Eustachian Tube Dysfunction

How the Eustachian tube works

Each Eustachian tube runs from the middle ear (behind the eardrum) to the back of the nose. It is normally closed, and opens briefly when you swallow, yawn or chew to:

• equalize air pressure on both sides of the eardrum
• drain mucus from the middle ear
• protect the middle ear from germs and loud sounds

When the tube stays blocked, pressure in the middle ear falls, pulling the eardrum inward. Fluid may build up behind the eardrum.

Types

Symptoms

• a plugged or full feeling in one or both ears
• muffled or reduced hearing
• popping, clicking or crackling sounds
• ear pain or pressure
• ringing in the ear (tinnitus)
• mild dizziness or imbalance

In children, ETD often shows up as difficulty hearing, inattentiveness, or repeated ear infections.

Causes and risk factors

• colds and other upper respiratory infections (common cold)
• allergic rhinitis and sinusitis
• air travel, diving and mountain driving
• enlarged adenoids in children
• smoking and secondhand smoke
• acid reflux into the throat
• obesity
• rarely, tumors at the back of the nose (one-sided symptoms in adults need checking)
• patulous ETD: significant weight loss, pregnancy, some hormonal and neurological conditions

Complications

• Otitis media with effusion: fluid behind the eardrum causing hearing loss, common in children
• acute middle ear infections
• Barotrauma: pressure injury to the eardrum or inner ear
• retraction of the eardrum and, rarely, cholesteatoma with long-standing dysfunction

Diagnosis

A doctor will look at the eardrum with an otoscope for retraction or fluid, check the nose and throat, and may perform:

• tympanometry: measures eardrum movement and middle ear pressure
• hearing test
• nasal endoscopy in adults with persistent one-sided symptoms

How to unblock a Eustachian tube

Home measures

• Swallow, yawn or chew gum to open the tube.
• Valsalva maneuver: close your mouth, pinch your nose and gently blow as if blowing your nose, until you feel a pop. Do not blow hard, and avoid it if you have a cold with heavy congestion.
• Toynbee maneuver: pinch your nose and swallow.
• Autoinflation devices: blowing up a balloon through the nose with a special nozzle can help children and adults.
• Steam and saline rinses to clear the nose.

Medicines

• Steroid nasal sprays for allergies and long-lasting congestion. They take days to weeks to work.
• Decongestant nasal sprays for no more than 3 days, or oral decongestants short term. Avoid oral decongestants with high blood pressure, heart disease or glaucoma.
• Antihistamines if allergies are the trigger.
• Pain relievers such as acetaminophen (paracetamol) or ibuprofen at the label dose.

For flying

• Chew gum or suck candy during descent, and swallow often.
• Stay awake during descent and do the Valsalva maneuver gently.
• Use a decongestant spray about 30 minutes before descent if you have a cold, if appropriate for you.
• Babies can feed from a bottle or breast during descent.
• Consider postponing flights or diving with a bad cold.

When symptoms persist

• Ear tubes (tympanostomy tubes): small tubes placed in the eardrum to ventilate the middle ear, common in children with persistent fluid and hearing loss.
• Balloon dilation of the Eustachian tube: a small balloon is inserted through the nose and inflated to widen the tube, for adults with chronic obstructive ETD.
• Adenoidectomy in children with large adenoids.

Frequently asked questions

How long does Eustachian tube dysfunction last?

After a cold or flight, symptoms usually clear within a few days to 2 weeks. Dysfunction related to allergies or chronic sinus problems can last longer. Symptoms lasting more than 3 months should be assessed by an ENT specialist.

How can I unblock my Eustachian tube at home?

Try swallowing, yawning, chewing gum, or a gentle Valsalva maneuver. Saline rinses and steam can help clear the nose. A steroid nasal spray helps if allergies are the cause, and a decongestant spray can be used for up to 3 days.

Can Eustachian tube dysfunction cause dizziness?

Yes, pressure changes in the middle ear can cause mild dizziness or a feeling of imbalance. Severe spinning vertigo, especially with hearing loss, suggests an inner ear problem and needs prompt assessment.

Is Eustachian tube dysfunction serious?

Usually not. It is common and often resolves on its own. Long-lasting dysfunction can lead to fluid behind the eardrum, hearing loss or ear infections, so persistent symptoms deserve treatment.