Eustachian Tube Dysfunction

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

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.

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.

Types

Three subtypes have been described:

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.

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.

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.

Tentative evidence supports the use of balloon dilation of the Eustachian tube. No high quality studies, however, have been done as of 2018. More recently, Dennis Poe and co-workers published prospective, multicenter, randomized, controlled trial. Dilatation of the eustachian tube using balloon catheter has gained attention as a method of treating eustachian tube obstruction. There are two methods of performing this procedure depending on the route of the catheter introduction and the area of the Eustachian tube to be dilated. Dennis Poe have popularized the transnasal introduction and the dilatation of the distal (nose side) eustachian tube. Muaaz Tarabichi pioneered the transtympanic (trans-ear) introduction of the balloon catheter and the dilatation of the proximal part (the ear side) of the cartilaginous eustachian tube.