What is Eustachian Tube Dysfunction?
The Eustachian tube, sometimes referred to as your auditory tube, is crucial for maintaining the balance in your middle ear. This tube starts at the middle ear and goes down and forward to open behind a bone in the nose called the inferior turbinate. The Eustachian tube opens in response to positive pressure, like when you yawn, sneeze, or swallow.
The Eustachian tube has three main jobs:
1. It helps balance the pressure of the middle ear with the pressure in your nose (which is usually close to the pressure of the air around us). This balance of pressure makes it easier for your eardrum (also known as the tympanic membrane) to vibrate, which is needed for you to hear properly.
2. It has a cleaning function too. Certain cells lining the tube sweep away any waste products or secretions from the middle ear, moving them towards the nose so they can be eliminated.
3. It also protects the middle ear from loud noises and any potentially harmful substances or germs that may come from your nose.
If the Eustachian tube isn’t working correctly in one or more of these aspects, it’s known as Eustachian tube dysfunction (ETD). ETD can be acute (coming on quickly and lasting less than three months) or chronic (lasting more than three months). About 1% of people have ETD, which can cause symptoms like a feeling of fullness or “popping sounds” in the ears, reduced hearing, ringing in the ears (tinnitus), hearing your own voice too loudly (autophony), ear pain, and balance problems. ETD can be caused by changes in pressure (baro-challenge induced), an overly open tube (patulous), or a tube that doesn’t open properly (dilatory ETD).
What Causes Eustachian Tube Dysfunction?
When someone experiences Baro-challenge-induced Eustachian tube dysfunction, it means that the Eustachian tube (a small passageway that connects your throat to your middle ear) doesn’t open correctly when there are changes in the pressure around them. This can be a problem for people who experience drastic changes in pressure, like deep-sea divers or people descending from high altitudes. These pressure changes cause the Eustachian tube to become inflamed and swollen, which can make it harder for it to open and regulate pressure.
People might not notice any symptoms unless they’re in a situation where the pressure changes a lot, as normal ear examinations would not show anything unusual. However, there are treatments available which help to reduce swelling in the Eustachian tube to help it open properly, like oral or nasal decongestants.
On the other hand, Patulous Eustachian Tube Dysfunction is when the Eustachian tube remains open when it should be closed. This can lead to a person hearing their voice echo in their ear, a symptom known as “autophony.” Usually, individuals might try to relieve this by sniffing frequently.
In some cases, the Eustachian tube can become inflamed and swollen due to illnesses like a head cold, a throat infection, or acid reflux disease. These conditions can block the opening of the Eustachian tube, stopping it from working properly. In rare cases, it could be serious conditions like nasopharyngeal carcinoma (a type of head and neck cancer), which needs to be ruled out. However, most often, it could be due to non-malignant causes like enlarged adenoids (extra growth of the tissue at the back of the nasal cavity) or complications after adenoid removal surgery. Often people describe a feeling of fullness or pressure in their ear due to Eustachian tube dysfunction.
Risk Factors and Frequency for Eustachian Tube Dysfunction
Eustachian tube dysfunction, or ETD, is more common in children than adults. For instance, every 1 visit to a child’s clinic for ETD is met with about 0.77 visits to an adult clinic for the same issue. Indeed, a considerable 90% of children experience otitis media with effusion (a complication of ETD) before even starting school. On the other hand, only about 1% of the adult population gets diagnosed with ETD. More males are likely to be diagnosed with ETD before they turn 20, whereas females are more prone to this condition at older ages. It’s important to note that the prevalence of ETD is not influenced by different seasons.
Signs and Symptoms of Eustachian Tube Dysfunction
Understanding a person’s history is essential in diagnosing Eustachian tube dysfunction (ETD). We usually look at any factors that might lead to inflammation or swelling of the internal lining of the Eustachian tube. These factors could include acid reflux, allergies, a recent upper respiratory infection, or conditions such as Samter’s triad or rhinosinusitis. People who have undergone adenoidectomy, or have family history of ETD or conditions like Kartagener syndrome or cystic fibrosis are at risk. Specifically, people with Down syndrome and cleft palate disorders can often experience ETD.
It’s also important to consider environmental factors. For example, were they exposed to secondhand smoke or environmental allergens? How about participating in activities like diving or hiking at high altitudes? We also need to know if the person has been using nose sprays, such as oxymetazoline or corticosteroids.
Physically examining the head and neck is a part of the process. Using an instrument called an otoscope allows us to check the eardrum for signs of retraction or negative pressure in the middle ear. On rare occasions, we might find a condition called hemotympanum in individuals who have ETD due to sudden pressure changes.
An examination also involves checking the back of the throat and nose. With a procedure called flexible nasoendoscopy (FNE), we can directly examine the lining of the nasal cavity for any signs of swelling or inflammation, and the voice box for any signs of acid reflux disease. FNE also allows us to view the area behind the nose and the opening of the Eustachian tube on the opposite side. The valve of the Eustachian tube is typically S-shaped when closed and becomes round when it’s open. This should happen when the person swallows.
Testing for Eustachian Tube Dysfunction
Insufflation of the tympanic membrane is a procedure done to determine if there is any active negative pressure in your ear, indicative of a potential problem. A type C Tympanogram is a specific test that can suggest if there’s abnormal pressure within the middle ear, which may cause hearing issues or discomfort.
Audiological tests – tests to measure your hearing abilities – are also necessary. These include a pure tone audiometry test (a simple hearing test) and Rinne’s and Weber’s tuning fork tests. Both are standard tests using tuning forks to check for different types of hearing loss.
The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) is a tool your doctor can use to understand better how severe your Eustachian Tube Dysfunction (ETD) symptoms are. This questionnaire has 7 questions, each scored between 1 (no problem) and 7 (severe problem). If the average score from all the questions is more than 2.0, it usually indicates that you might have Eustachian Tube Dysfunction.
Treatment Options for Eustachian Tube Dysfunction
If you have Eustachian tube dysfunction, which is when your ear tube doesn’t open or close correctly, your treatment will depend on what’s causing the issue:
1. If the dysfunction is due to acid reflux, you might need to make lifestyle changes such as losing weight and altering your diet to reduce acid production. Medication that reduces acid, called proton pump inhibitors, might also be considered.
2. If the issue is related to allergies, try making changes to avoid any potential allergens. Medicines like antihistamines and nasal corticosteroid medication can also help manage allergies.
3. If the condition is caused by a sinus infection or an inflammation of your sinuses, treatment for this should be started. If the cause is a granulomatous disease, which is a type of inflammation caused by certain immune disorders like sarcoidosis or granulomatosis with polyangiitis (also known as Wegener disease), you will need medicines that suppress your immune system.
4. There could be a need for a surgical procedure to widen your Eustachian tube if it’s too narrow. This is performed using a special type of balloon catheter. Studies have shown this treatment can improve symptoms after 12 months. If the dysfunction is due to a middle ear infection with fluid build-up, it’s commonly managed with the insertion of a tiny tube in the eardrum to help the fluid drain.
5. If the problem is due to enlarged adenoids, which are small lumps of tissue at the back of your nose, you may need an operation to remove them (adenoidectomy). This is more common in children who may have fluid in the middle ear. Using a device that inflates by itself to increase pressure in your nose and open the Eustachian tube has shown a positive outcome in correcting the pressure in your middle ear and helping fluid to clear.
What else can Eustachian Tube Dysfunction be?
Autophony, or the heightened hearing of one’s own voice, isn’t only seen in cases of patulous Eustachian tube dysfunction, which is a condition where the Eustachian tube remains abnormally open. This symptom can also occur in other conditions, such as:
- Superior canal dehiscence, a rare condition where there is a small hole in the bone that covers one of the inner ear balance canals.
- The presence of a foreign body in the external ear canal.
Another condition, temporomandibular joint dysfunction, commonly results in a ‘popping’ sound and could potentially cause reduced hearing. This condition is typically also associated with discomfort when moving the jaw.
What to expect with Eustachian Tube Dysfunction
The outcome often depends on the root cause of the condition and how well one follows the treatment plan. In general, though, for kids, Eustachian tube dysfunction gets better as they grow older. This improvement happens because the Eustachian tube and its surrounding muscles, which help with air flow, naturally mature as a child grows. This typically happens around the age of seven.
Possible Complications When Diagnosed with Eustachian Tube Dysfunction
If Eustachian tube dysfunction is left untreated, it can lead to several complications. These include:
- Conductive hearing loss: This is a type of hearing loss where sound cannot adequately travel through the outer and middle ear to the inner ear.
- Chronic otitis media: A long-term infection or inflammation of the middle ear.
- Otitis media with effusion, also known as glue ear: This is a condition where sticky fluid builds up in the middle ear, often leading to hearing problems.
- Eardrum retraction: This is when the eardrum is pulled inward due to negative pressure in the middle ear, which could cause hearing loss.
Preventing Eustachian Tube Dysfunction
Patients should be educated about the importance of adopting healthy lifestyle changes, like quitting smoking and making dietary adjustments. These changes can help lower the chances of experiencing inflammation and illness again in the future. They should also be encouraged to identify and seek medical help for situations that require a doctor’s attention and possible treatment.
