Eustachian tube dysfunction (ETD) results in negative pressure in the middle ear cleft.
EDT is closely related to the development of chronic otitis media and is often accompanied by chronic inflammatory disease of the nasal cavity.
Often accompanied by chronic inflammatory disease of the nasal cavity.
Diagnosis may be confirmed by tympanometry and nasal endoscopy.
Treatment involves supportive care and management of contributing disease factors. Some patients may benefit from a trial of intranasal corticosteroids. Decongestants and antihistamines are ineffective in the treatment of ETD.
Surgery is appropriate if the Eustachian tube is obstructed or in the case of trauma. Pressure equalisation tube insertion may be considered if there are chronic otological complications. Balloon dilation of the Eustachian tube is an emerging procedure that may be an option for some patients with chronic ETD refractory to medical treatment.
Eustachian tube dysfunction (ETD) is the inability of the Eustachian tube to properly regulate air pressure inside the middle ear and/or effectively drain secretions from the middle ear cleft. Occasionally, dysfunction may involve reflux of nasopharyngeal secretions in the middle ear. These malfunctions may be due to a variety of pathophysiological changes that in some way impede the normal opening and closing of the Eustachian tube.
History and exam
Key diagnostic factors
- presence of risk factors
- inability to 'pop' or 'clear' the ear with changes in barometric pressure
- normal head and neck examination
Other diagnostic factors
- aural fullness
- subjective hearing loss
- history of serous otitis media or of chronic otitis media
- oedema of the Eustachian tube orifice
- history of retracted or hypermobile tympanic membrane
- cleft palate
- adenoid hypertrophy
- allergic rhinitis
- chronic rhinosinusitis
- neoplasm of nasopharynx or infratemporal fossa
- Eustachian tube trauma
- Eustachian tube infection
- age <5 years
- cigarette smoking
- radiation exposure
- history of recent weight loss
1st investigations to order
- nasal endoscopy
Investigations to consider
- CT scan
Edward D. McCoul, MD, MPH
Department of Otorhinolaryngology
Ochsner Clinical School
University of Queensland School of Medicine
EDM is the author of references cited in this topic and is a consultant for Stryker.
Dr Edward D. McCoul would like to gratefully acknowledge Dr Erica R. Thaler, the previous contributor to this topic.
ERT declared that she had no competing interests.
Alan G. Micco, MD
Otolaryngology: Head and Neck Surgery
Northwestern University Feinberg School of Medicine
AGM declares that he has no competing interests.
Niels van Heerbeek, MD, PhD
Department of Otorhinolaryngology, Head & Neck Surgery
University Medical Centre
NVH declares that he has no competing interests.
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- Balloon dilation for chronic Eustachian tube dysfunction
- Balloon dilation of the Eustachian tube
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