Eustachian Tube Problems

The main function of the Eustachian tube is to ventilate the middle ear space.

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.

How long are Eustachian tubes?

In adults, the Eustachian tube is approximately 35 mm long (1.3 inches) and approximately 3 mm in diameter (less than 1/10 inch).

Who discovered Eustachian tubes?

The Eustachian tube was named in honor of the 16th-century Italian anatomist Eustachius. Sources credit Alcmaeon of Sparta as the first to describe the structure in approximately 400 BC.

Picture of the Structures of the Inner Ear and Eustachian Tubes

The primary function of the Eustachian tube is to ventilate the middle ear space, ensuring that its pressure remains 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 the failure of the Eustachian tube to effectively regulate air pressure.

Partial or complete blockage of the Eustachian tube can cause sensations of popping, clicking, 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.

Eustachian tube problems and the associated ear infections are among the most common problems seen by healthcare professionals. Many people have chronic problems regulating middle ear pressure.

The Eustachian tube can be blocked, or obstructed, for a variety of reasons, for example:

• 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 of Eustachian tube dysfunction range from allergies to excessively small Eustachian tubes (as may afflict children with Down Syndrome).

People with some Eustachian tube dysfunction may experience signs and symptoms, for example:

• Intermittent ear fullness
• Ear-popping or cracking
• Pain
• Mild hearing loss (an attenuation of sound)
• Ringing in the ears (tinnitus)
• Occasionally poor balance

Many people with Eustachian tube blockage or dysfunction who travel use a decongestant pill or nasal spray an hour before takeoff, and if necessary, before descent. The decongestant acts to shrink the membranes lining the nose and throat, allowing the ears to equalize more easily.

Similarly, people experiencing chronic daily problems with Eustachian tube dysfunction can benefit from aggressive control of allergies (with antihistamines, decongestants, and prescription nasal sprays).

Acid reflux control may help some people if their reflux is irritating the lining in the back of the nose and the Eustachian tube opening.

An evaluation with an allergy specialist or allergist may help diagnose the cause of the Eustachian tube dysfunction or blockage.

Several maneuvers may be done to improve the Eustachian tube function and thus aid in the equalization of air pressure.

• The simple act of swallowing activates the muscles in the back of the throat that help open the Eustachian tube. Any activity that promotes swallowing can help open the Eustachian tube, for example, chewing gum, drinking, or eating.
• Yawning is even more effective because it is a stronger muscle activator.
• If the ears still feel full, the person can try to forcibly open the Eustachian tube by taking a deep breath and blowing while pinching your nostrils and closing your mouth. When a "pop" is felt, you know you have succeeded. If problems persist despite trying to forcibly open the tubes you may need to seek medical attention. If you feel dizzy performing this maneuver, then stop and discuss this with your doctor.
• If you have a cold, sinus infection, ear infection, or suffering from allergies, it may be advisable to postpone air travel.
• Similarly, individuals with Eustachian tube problems may find such sports as scuba diving painful, and in some situations quite dangerous.
• Babies traveling on airplanes cannot intentionally pop their ears but may do so if they are sucking on a bottle or pacifier. Crying, similar in function to yawning, will also enable equalization of air pressure.

In severe situations, a "pressure equalization tube" (PET) can be surgically placed in the eardrum, replacing the role of a functioning Eustachian tube, and thus guaranteeing equalization of middle ear pressure. This procedure is most commonly seen in young children who experience recurrent ear infections as a consequence of a poorly functioning Eustachian tube.

A rapid change in altitude, and thus air pressure is equalized across the eardrum by a normally functioning Eustachian tube. A healthy tube opens frequently and widely enough to equalize these changes in air pressure. With altitude changes during the descent of an airplane, air pressure increases as the plane lowers. The air pressure change pushes the eardrum inward (retraction). People with Eustachian tube blockage can develop fullness of the ear, dulled hearing, and possibly pain when this occurs.

Those with poorly functioning Eustachian tubes may experience similar symptoms when riding in elevators, driving through the mountains, or diving to the bottom of a swimming pool. Scuba divers learn tricks to equalize their ear pressures.