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Eustachian Tube Dysfunction

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Air travel and the Eustachian tube

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Some people develop ear pain when descending to land during a plane journey. It is caused by unequal pressures that develop on either side of the eardrum as the plane descends. As a plane descends, the air pressure becomes higher nearer the ground. This pushes the eardrum inwards which can be painful. In most people, just normal swallowing and chewing quickly cause air to travel up the Eustachian tube to equalize the pressure.
 
However, if you have a narrow Eustachian tube, a cold, allergies, or anything else that can cause blockage to the Eustachian tube, the pressure does not equalize very easily when the plane descends. This can cause severe ear pain.

 

 If you suspect you have Eustachian Tube Dysfunction, take this quick quiz: Eustachian Tube Dysfunction Patient Questionnaire, and bring it with you when you come to see your doctor.

To learn about the Acclarent AERO’s Balloon Dilation System, click here.

What is the Eustachian tube and what does it do?

The Eustachian tube is a narrow tube that connects the space behind the eardrum (the middle ear) with the back of the nose. The middle ear is normally filled with air. The air in the middle ear is should be continuously circulating from the nose to the ear.
The Eustachian tube is normally closed but opens when we swallow, yawn or chew. This allows air to flow into the middle ear and any mucus to flow out. This keeps the air pressure equal either side of the eardrum. The eustachian tube helps equalize air pressure on each side of the eardrum and keeps the middle ear free of mucus, allowing the eardrum to vibrate efficiently. This vibration is needed for us to hear properly.

 How do we hear?

Sound waves hit the eardrum. Vibrations of the eardrum pass on to three tiny bones (the ossicles) in the middle ear. These bones transmit the vibrations to the cochlea in the inner ear. Sound signals are sent from the cochlea to the ear nerve and then on to the brain.

What is Eustachian Tube Dysfunction (ETD)?

ETD means that the Eustachian tube is blocked or does not open properly. Air cannot get into the middle ear and the air pressure on the outer side of the eardrum becomes greater than the air pressure in the middle ear. This pushes the eardrum inward. The eardrum becomes tense and does not vibrate well when hit by sound waves.

Symptoms of Eustachian tube dysfunction (ETD)

ETD could include one or a combination of the following symptoms with one or both ears affected:
  • Muffled or dulled hearing.
  • Ear pain
  • A feeling of fullness in the ear,
  • Tinnitus (ringing or buzzing in the ear)
  • Dizziness
Symptoms can last from a few hours to several weeks or more. It depends on the cause. In most cases due to a cold (the common cause) the symptoms are likely to go within a week or so. As symptoms are easing, you may have popping sensations or noises in the ear. Also, the dulled hearing may come and go for a short time before getting back to normal.


What Causes Eustachian Tube Dysfunction (ETD)?

ETD occurs if the Eustachian tube becomes blocked, if the lining of the tube swells, or if the tube does not open fully to allow air to travel to the middle ear.
  • Colds and other nasal, sinus, ear or throat infections-   This is the common cause of ETD. The blocked nose, or thick mucus that develops during a cold or other infections, may block the Eustachian tube. An infection may also cause the lining of the Eustachian tube to become inflamed and swollen. Most people will have had one or more episodes in their life when they have had a cold and find that they cannot hear so well due to ETD. The symptoms of ETD may persist for up to a week or so (sometimes longer) after the other symptoms of the infection have gone. This is because the trapped mucus and swelling may take a while to clear even when the virus or bacteria causing the infection has gone.
  • Glue ear Glue ear is a condition where the middle ear fills with glue-like fluid. The Eustachian tube becomes congested and prevents the free flow of air into the middle ear, causing the difference in air pressure mentioned above. The eardrum becomes tight, reducing its ability to vibrate, resulting in dulled hearing. The situation is made worse by the glue-like fluid damping down the vibrations of the drum even further. It is a common condition in children. It clears by itself in most cases but some children need an operation such as tube placement to fix the problem.
  • Allergies-  Allergies that affect the nose, such as persistent rhinitis and hay fever, can cause extra mucus and inflammation in and around the Eustachian tube and lead to ETD.
  • Blockages-  Anything that causes a blockage to the Eustachian tube can cause ETD – for example, enlarged adenoids. Rarely, ETD can be a symptom of tumours that develop at the back of the nose. These will usually cause other symptoms in addition to ETD.

 

 

Anatomy of the Middle Ear

What is the treatment for Eustachian tube dysfunction (ETD)?

Treatment options depend on the cause and severity of the condition.  Often, no treatment is needed.  In many cases, the ETD is mild and does not last longer than a few days or a week or so. For example, this is common following a cold. No particular treatment is needed and the symptoms often soon go.

  • Try to get air to flow into the Eustachian tube-  Air is more likely to flow in and out of the Eustachian tube if you swallow, yawn or chew. Also, try doing the following. Take a breath in. Then, try to breathe out gently with your mouth closed and pinching your nose (the Valsalva manoeuvre). In this way, no air is blown out but you are gently pushing air into the Eustachian tube. If you do this you may feel your ears go ‘pop’ as air is forced into the middle ear. This sometimes eases the problem. This is a particularly good thing to try if you develop ear pain when descending to land in a plane.
  • Swallow and chew. ETD is improved by swallowing, chewing gum, drinking, or yawning.
  • Decongestant nasal sprays or drops- A decongestant may be advised by your doctor if you have a cold or other cause of nasal congestion. You can buy these from pharmacies. They may briefly relieve a blocked nose. However, you should not use a decongestant spray or drops for more than 5 days at a time. If they are used for longer than this, they may cause a worse rebound congestion in the nose.
  • Antihistamine tablets or nasal sprays- Antihistamines may be advised by your doctor if you have an allergy such as hay fever. In this situation they will help to ease nasal congestion and inflammation.
  • Steroid nasal spray– A steroid nasal spray may be advised if an allergy or other cause of persistent inflammation in the nose is suspected. It works by reducing inflammation in the nose. It takes several days for a steroid spray to build up to its full effect. Therefore, you will not have an immediate relief of symptoms but the medications will slowly kick in.
  • Ventilation tube insertion:  If troublesome Eustachian tube dysfunction persists, a tympanostomy tube (also known as a ventilation tube or grommet) may be inserted through a small incision. In some cases repeated tube insertions may be required. Special long-acting tubes are sometimes used but these are subject to crusting, infection, obstruction and permanent tympanic membrane perforation.
  • The ACCLARENT AERA™ Eustachian Tube Balloon Dilation System is the first & only device which is indicated to dilate the Eustachian tube that is FDA approved in the US.   A doctor uses a catheter to insert a small balloon through the patient’s nose and into the Eustachian tube. Once inflated, the balloon opens up a pathway for mucus and air to flow through the Eustachian tube, which may help restore proper function. After the Eustachian tube is dilated, the balloon is deflated and then removed. The procedure is short and is performed under general anesthesia.   Learn more here . (see image below)

The ACCLARENT AERA™ Eustachian Tube Balloon Dilation System