It can go away on its own, or it can be complicated by acute otitis media when infected with accumulated mucus.

Do we eat antibiotics?
Otitis media is one of the leading reasons for prescribing antibiotics, often unjustified. In France, more than 3 million, and in the United States about 30 million, antibiotic prescriptions for acute otitis media are written each year.

But is it necessary to take antibiotics if otitis occurs?
Not always. There are publications that antibiotics generally do not have any effect on recovery from otitis media. And why, you ask, to poison the body? But in a real situation, it is necessary to take into account the likelihood of developing complications of otitis media, and these complications are as follows: perforation (that is, a hole) of the eardrum, adhesion (gluing) of the auditory ossicles or their destruction, brain abscess, meningitis. That is why it is impossible to unambiguously refuse antibiotics for otitis media.

But you need to know that:
Antibiotics are indicated only for AOM, but should not be used for EOM (tubootitis), that is, in the first 48 hours after the onset of the disease, if a person has a viral disease, i. e. SARS, then antibiotics are even harmful, they will weaken the immune system and cause allergization.
The diagnosis of AOM requires confirmation of the presence of effusion in the middle ear, that is, if during examination by an ENT doctor, a hyperemic and protruding tympanic membrane is noticed, in combination with acute local manifestations (sharp pain) and general symptoms (dizziness, vomiting, temperature), then this is really acute otitis media and here you need to drink antibiotics (not from otitis media, but from probable complications!)

We treat ourselves
How can we help ourselves or our child with acute pain in the ear, when otitis has suddenly begun?
Firstly, it is necessary to provide the child with bed rest and rest, especially if he has a temperature. It is necessary to put the child with the sore ear up and drip there (if there was no perforation of the eardrum before!) A few drops of Otipax, give the child an anesthetic (panadol, efferalgan or nurofen in syrup for children, at a dose corresponding to the age and body weight of the child (according to instructions), drip a few drops of a diluted solution of “dolphin” or aqua-maris into the nose (previously fashionable vasoconstrictor drops give a temporary and not radical effect, and after they often have the effect of “recoil” – the nose is even more blocked, so it is better not to use these remedies without the urgent recommendations of a doctor!) and give the child to chew on the children’s orbit. Yes, yes, give chewing gum! Let him chew it 4-6 times a day during the entire time of otitis media. This will lead to the opening and cleansing of the auditory tubes, possibly and to a quick recovery. Chewing gum is so useful for a runny nose and otitis media that talk about an alternative to antibiotics is possible! xylitol (xylitol), a natural 5-alcohol found in chewing gum, inhibits the growth of Streptococcus mutans and S. pneumoniae bacteria in vitro. Chewing gum (5 times a day) with xylitol reduces the incidence of acute otitis media in children by 1/3!
And of course, the child must be shown to the ENT doctor. After all, it is he who, upon direct examination, can determine what kind of otitis media the patient has – exudative or already average ?! And better, sooner. If a doctor is not available, Otipax drops should be instilled every 15 minutes 3 times, and then every 2-3 hours, and then less often, 3 times a day. These measures often save you from otitis media in 1-2 days than a long wait when the doctor comes or you get to see him.
It is also useful to have a blue glass lamp at home (an ordinary 60-75 W blue light bulb) and screwing it into a table lamp instead of the usual one, heat the child’s sore ear 1-2 times a day from a distance of 15-20 cm for 5 minutes 7-8 days in a row.
If the measures in this booklet do not help within 48 hours after the onset of acute pain, the doctor must definitely see the child! He will probably still have to eat an antibiotic or perform some kind of medical manipulation.

How not to get otitis media?
In order not to get sick with otitis at all, one must not get sick with a runny nose! Neither the removal of enlarged adenoids (proven by research), nor antibiotic prophylaxis saves from otitis media. Most often, otitis occurs from improper blowing your nose!

How to blow your nose correctly?
How to blow your nose is not correct: they pressed the nose of the child with a handkerchief and said: “Blow!”. He will blow, but only the whole infection will fly into the ears through the Eustachian tube. How to blow your nose correctly: do not pinch your child’s nostrils! No need to press the wings of the nose! Let him blow his nose once or twice like this (and only hold a handkerchief next to your nose, don’t touch your nose at all, nothing that can get smeared a little, wipe it gently, use baby cream for irritation under your nose with a prolonged runny nose), and then you can blow your nose like this: one nostril was pressed, the child took in air with his mouth and blew his nose into a free nostril, then change the nostril. And if you pinch the nostril right away or even press the wings of the nose, as many parents like to do when the child blows his nose, then he will probably get otitis media.

Excursion to psychology
The human body, like a finely tuned musical instrument, sensitively reacts with every cell to changes in the psychological atmosphere around it. Especially children with all their nature experience stressful moments of life. And there is an opinion that in those families where the child hears what he does not want to hear (swearing and screams of parents, extremely emotional disputes of relatives, insults and insults, even as a “joke” inflicted on him or his mother, obscene expressions, abuse), children suffer from ear diseases more often and more severely.