What is the Eustachian tube?

The Eustachian tube is a tube that drains the ear and empties in the back of the nose and throat (See Figure).

The Eustachian tube works to keep the air pressure of the middle ear the same as air pressure outside. Eustachian Tube Dysfunction (ETD) occurs when the Eustachian tube cannot work well. Common symptoms of ETD include:

• Crackling noises
• Mild hearing loss or “plugged ear” that may change daily
• Ear fullness, pressure, or pain

ETD is usually annoying and does not result in outright ear damage. However, during air travel or scuba diving, “ear barotrauma” can occur. This is the medical term for damage that occurs when the Eustachian tube cannot regulate pressure properly. Baro = pressure and trauma = damage. Barotrauma can result in perforated eardrums. Perforated eardrums for this reason often heal on their own over 90% of the time. Very rarely does barotrauma result in inner ear damage.  

What causes eustachian tube problems?

• Sudden pressure changes from air travel or scuba diving
• Allergies
• Sinus congestion
• Colds and upper respiratory infections
• Anatomical abnormalities such as cleft lip/palate or Trisomy 21 (Down Syndrome)
• Smoking and other irritants
• Hormonal changes associated with pregnancy

Will I need tests?

Learning more about your symptoms, an ear exam and a hearing test are often all that is needed.

How are eustachian tube problems treated?

Treatment depends on what's causing ETD. There are a variety of treatments available. These treatments are tailored to the patient.

Eustachian tube balloon dilation

• Nose sprays such as decongestants may help during flights, but nasal steroid sprays do not seem to work well for Eustachian tube dysfunction.
• Antihistamines – These medicines are usually used to treat allergies. They help stop itching, sneezing, and runny nose symptoms. Decreasing allergic irritation in the nose can help the Eustachian tube work better.
• Decongestants – These medicines can help with stuffy nose symptoms.
• Surgery – Most people do not require surgery for ETD. Some procedures that may help are:
• Ear tubes
• Balloon dilation of the Eustachian tube (see video above)
• Eustachian tuboplasty for the opening of the Eustachian tube
• Antibiotics are not needed to treat eustachian tube problems.