Overview
The Eustachian tube connects the middle ear to the nasopharynx and equalises the pressure of the middle ear and the nasopharynx. In Eustachian tube dysfunction (ETD), there is negative pressure in the middle ear. ETD is closely related to developing chronic otitis media.
Epidemiology
- More common in children – the Eustachian tube is shorter and straighter in children
- Prevalence is lower in adulthood
- Incidence is higher in people with Down’s syndrome and cleft palate
Risk Factors
- Allergic rhinitis
- Chronic rhinosinusitis
- Upper respiratory tract infections
- Adenoid hypertrophy
- Cleft palate
- Down’s syndrome
Presentation
Patients usually have the sensation of their ear being “full” without the ability to “pop” or “clear” the ear. Features overall are:
- Aural fullness – does not pop or clear with changes in pressure
- Hearing loss – this is due to the aural fullness rather than true hearing loss
- Autophony – patient hears their voice/pulse/breathing unusually loudly
- Seen in patulous (open) Eustachian tubes due to vocal sounds being conducted to the middle ear
Investigations
All patients
- Tympanometry:
- Shows negative pressures
- Nasal endoscopy:
- Shows oedema/obstruction of the Eustachian tube
Management
All patients
- 1st-line: observe + manage underlying cause e.g. adenoidectomy for adenoid hypertrophy
Complications
- Acute/chronic otitis media
- Otitis media with effusion (glue ear)
Prognosis
- Prognosis is very good if the cause of ETD can be surgically managed
- If ETD presents in a child, it will likely resolve spontaneously as they grow older
