Eustachian tube dysfunction

The Eustachian tubes are tubes that connect the middle ear to the back of the nose and throat. Their function is to equalise pressures by allowing air to circulate when sneezing, yawning and swallowing. It is most common in children under 5 years of age, although it can occur in all ages. 

The dysfunction is usually caused by inflammation or accumulation of mucus inside the tubes. Other contributing factors: smoking, sleeping on the stomach and, in children, prolonged use of a bottle. 

It manifests itself with a feeling of pressure or of having blocked ears. Hearing is reduced, as if muffled. It may be accompanied by ringing in the ears, pain (in one or both ears) and impaired balance. 

Diagnosis is clinical, by directed questioning and examination of the ears. 

Eustachian tube dysfunction may improve spontaneously. Chewing gum or yawning may help to open the tubes. If the cause is allergic inflammation, antihistamines, nasal decongestants or corticosteroids may be used. 

There are very fine devices that are inserted through the nose into the Eustachian tube and allow the tube to be dilated by inflating a balloon. Afterwards, pressurised air can be blown into the tubes to relieve the air pressure in the ears. 

Finally, a myringotomy can be performed in which a hole is made in the tympanic membrane to relieve pressure and drain fluid if present. In children who frequently get ear infections, a small tube can also be implanted in the eardrum to promote continuous drainage of fluid; they fall out spontaneously within a few months of implantation.