Eustachian tube dysfunction

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Eustachian tube dysfunction
Video explanation
SpecialtyENT surgery
SymptomsFullness, popping, ear pain.[1]
ComplicationsOtitis media, cholesteatoma[1]
TypesDilatory, baro-challenged induced, patulous[1]
CausesUpper respiratory tract infection, allergic rhinitis, pressure changes, recent weight loss[1]
Diagnostic methodBased on symptoms and examination[1]
Differential diagnosisEndolymphatic hydrops, temporomandibular joint dysfunction, superior canal dehiscence syndrome, labyrinthine fistula[1]
TreatmentDepends on the cause[2]

Eustachian tube dysfunction (ETD) is defined as pressure abnormalities in the middle ear which result in symptoms.[3] Symptoms often include fullness, popping, or pain in the ear.[1] Other symptoms may include ringing or muffled hearing.[1]

Causes may include an upper respiratory tract infection, allergic rhinitis, pressure changes, or recent weight loss.[1] Diagnosis is based on symptoms and examination.[1] It is divided into three types: dilatory, were the tube dose not open; baro-challenged induced, which occurs with pressure changes; and patulous, were the tube dose not close properly.[1] It is also divided into acute and chronic depending on if it last less or more than 3 months.[1]

Treatment depends on the probable cause.[2] This may involved addressing GERD, avoiding allergens, removing enlarged tonsils, or dilating the tube.[2] It affects about 1% of adults.[2] Under 20, males are more likely to be affected, while in older ages, females are more likely to be affected.[2]

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]


Eustachian tube dysfunction can be caused by a number of factors. Some common causes include the flu, allergies, a cold, and sinus infections.[4]


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]


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


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 by mouth or topical decongestants, by mouth steroids, by mouth antihistamines, and topical nasal steroid sprays, such as Flonase.[5]

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.[6]

Tentative evidence supports the use of balloon dilation of the Eustachian tube.[7] No high quality studies, however, have been done as of 2018.[7]


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 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. 2.0 2.1 2.2 2.3 2.4 2.5 Hamrang-Yousefi, S; Ng, J; Andaloro, C (January 2020). "Eustachian Tube Dysfunction". PMID 32310368. {{cite journal}}: Cite journal requires |journal= (help)
  3. 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.
  4. "Eustachian Tube Dysfunction". Family Doctor. American Academy of Family Physicians. Archived from the original on 27 July 2019. Retrieved 18 August 2019.
  5. "Eustachian Tube Dysfunction". McGovern Medical School - Otolaryngology - Head and Neck Surgery. The University of Texas Health Science Center at Houston (UTHealth). Archived from the original on 23 August 2019. Retrieved 23 August 2019.
  6. "Treatments for Eustachian Tube Dysfunction". Stanford Health Care. Stanford Health Care. Archived from the original on 19 August 2019. Retrieved 19 August 2019.
  7. 7.0 7.1 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.

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