Eustachian tube dysfunction

Eustachian tube dysfunction (ETD) is defined as pressure abnormalities in the middle ear which result in symptoms.[2]

Eustachian tube dysfunction
Specialty	ENT surgery
Symptoms	Aural fullness, ears popping, pressure, a feeling the ears are clogged, crackling, ear pain, tinnitus, autophony, muffled hearing[1]
Complications	Otitis media, cholesteatoma[1]
Types	Dilatory, baro-challenged induced, patulous[1]
Causes	Common cold, influenza, allergic rhinitis, sinusitis[1]
Differential diagnosis	Endolymphatic hydrops, temporomandibular joint dysfunction, superior canal dehiscence syndrome, labyrinthine fistula[1]

Signs and symptoms

Symptoms include aural fullness, ears popping, a feeling of pressure in the affected ear(s), a feeling that the affected ear(s) is clogged, crackling, ear pain, tinnitus, autophony, and muffled hearing.[1]

Diagnosis

While Eustachian tube dysfunction can be hard to diagnose, due to the Eustachian tubes and the nasopharynx not being easily visible, usually a tympanometry is indicated, along with findings on an otoscopy. For cases of baro-challenge induced Eustachian tube dysfunction, diagnosis usually relies on the history of the patient and their reported symptoms, as otoscopy and tympanometry is sometimes normal at normal ambient pressure.[1]

Types

Three subtypes have been described:[1]

1. Dilatory Eustachian tube dysfunction: Functional, dynamic (muscle failure), or anatomical obstruction of the Eustachian tube
2. Baro-challenge induced Eustachian tube dysfunction: Eustachian tube dysfunction which generally features a normal otoscopy and normal tympanometry
3. Patulous Eustachian tube dysfunction

Causes

Eustachian tube dysfunction can be caused by a number of factors. Some common causes include the flu, allergies, a cold, and sinus infections.[3]

Treatment

First-line treatment options are generally aimed at treating the underlying cause and include attempting to "pop" the ears, usually via the Valsalva maneuver, the use of oral or topical decongestants, oral steroids, oral antihistamines, and topical nasal steroid sprays, such as Flonase.[4]

If medical management fails, myringotomy, which is a surgical procedure in which an incision is made in the eardrum to drain pus from the middle ear or to relieve pressure caused by a large buildup of fluid, is indicated, and usually accompanied by the insertion of a tympanostomy tube.[5]

Tentative evidence supports the use of balloon dilation of the Eustachian tube.[6] No high quality studies, however, have been done as of 2018.[6]

References

1. Schilder, AG; Bhutta, MF; Butler, CC; Holy, C; Levine, LH; Kvaerner, KJ; Norman, G; Pennings, RJ; Poe, D; Silvola, JT; Sudhoff, H; Lund, VJ (October 2015). "Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis". Clinical Otolaryngology. 40 (5): 407–11. doi:10.1111/coa.12475. PMC 4600223. PMID 26347263.
2. Tysome, JR; Sudhoff, H (2018). "The Role of the Eustachian Tube in Middle Ear Disease". Advances in Oto-rhino-laryngology. 81: 146–152. doi:10.1159/000485581. ISBN 978-3-318-06314-1. PMID 29794454.
3. "Eustachian Tube Dysfunction". Family Doctor. American Academy of Family Physicians. Retrieved 18 August 2019.
4. "Eustachian Tube Dysfunction". McGovern Medical School - Otolaryngology - Head and Neck Surgery. The University of Texas Health Science Center at Houston (UTHealth). Retrieved 23 August 2019.
5. "Treatments for Eustachian Tube Dysfunction". Stanford Health Care. Stanford Health Care. Retrieved 19 August 2019.
6. Huisman, JML; Verdam, FJ; Stegeman, I; de Ru, JA (January 2018). "Treatment of Eustachian tube dysfunction with balloon dilation: A systematic review". The Laryngoscope. 128 (1): 237–247. doi:10.1002/lary.26800. PMID 28799657.