Eustachian Tube Dysfunction: Symptoms, Causes and Treatment

Eustachian Tube Dysfunction or ETD is a condition in which the tubes between your middle ear and upper throat get obstructed. Young children aged 1 to 6 years are particularly at risk of developing eustachian tube dysfunction, as their eustachian tubes are smaller and are aligned more horizontally than vertically, which increases the chances of blockage due to mucus and germs. Children’s immune system is less developed and thus more prone to infections. 

However, ETD is reasonably harmless in most patients, but the condition may be present differently depending on the cause of ETD. The most common types of ETD are as follows:

1. Patulous Eustachian Tube Dysfunction: Patulous ETD is a condition in which the eustachian tube remains open due to impairment in the valves of the eustachian tube. This can lead to the sound travelling from the nasal cavity to the ears allowing the person to hear his or her voice, breath, and even blood pumping too loudly. 
2. Obstructive Eustachian Tube Dysfunction: In this condition, the valves of the eustachian tubes don’t open as they should. This leads to pressure imbalance or pain due to fluid accumulation in the ear.
3. Baro - Challenge - Induced Eustachian Tube Dysfunction: This condition is similar to obstructive ETD. But the symptoms of this condition are experienced only with altitude changes. It can happen during scuba diving, aeroplane flights or driving in the mountains.

People with ETD may experience several signs and symptoms. Common ETD symptoms include: 

1. Difficulty in hearing
2. Tinnitus or ringing in the ears
3. A feeling that the ears are plugged
4. Clicking or popping sounds
5. Chronic pain as experienced during an ear infection
6. Ticklish sensation in the ears
7. Dizziness, vertigo, or balance problems

Depending upon the cause of the ETD, these symptoms can last for long. ETD caused due to ear infection lasts for a longer time whereas, patients with ETD caused due to altitude changes can expect relief when the ear pressure adjusts to the atmospheric pressure, i.e., when the patient reaches a lower altitude. 

The cause of ETD is not always identified, but it is believed to be caused by the following factors:

1. Flu, common cold, or other seasonal allergies.
2. Sinus infection.
3. Gastroesophageal reflux disease or acid reflux: the stomach acid can back up in the throat, damaging the oesophagus's tissue lining and causing pain and inflammation in the eustachian tube. 
4. Chronic neuromuscular or immunological disease.
5. Stress and anxiety.

Altitude changes can also lead to ETD. A person can experience the effects of altitude change when he or she is:

1. Hiking
2. Holidaying at a hill station
3. Travelling by air (by aeroplane)
4. Riding an elevator

Anyone can experience ETD, but some people are at a higher risk of acquiring the symptoms. 

1. Obesity: it increases the risk of ETD as the fatty deposits may accumulate around the eustachian tubes, causing a fluid buildup in the ears. 
2. Smokers: are more prone to ETD as smoking can damage the delicate hair in the throat and the middle ear. These hairs, known as cilia, help clear the wax buildup to keep the ear canal open. When the cilia are damaged, the chances of mucus getting stuck increase significantly. 
3. Allergies: People with allergies are more vulnerable to ETD as allergies can lead to increased mucus and congestion.

Some of the medical factors responsible for ETD may include, 

1. Cleft Palate: It is a condition when the structures that make up the upper lip or palate fail to join when a baby is developing in the womb. So, it commonly affects children from birth and in a majority of cases, a cleft palate leads to ETD. 
2. Trisomy 21: A type of Down Syndrome (a genetic disorder when a person has an extra chromosome) that leads to forming a small and abnormally shaped eustachian tube.
3. Generalized Hypotonia: It is also known as poor muscle tone and is identified at the time of birth. It can decrease the muscle function in the soft palate in the mouth and can lead to eustachian tube collapse. 

By taking certain precautions, the risk of ETD can be reduced. Following measures can be done to prevent ETD:

1. Wear safety earplugs before a flight to reduce the risk of discomfort caused due to rapid altitude changes. 
2. Avoid extreme temperatures that may worsen the ETD symptoms.
3. Drink enough water to keep the layer of mucus thin. 
4. Maintain good hygiene for protection against cold and seasonal influenza.

The primary care doctor will be able to diagnose ETD by physical examination. He or she may ask the patient about the symptoms such as hearing changes, pain, etc. The doctor then will examine the inner ear to check the ear canal and passages into the nose and throat. 

The doctor may also check the response of the eardrums when the patient takes a deep breath or swallows. Sometimes, the pressure inside the ear is also measured using specialized tools.

How to prepare for the doctor's consultation?

1. List down symptoms including any that may seem unrelated to the condition.
2. List down the relevant events that may be related to the condition.
3. The patient must tell the doctor the list of medications and supplements that he takes.
4. The following questions should be asked the doctor:
   1. What treatment is best suitable for me?
   2. How can I stay comfortable in this condition?
   3. Do you think I have any other conditions?
   4. Do I need to see a specialist for my condition?
   5. Why is surgery needed?

ETD usually resolves on its own, so treatment is often not necessary. But if the patient’s symptoms last for more than two weeks, treatment may be necessary. Treatment may include home remedies, medication, and surgery for severe cases. The cause and severity of the symptoms decide the type of treatment required.

ETD treatment without surgery

1. Home Remedies: Following are some simple home remedies that can help reduce the symptoms of ETD.
   1. Chewing gum
   2. Yawning 
   3. Swallowing
   4. Breathing out forcefully with nostrils and mouth closed
   5. Using a saline nasal spray or irrigation system to clear out nasal passages
   6. If a small baby has ETD symptoms, a pacifier or bottle can help get relief, as the sucking motion may clear up the blockage.
2. Medications: Some over-the-counter medications can help in getting relief from the symptoms. For example, 
   1. Prescribed oral antibiotics
   2. Anti-allergics (Antihistamines)
   3. Pain relievers
   4. Corticosteroids to reduce inflammation
3. Self-Inflation of the Ears: When the air gets blocked in the eustachian tubes causing pain and discomfort, it can be forcibly blown out of the ear by pinching the nose and popping the ears. The best way to pop the ears is to, 
   1. Take a breath.
   2. Close the mouth and nostrils with the help of fingers.
   3. Gently blow out against the pressure. This opens the eustachian tubes a little, releasing the fluid and pressure stuck in the ears. 
4. Blowing a Balloon to Pop the Ears: Blowing up a balloon helps push the air up to the eustachian tube. Some balloons are specially used to get relief from ETD symptoms.
   1. The patient has to blow up the balloon using his or her nose while keeping one nostril closed at a time.
   2. The patient must note that this method should not be used if he or she has a cold or a runny nose, as the infected mucus can enter the middle ear and cause an ear infection.

ETD treatment with surgery

If ETD gets severe, the patient may require surgery. The surgery is typically performed to bypass the eustachian tubes and resolve the ventilation problems in the middle ear. This helps in restoring normal hearing ability in the patient. The different surgical procedures may include:

1. Myringotomy: In this procedure, a tiny incision is made to drain the fluid stored in the middle ear. In the case of adults, the incision is left open for a long time until the inflammation in the eustachian tubes resolves. 
2. Tympanostomy: in this procedure, the surgeon may sometime place a tiny, hollow tube made of metal or plastic into the eardrums after making an incision. This tube can provide proper middle ear ventilation for six to twelve months. The tubes generally get pushed out automatically on their own over time as the eardrum heals. However, the patient may require a repeat placement if the tubes get out of place sooner than they should remain in position. 
3. Eustachian Tuboplasty: This is a new procedure, also known as eustachian tube balloon dilation. In this procedure, a surgeon uses endoscopic instruments to expand the eustachian tubes with the help of balloons. Using the instrument, the surgeon threads a balloon to the patient’s nasal passages into the eustachian tubes. The balloon is inflated for two minutes and then deflated and removed. 

ETD usually recovers over time, but in severe cases, if ETD is not treated in time, it can cause worsening symptoms that would be troublesome and will interfere with daily activities. Some of the risks and complications of ETD include:

1. Chronic otitis media (middle ear infection).
2. Otitis media with effusion (glue ear): This refers to fluid buildup in the middle ear. It may last for a few weeks, but more severe cases can cause permanent hearing damage.
3. Eardrum retraction: in this, the eardrum is seemingly sucked back further into the canal.

When to see a doctor?

The patient can consult the doctor if he/she experiences:

1. Difficulty in hearing
2. Ringing in the ears
3. A feeling that the ears are plugged
4. Clicking or popping sounds
5. Chronic pain 

There are several ways to help relieve ETD, including hovering over a pot of hot water. Sometimes, food is also the best medicine for quick relief. Following are some food items that can help relieve congestion caused by ETD.

1. Antioxidant-rich foods: food items such as citrus, kiwi, spinach, berries and other vegetables protect the mucous membranes in the eustachian tube. Such food items are loaded with vitamins and minerals.
2. Pineapple: pineapples are a great decongestant because it contains the enzymes called bromelain as they break down the junk that builds up in the eustachian tube and helps reduce inflammation and swelling.
3. Garlic: it helps reduce inflammation and pain.
4. Ginger and Turmeric: these spices have anti-inflammatory properties that help open up eustachian tubes. The best way to have ginger and turmeric is by adding them to hot lemon water or by creating a refreshing tea from them.