OVERVIEW: Eustachian Tube Dysfunction (ETD) is a common problem that results in pressure and popping of the ears. It is due to chronic or acute blockage of the Eustachian Tube which is a narrow passage that connects the inner ear to the nose. The eustachian tube is 36mm in length and is composed of bone (1/3 length) and cartilage (2/3 length). When open and clear the ears feel normal. When the Eustachian Tube is blocked the symptoms can vary from mild to severe. Patient’s often note symptoms when flying, diving or when having increased nasal congestion from a cold or allergies. Others can feel the symptoms all the time.
SYMPTOMS: ETD causes a variety of symptoms. Ear fullness and pressure with trouble clearing the ears is the most common symptom. Clicking and popping can also occur. Ringing in the ears, distorted hearing, ear pain and a brief feeling of dizziness can also be noted in people with ETD. Patients can also be more prone to middle ear fluid and infections with ETD. Symptoms can be acute and short lived or can present as a chronic problem.
CAUSES: People can be born with Eustachian Tubes that are narrow or do not function well – this is usually seen in children that get recurrent ear infections. In adults any process that increases inflammation of the Eustachian Tube can cause symptoms – this includes allergies, colds, sinus infections and very commonly acid reflux. Large amounts of weight gain can also result in fatty deposits around the Eustachian Tube opening. Nasal polyps, adenoid tissue and benign or cancerous growths can also impact the Eustachian Tube and need to be identified. Situations where there is increased pressure on the ear drum (flying, hiking at high altitude, diving) can exacerbate ETD symptoms.
DIAGNOSIS: ETD is diagnosed by a thorough history and physical exam. Nasal Endoscopy can be done in the office to directly visualize the Eustachian Tube in the back of the nose and identify potential causes of the problem. Audiograms (Hearing Test) are also helpful in identifying any hearing problems and the pressure on the ear drum. CT scans of the inner ear also provide detailed diagnostic insight into causes of Eustachian Tube Dysfunction and possible treatment plans.
TREATMENT: Patients with acute and short duration of symptoms can be managed medically by treating infections, allergies or acid reflux. Often a short course of oral steroids with nasal sprays can help clear the Eustachian Tube. Another option is to place a small tube in the ear drum to decrease the ear pressure. This may not work as well as treating the actual Eustachian Tube and can result in a perforation or scarring of the ear drum. In patients with more severe or chronic symptoms, a revolutionary new minimally invasive procedure can be done where the Eustachian Tube is dilated with a soft balloon catheter (much in the same way that blocked arteries are cleared). This procedure is called Eustachian Tube Balloon Dilation and it can be done in the office or operating room. Starting in 2021 this procedure is covered by insurances.