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Eustachian tube dysfunction

Last reviewed: 28 Oct 2023
Last updated: 08 Feb 2022



History and exam

Key diagnostic factors

  • inability to "pop" or "clear" the ear with changes in barometric pressure
  • normal head and neck exam
More key diagnostic factors

Other diagnostic factors

  • aural fullness
  • subjective hearing loss
  • autophony
  • history of serous otitis media or of chronic otitis media
  • edema of the Eustachian tube orifice
  • history of retracted or hypermobile tympanic membrane
Other diagnostic factors

Risk factors

  • 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
  • GERD
  • radiation exposure
  • history of recent weight loss
More risk factors

Diagnostic investigations

1st investigations to order

  • nasal endoscopy
  • tympanometry
More 1st investigations to order

Investigations to consider

  • nasopharyngoscopy
  • CT scan
More investigations to consider

Treatment algorithm


all patients



Edward D. McCoul, MD, MPH

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 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.

Peer reviewers

Alan G. Micco, MD

Associate Professor

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


The Netherlands


NVH declares that he has no competing interests.

  • Eustachian tube dysfunction images
  • Differentials

    • Sensorineural hearing loss
    More Differentials
  • Guidelines

    • Balloon dilation of the Eustachian tube
    • Balloon dilation for chronic Eustachian tube dysfunction
    More Guidelines
  • Patient leaflets

    Ear infection with fluid

    Ear pain during air travel

    More Patient leaflets
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