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by EBSCO Medical Review Board

Eustachian Tube Dysfunction

(ETD; Barotitis Media; Ear Popping; Pressure-related Ear Pain)

Definition

Eustachian tube dysfunction (ETD) is when the tube does not open when swallowing or yawning. This tube connects the middle ear to the back of the nose and upper throat. Its purpose is to equalize air pressure in the middle ear with the pressure outside it. This does not happen with ETD.
Eustachian Tube
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Causes

ETD happens when the eustachian tube is blocked or not working as it should. Causes may be:
  • Inability of the tiny hairs inside the ear to remove fluid and infection
  • Poor squeezing function within the eustachian tube
  • A narrow tube—in infants
  • Adenoid tissue blocking the tube—in children
  • Swollen nasal passages that cause a blockage
  • Tumors—in adults

Risk Factors

This problem is more common in children. Other things that may raise the risk are:
  • Nasal congestion from an allergy
  • A cold or other upper respiratory infection
  • Ear or sinus infections
  • Environmental allergies
  • Children with large adenoids
  • Activities with large, rapid altitude changes, such as flying in an airplane or scuba diving
  • Tumors in the nose or throat

Symptoms

Problems may be:
  • A feeling of fullness or clogging in the ear
  • Discomfort or pain in the ear
  • Hearing loss
  • Ringing in the ear
  • A feeling of spinning when standing still
  • Problems that are not eased by swallowing, yawning, or chewing

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. It will focus on the ears. Hearing tests may be done.
You may need to see a doctor who treats the ears, nose, and throat.

Treatment

Most people get better without treatment. Things like swallowing, yawning, or chewing may help ease pressure.
People who do not improve or have severe symptoms may need treatment. The goal is to ease pressure. Medicines may be given, such as:
  • Pain relievers, such as acetaminophen or ibuprofen
  • Oral antihistamines to ease allergies
  • Decongestants
  • Nasal steroids to ease congestion and swelling
Rarely, people who are not helped by these methods may need a myringotomy. An incision is made in the eardrum to allow the pressure to equalize and fluid to drain.

Prevention

Managing things like allergies and colds may lower the risk.
The risk may be lowered when traveling by plane by:
  • Swallowing often, such as by sucking on hard candy, chewing gum, or drinking water
  • Breathing in and breathing out while holding the nostrils and keeping the mouth closed on ascent and descent
  • Wearing earplugs that equalize pressure in the ears

RESOURCES

American Hearing Research Foundation
http://www.american-hearing.org
Family Doctor—American Academy of Family Physicians
https://familydoctor.org

CANADIAN RESOURCES

Canadian Hearing Society
http://www.chs.ca
Canadian Society of Otolaryngology—Head and Neck Surgery
http://www.entcanada.org

References

Eustachian tube dysfunction. Patient website. Available at: https://patient.info/ears-nose-throat-mouth/earache-ear-pain/eustachian-tube-dysfunction. Accessed February 10, 2021.
Nasopharyngeal cancer treatment (Adult). National Cancer Institute website. Available at: https://www.cancer.gov/types/head-and-neck/patient/adult/nasopharyngeal-treatment-pdq. Accessed February 10, 2021.
Otitis media with effusion (OME). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/otitis-media-with-effusion-ome. Accessed February 10, 2021.
Schilder AG, Chonmaitree T, et al. Otitis media. Nat Rev Dis Primers. 2016 Sep 8;2:16063.

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