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Eustachian Tube Problems PATIENT INFORMATION

The ear consists of three parts. The external ear comprises the outer ear that you see as well as the ear canal. The middle ear is a chamber located within the bone of the ear that is divided from the external ear canal by the eardrum. The three ear bones rest within the middle ear cavity. The middle ear cavity is connected to the mastoid cavity behind the ear. This is the ear sinus. In the front of the middle ear, there is a tube that leads from the back of the nose to the middle ear and connects these two chambers, called the Eustachian tube. The lining of the nose and throat, as well as that of the Eustachian tube and middle ear, are all very similar. Indeed, it is very similar all the way down into the lungs. Disorders that affect the nose and the lining of the windpipe and its branches also affect the Eustachian tube and the ear. Also, there are many conditions that affect this tube that don't necessarily affect the nose or the windpipe. The Eustachian tube is normally closed. Every ten seconds or so when we swallow, the small muscles from the back of the palate open the Eustachian tube and equalize pressure from the ear to the back of the nose. We are not aware of this, it just happens naturally. (Diagram A)

Problems with this tube develop when the tube does not open as it should, or when it is opened too much. This webpage will discuss a few of the conditions associated with this tube.

Serous Otitis Media
Sometimes the tube is blocked. This results in a vacuum developing in the middle ear which sucks the eardrum down. If this condition persists, fluid will be drawn into the middle ear and will prevent proper vibration of the eardrum and ear bones, resulting in a hearing loss. This condition often follows an ear infection (acute otitis media). Most of the time after an ear infection, this fluid will clear on its own within a couple of weeks.

If the fluid in the ear persists due to a blockage in the Eustachian tube, there are two types of treatment available. In children, it is often helpful to keep the child on a once a day dose of antibiotics to prevent any recurrent infection that may prolong the recovery. Often, this is enough to allow the tube to return to normal and the fluid to drain. Antihistamines and decongestants do not seem to be very effective in relieving this disorder in children.

In adults, medicines are often effective in relieving the problem. The use of nasal sprays to shrink the swelling of the opening of the Eustachian tube in the back of the nose, as well as decongestants, is often helpful in relieving the problem.

It is often helpful to forcefully inflate air into the middle ear space through the swollen tube by practicing the Valsalva maneuver. This consists of holding the nose and blowing forcefully until your ears "pop." Sometimes, this doesn't work and it is helpful to force air into the nose with a small bulb, called a Poliztzer bulb. You may be given one of these to use at home. 

Surgical Treatment
In the event that medicine fails to clear this problem, sometimes surgery is necessary. This involves making an incision through the eardrum and sucking the fluid out. If this is a recurrent problem, it is usually recommended to place a ventilation tube in the eardrum itself to act as an artificial Eustachian tube to prevent recurrence of the fluid. These tubes usually remain in place for six months to two years and are naturally extruded from the eardrum as it grows. Less than 1% of the time, a hole remains where the tube was located. This may require another operation in the future to close it.

Adenoids
The adenoids are located in the back of the nose at the area in which the Eustachian tube opens into the back of the nose. Often congestion in the adenoids will cause some congestion around the opening of the tube and make this problem worse. Occasionally, it is recommended to take the adenoids out to treat this condition.

Allergy
This problem is often caused from allergic problems. Allergies are caused by a reaction of the lining of your nose, your throat, and also the Eustachian tube to various things in the air or that we eat. It causes swelling that results in closing of the tube and the resultant problems, thereof. Often antihistamines are recommended to treat the allergic condition. Sometimes, an evaluation by an allergist is necessary.

Cleft Palate
When the palate does not perform properly, the muscles that attach from the palate to the Eustachian tube don't open the tube properly, and most children with cleft palate have difficulty with Eustachian tube dysfunction. Fortunately, the measures outlined above are effective in relieving this condition.

Special problems with Children
Children are more prone to have problems with the Eustachian tube because of three special problems of the tube in childhood. The tube is oriented horizontally, rather than vertically, and doesn't drain as easy when you are a child. Also, the palate muscles that open the tube don't work as well when one is small. After one is older, they start working better and open the tube better. The adenoids are rather large in children and block the drainage from around the tube. As one gets older, the adenoids shrink up and this problem is not as common. Nevertheless, this problem can be seen at any age.

Eustachian Tube Problems Related to Flying and Diving
Pressure changes that occur with flying or diving can affect the Eustachian tube and cause blockage of the tube. This is especially common if one has experienced a recent cold, causing some swelling of the tube. There are several things that can be done to lessen the chance of problems with the Eustachian tube in flying or diving. It is often useful to use Afrin or a generic form of Afrin nasal spray. Use two squirts in each side of the nose approximately thirty minutes before you fly or dive. It is also recommended to take a decongestant, such as Sudafed extended release tablets, that lasts for twelve hours prior to flying or diving. It is useful to chew gum or suck on mints when flying to stimulate swallowing and opening the tube. This is especially helpful when children are flying. It is also recommended to use the Valsalva maneuver to pop the ears by forcefully blowing with your nose pinched off to force air up into the Eustachian tube.

Remember when diving that it is very important to pop your ears at the surface and continue this frequently near the surface as you descend. It is also more important that you clear your ears as you descend in an airplane, too.

Patulous Eustachian Tube
Occasionally, one experiences just the opposite of a blocked Eustachian tube. This occurs when the tube is open all the time. This is not a normal condition, and it generally causes a full feeling in the ear and an echo in the ear when one talks. It can be quite bothersome to some people and causes abnormal sounds when swallowing. This condition goes away when reclining or bending over. This is because the blood rushes to your head in these conditions and causes a little swelling around the tube. In many cases, an explanation of the cause of this problem and some reassurance that it is nothing serious is all that is needed. However, if it becomes bothersome, there are some medications that can be used to congest the back of the Eustachian tube to keep it closed better. In the event that these medications are unsuccessful, placement of a ventilation tube in the ear prevents the pressure changes associated with breathing and swallowing when this tube is open. Very rarely, a catheter needs to be inserted into the Eustachian tube itself to block the opening.

Acute Otitis Media
This is a common ear infection. It is caused from a bacteria getting into the middle ear and causing an infection. This is common when the Eustachian tube does not function properly. However, the resultant swelling from the infection can also cause swelling of the Eustachian tube and a lingering fluid collection in the ear following the infection. This condition usually clears quite readily with appropriate antibiotic treatment. In severe cases, it is sometimes necessary to make a hole in the eardrum to drain any pus that may have accumulated.

Tympanostomy or P.E. Tubes
These small tubes are placed in the eardrum after draining fluid from the ear. In children, this operation is performed with a general anesthetic to allow them to sleep while it is done. Actual incision of the eardrum is a very painful event. However, after the tube is in place, there is no pain. This procedure is done in the office with the use of numbing medicine for adults. As the eardrum grows, it will push the tube out of the eardrum, and 99% of the time, the eardrum is healed under the tube. Most of the time, the Eustachian tube is working well after this has happened. However, occasionally, the hole where the tube was does not close. This occurs less than 1% of the time and may require another operation to repair the hole in the eardrum.

This procedure is usually done early in the morning on children so they won't be hungry for long. It is necessary that children and adults undergoing a general anesthetic not have anything to eat or drink the morning of the surgery. After the surgery, there is no pain in the ear. Occasionally, there will be a need to place some antibiotic drops in the ear canal to go through the tube and fight infection present in the middle ear. Some children have drainage from the middle ear through the tube into the ear canal after the tube is placed. This is not a painful condition, and it is good that the infection can drain out. However, it needs to be treated. This is usually cleared up with the use of antibiotic drops. On extremely rare occasions, the tubes have to be removed for the persistent drainage and the eardrums allowed to heal up. The tubes do a great job of improving the hearing in persons with development of fluid behind the eardrum. In addition, they prevent the serious problems associated with Eustachian tube blockage that occur over a period of time, such as development of cysts in the ear and destruction of the ear bones.

Summary
This small tube between the middle ear and the back of the nose usually works quite well. However, when it does not work properly, it can cause a great deal of problems as outlined above. Fortunately, we are able to alleviate most of the symptoms associated with these problems with medical or surgical treatment.

The content of this site is intended for information purposes only; it is not meant to take the place of seeing a healthcare professional. If you have any concerns regarding your own or someone else's health, we strongly encourage you to consult a physician.

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