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Eustachian Tube Dysfunction

Updated: Nov 29, 2022

We have had an influx of people coming in to clinic lately that have a perceived blockage of wax but no wax is present regularily this is because of;

Patulous Eustachian tube dysfunction is a disorder of the valve of the Eustachian tube that causes it to remain open. When this valve remains open, sound can travel from the nasal-sinus cavity to the ears, allowing you to hear your own voice or your own breathing too loudly, or even the sound of blood pumping.

The Eustachian tube is an opening that connects the middle ear with the nasal-sinus cavity. This tube helps to:

  • Balance pressure in the middle ear (commonly felt as your ears popping)

  • Drain fluid from the middle ear

  • Protect the ear from both hearing sounds your body causes and nasal drainage

This tube contains a valve that opens and closes. Inadequate opening of this tube can cause a buildup of fluid in the ears, which can lead to a feeling of pain and pressure in the ear. A tube that is too open can also cause a persistent feeling of pressure as well as hearing unusual sounds such as your own breathing or your own voice too loudly. Eustachian tube disorders are common and one of the leading causes of ear infections (otitis media).

How do we treat this?

Often, no treatment is needed

In many cases, the muffled hearing and popping are mild and do not last longer than a few days or a week or so. This is common after 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 breathe out gently with your mouth closed and pinching your nose (the Valsalva manoeuvre). In this way 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. Occasionally doing this can make you dizzy so make sure you are sitting down.

· This is a particularly good thing to try if you develop ear pain when descending to land in a plane.

Steam Inhalation

Inhalation of steam with Menthol Crystals can help open the airways and in turn the Eustachian Tube. Instead of Menthol Crystals other inhalants can be added to the boiling water such as Olbas Oil or Chest Rub. Special Steam Inhalation cup can be bought but if using a bowl swimming goggles can be used to stop irritation of the eyes.

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 5-7 days at a time. If they are used for longer than this, they may cause a worse rebound congestion in the nose and can damage the lining of your nose. They are not recommended for use in children.

Buteyko Breathing

Coupled with the above, these breathing exercises help to force the opening of the Eustachian Tube.

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, such as chronic sinusitis or persistent rhinitis, 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 when you first start it. However, if any inflammation is reduced in the back of the nose then the Eustachian tube is able to work better.

Steroid nose drops

Betamethasone nose drops are steroid nose drops. They are very similar to the steroid nasal sprays but because they are drops they can run deep into the back of the nose. They can only be prescribed. For more details, see the leaflet called How to use nose drops.

Referral to a specialist

· If symptoms continue or the cause of the Eustachian tube dysfunction is not clear, you may be referred to an ear specialist for assessment.

· Treatment options depend on any underlying cause that may be found.

· A small plastic tube (a grommet) can be inserted through the eardrum, under an anaesthetic, to allow air to get into the middle ear.

· A treatment recently developed is called balloon dilatation. This involves inserting a tiny tube with a small balloon on the end into the Eustachian tube through the nose. The balloon is filled with salt water and left in place for a few minutes in order to stretch the Eustachian tube. From December 2019, this procedure has been approved in the UK on the NHS for routine use.

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