The eustachian tube runs from the middle ear to the back of the nose and throat. It helps drain fluid from the middle ear, which is the space behind the eardrum. If this tube becomes plugged or infected, it can cause eustachian tube dysfunction (ETD).

If eustachian tubes are blocked, they can cause discomfort and lead to hearing problems. Any of these symptoms can count as ETD.

There are a few different causes of ETD, and certain factors may increase a person’s likelihood of developing it.

  • The eustachian tubes help regulate ear pressure and drain excess fluid from the middle ear.
  • When they are blocked, symptoms can include pain, popping sounds in the ears, or fluid in the ears.
  • The treatment depends on the underlying cause.

A person can often easily manage ETD at home. However, persistent symptoms may require contacting a doctor for treatment.

The eustachian tubes are canals that run from the back of the nose and upper throat to the middle ear, helping keep the air pressure behind the eardrum the same as the pressure outside. They remain closed most of the time but will open as a person swallows, chews, or yawns.

Some people can have a condition that health experts refer to as patulous eustachian tube, where tubes stay open when they should be closed. This causes a person to experience autophony, which is when they can hear their own breathing and voice inside their head.

In addition, these canals are so tiny that blockages can happen for many reasons. Blocked eustachian tubes can cause discomfort and lead to hearing problems. Any of these symptoms can count as ETD.

ETD covers a variety of symptoms and has a range of potential causes. Season allergies and illnesses that create inflammation in the area, such as the flu or cold, are common causes of ETD.

Sinus infections can also trigger ETD, as a sinus infection causes the eustachian tubes to become inflamed or filled with mucus. More serious infections can cause ETD as well.

Moreover, ETD may stem from simple changes in altitude or air pressure. For instance, driving up a mountain or sitting in a plane can cause ETD. Even just riding the elevator in a tall building may be enough for some people to develop unpleasant symptoms.

It is common to experience ETD occasionally, but some people have symptoms more often than others.

Lifestyle risks

Lifestyle risks include smoking and carrying excess body weight.

Smoking can damage the delicate hairs in the throat and middle ear.

Carrying excess body weight can lead to fatty tissue deposits to form around the eustachian tubes, causing fluid buildup in the ear.

However, significant weight loss can also lead to dysfunction when fat buildup in the tubes decreases too quickly.

Engaging in certain activities may also put a person more at risk of pressure changes, which could trigger ETD symptoms. These activities include:

  • hiking at high altitudes
  • rock climbing
  • skiing or snowboarding
  • scuba diving

Medical risks

People with allergies may experience ETD more often, as allergies can cause increased mucus and congestion.

Children are also at higher risk of ETD, as their eustachian tubes are smaller and orient more horizontally than vertically. This makes the tubes more likely to become clogged by mucus or germs.

Furthermore, a child’s immune system is less able to fight off infections, as it is not fully developed. Children have more frequent colds and sinus infections, which are direct causes of ETD.

Enlarged adenoids can also cause eustachian tube obstruction and lead to bacterial growth, which can then result in ear infections.

The following medical conditions are risk factors as well:

  • Cleft palate: It commonly affects children from birth and almost always leads to ETD.
  • Trisomy 21: This is a type of Down syndrome that causes small and abnormally shaped tubes, poor muscle tone, and a decrease in the cartilage density within the tube.
  • Generalized hypotonia: Also called poor muscle tone, this condition can occur for a number of reasons. It can impair the function of a muscle in the soft palate in the mouth and lead to a eustachian tube collapse.
  • Laryngopharyngeal reflux: This condition can obstruct the eustachian tubes.

Yet another risk factor is having a ciliary disorder, such as primary ciliary dyskinesia, which is an inherited condition where the cilia in the airway do not work properly.

Symptoms of ETD can vary from mild to severe and may be different for each person.

Common symptoms include:

  • a plugged feeling in the ears
  • the ears feeling as if they are filled with water
  • tinnitus, or ringing in the ear
  • muffled hearing or partial hearing loss
  • ticking or popping sounds
  • pain and tenderness around the ear
  • a tickling or tingling sensation
  • trouble with balance

The length and severity of ETD symptoms depend on their cause. For instance, if ETD results from a change in altitude, these symptoms will often go away as the body adjusts to the pressure or reaches a lower altitude.

By contrast, ETD that is due to an illness or infection can last much longer. Anyone with ETD symptoms that last more than 2 weeks should seek guidance from a doctor.

Children with symptoms of ETD should receive medical help sooner, as the symptoms of ETD are similar to an ear infection.

When people experience dysfunction due to a nonviral cause, they are more likely to experience symptoms that persist for longer.

ETD can cause complications such as:

  • ear infection
  • middle ear atelectasis, which is a retraction of the eardrum
  • chronic otitis media, which is when there is persistent fluid in the ear
  • cholesteatoma, which is an abnormal skin growth in the middle ear

Any of these conditions can lead to dysfunction that causes hearing loss.

Doctors usually diagnose ETD based on a physical examination and a person’s symptoms.

A doctor may ask about hearing changes, pain in the ears, or feelings of pressure. They will also look inside the eardrum and the middle ear using an otoscope, checking for any signs of infection or blockages.

A doctor may need to look at an audiogram. This shows the results of a hearing test, or a tympanogram, which shows the function of the eardrum.

If there are cholesteatomas in the ear, or if there are concerns about skin migration into the middle ear, the doctor may order additional imaging tests.

If ETD occurs as a result of another condition, the doctor may ask questions about that as well in order to determine the correct treatment.

The symptoms of ETD will usually clear up on their own. If another condition is causing the symptoms, however, they will resolve once a person receives treatment for the underlying cause.

Home remedies

If the symptoms of ETD are bothersome, some simple home remedies may help. A person can address minor ETD symptoms, such as those due to a change in altitude or air pressure, by chewing gum or forcing a yawn.

Many people also find that the symptoms of minor ETD can go away as they swallow, so drinking a beverage or having a snack may help. These remedies help open and close the eustachian tube and relieve the pressure.

Doing the valsalva maneuver can also help. This means pinching the nose closed while closing the mouth, and blowing into the nose. This can also help relieve ear pressure on an airplane.

Children experiencing minor or temporary ETD symptoms can eat a snack or chew a piece of gum. Giving an infant a bottle or pacifier may help relieve the symptoms.

A person can relieve minor to moderate symptoms by using a saline nasal spray or irrigation system. Sometimes, dried mucus or other particles can get stuck in or near the eustachian tube and cause symptoms. Clearing the passageways can help eliminate anything clogged in the passage.

Over-the-counter medication

Depending on the cause, some over-the-counter drugs may help with ETD symptoms.

Someone who experiences ETD due to allergies may find relief using antihistamines, such as cetirizine (Zyrtec), diphenhydramine (Benadryl), or loratadine (Alavert, Claritin), or nasal steroid sprays.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, may help with pain and swelling. A person should check with a doctor to make sure these medications will not interact with any other medication they are taking.

Medical treatments

If the symptoms of ETD are due to a bacterial ear infection, a doctor will likely prescribe antibiotics. This may be a topical treatment or an oral antibiotic.

In severe cases of ETD, a doctor may prescribe oral steroids as well.

Surgery

Sometimes, fluids build up behind the eardrum and cannot escape through the dysfunctional eustachian tubes. In such cases, doctors may make a small cut in the eardrum to help with fluid drainage.

People who experience frequent severe ETD may need pressure equalization (PE) tubes. These are implants that balance the pressure in the ears and help reduce the likelihood of middle ear infections. It is a common procedure for children, but it can be suitable for adults as well.

Other surgical procedures include:

  • eustachian tube balloon dilation, which uses a saline-filled balloon catheter to dilate the tubes
  • transtubal application of fluids, in which a surgeon uses a nasal microendoscope to pass fluids to the middle ear and regulate ear pressure
  • eustachian tuboplasty, which uses a laser or rotary cutting tool to clear obstructions from mucous membranes or cartilage in the eustachian tube

Most often, doctors use these procedures in adults. Children usually get PE tubes and will typically not need them as they get older.

A big part of any prevention strategy for ETD involves:

  • leading a healthy lifestyle
  • maintaining good hygiene to avoid cold- or flu-causing germs
  • practicing good management of any allergies or asthma

This can help prevent common triggers that can cause the condition.

ETD and flying

When people fly, they may experience a common sensation in their ears known as airplane ear, ear barotrauma, barotitis media, or aerotitis media. It is a sensation of pressure, sometimes also pain, in the ears as the plane ascends and descends.

The cause is a quick change in altitude and pressure. When this happens, and the eustachian tube does not ventilate properly, a dysfunction occurs.

Since flying can put a person at risk of the condition, it may help to do the following when on a plane:

  • swallowing repeatedly, for example, by drinking water, chewing gum, or eating candy as a way to help the process
  • doing the valsalva maneuver
  • yawning repeatedly to cause a popping sensation that can equalize pressure
  • wearing earplugs during take off and landing to reduce the impact of the pressure change
  • using a nasal decongestant for acute discomfort before, during, or after flying. However, a person should not use this for more than 3 days.

ETD is common, but most cases resolve with little or no help. Treating the underlying cause is the best way to treat and prevent recurring symptoms of ETD.

Children and adults who get symptoms that interfere with their daily lives, as well as those with chronic ETD symptoms, should contact a doctor to consider more thorough treatments.