Last reviewed: 16 Apr 2021
Last updated: 04 Sep 2018



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
  • autophony
  • history of serous otitis media or of chronic otitis media
  • oedema of the Eustachian tube orifice
  • history of retracted or hypermobile tympanic membrane

Risk factors

  • cleft palate
  • adenoid hypertrophy
  • allergic rhinitis
  • neoplasm of nasopharynx or infratemporal fossa
  • Eustachian tube trauma
  • Eustachian tube infection
  • age <5 years
  • cigarette smoking
  • GORD
  • radiation exposure
  • history of recent weight loss

Diagnostic investigations

Treatment algorithm


Associate Professor

Department of Otorhinolaryngology

Ochsner Clinical School

University of Queensland School of Medicine

New Orleans



EDM is the author of references cited in this topic and was previously a consultant for Acclarent Inc., the manufacturer of a balloon dilation device.

Dr Edward D. McCoul would like to gratefully acknowledge Dr Erica R. Thaler, the previous contributor to this monograph. ERT declares that she has no competing interests.

Peer reviewersVIEW ALL

Associate Professor

Otolaryngology: Head and Neck Surgery

Northwestern University Feinberg School of Medicine




AGM declares that he has no competing interests.


Department of Otorhinolaryngology, Head & Neck Surgery

University Medical Centre


The Netherlands


NVH declares that he has no competing interests.

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