Eustachian tube dysfunction
|Eustachian tube dysfunction|
|Symptoms||Fullness, popping, ear pain.|
|Complications||Otitis media, cholesteatoma|
|Types||Dilatory, baro-challenged induced, patulous|
|Causes||Upper respiratory tract infection, allergic rhinitis, pressure changes, recent weight loss|
|Diagnostic method||Based on symptoms and examination|
|Differential diagnosis||Endolymphatic hydrops, temporomandibular joint dysfunction, superior canal dehiscence syndrome, labyrinthine fistula|
|Treatment||Depends on the cause|
Eustachian tube dysfunction (ETD) is defined as pressure abnormalities in the middle ear which result in symptoms. Symptoms often include fullness, popping, or pain in the ear. Other symptoms may include ringing or muffled hearing.
Causes may include an upper respiratory tract infection, allergic rhinitis, pressure changes, or recent weight loss. Diagnosis is based on symptoms and examination. 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. It is also divided into acute and chronic depending on if it last less or more than 3 months.
Treatment depends on the probable cause. This may involved addressing GERD, avoiding allergens, removing enlarged tonsils, or dilating the tube. It affects about 1% of adults. Under 20, males are more likely to be affected, while in older ages, females are more likely to be affected.
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.
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.
Three subtypes have been described:
- Dilatory Eustachian tube dysfunction: Functional, dynamic (muscle failure), or anatomical obstruction of the Eustachian tube
- Baro-challenge induced Eustachian tube dysfunction: Eustachian tube dysfunction which generally features a normal otoscopy and normal tympanometry
- 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 oral or topical decongestants, oral steroids, oral antihistamines, and topical nasal steroid sprays, such as Flonase.
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.
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