EUSTACHIAN TUBE DYSFUNCTION
Condition and Symptoms
Eustachian Tube Dysfunction may occur when the mucosal lining of the tube is swollen, or does not open or close properly. If the tube is dysfunctional, symptoms such as muffled hearing, pain, tinnitus, reduced hearing, a feeling of fullness in the ear or problems with balance may occur.
The eustachian tube is a cartilaginous and bony tube providing a connection between the nasopharynx (at the back of the nose) and the middle ear. At rest, the eustachian tube is closed, but it opens on swallowing, yawning, sneezing and the Valsalva manoeuvre (forced exhalation against a closed mouth and nose).
When the eustachian tube opens it allows equalisation of pressures between the external environment and the middle ear by allowing air to pass through.
Dysfunction of the eustachian tube results in development of negative pressures within the middle ear. Long-term ETD has been associated with damage to the middle ear and the eardrum. Complications include otitis media with effusion (glue ear), middle ear atelectasis (retraction of the eardrum) and chronic otitis media.
After a detailed history is taken Mrs Bentley will examine the ear and will pass an endoscope into the nose under local anaesthetic. This is sometimes described as uncomfortable but not painful. It enables Mrs Bentley to directly visualise the opening of the eustachian tubes in the nasopharynx to ensure it is not being blocked eg by adenoidal tissue.
She will arrange audiograms and tympanograms which can assist in making the diagnosis and then once the diagnosis has been made she will present a number of treatment options.
Non-Surgical Options: Supportive care, which includes advice about self-management such as to swallow, yawn or chew to help equalise the pressure in the middle ear. Pressure equalisation methods, which is a technique whereby the Eustachian tube is reopened by raising the pressure in the nose. This can be achieved in several ways, including the Valsalva manoeuvre. Other methods she may suggest include blowing up a balloon through each nostril using a mechanical device.
The aim is to introduce air into the middle ear, via the Eustachian tube, equalising the pressures and allowing better fluid drainage.
Nasal douching, in which the nasal cavity is washed with a saline solution to flush out excess mucus and debris from the nose and sinuses.
Decongestants, antihistamines, nasal or oral corticosteroids which are aimed at reducing nasal congestion and/or inflammation of the lining of the Eustachian tube.
Mrs Bentley may need to prescribe antibiotics if rhinosinusitis is diagnosed which has led to ETD.
Surgical Options: The main surgical treatment in the UK is a pressure equalising tube (also known as a grommet) which is inserted into the eardrum through a small incision usually under local anaesthetic. Grommets typically fall out after 6–9 months.
Long-acting tubes are occasionally used, although these may be prone to crusting, infection, obstruction and permanent tympanic membrane perforation. This may be performed under either general or local anaesthesia.