The eustachian tube connects the middle ear to the nose and throat. Its purpose is to equalize middle ear and environmental pressure. Failure of the tube to open when it should is referred to as eustachian tube dysfunction (ETD). Resulting symptoms can include pressure or fullness of the ear(s) or the sensation that the ear is clogged and cannot open. In severe cases, there may also be pain in the ear(s). Many ETD sufferers also have significant trouble adjusting to changes in altitude as is necessary when flying, diving, ascending tall elevator buildings, etc. In rare cases, the eustachian tube may remain open chronically (patulous eustachian tube), resulting in a “hollow” quality to speech and sound, and less commonly the pressure or fullness that accompanies classic ETD.

Common causes of ETD include: allergies, ear infections, chronic sinus infections, rapid or severe weight loss, menopause, estrogen therapy, and chronic changes in altitude, which people like pilots are faced with. When diagnosing, it is important we rule out other common causes of ear pressure/fullness such as from temporomandibular joint disorder (TMJ disorder), migraine headaches, and Meniere’s disease.

The diagnosis of ETD is generally made solely from the patient’s history since there are rarely physical exam findings present. The most common complaint is that the ear feels clogged but will “pop” and temporarily allow relief of the full sensation before becoming clogged again. Some ETD patients will also complain of a “crackling” or “popping” sound that accompanies chewing, yawning, or swallowing.

Treatment for ETD is generally anecdotal as there has been no proven relief for chronic ETD. In patients with allergies or chronic sinus problems, medications such as decongestants, systemic or local antihistamines, and topical, nasal steroids sometimes offer benefit. Occasionally, those with severe ETD symptoms can have a temporary ventilation tube placed in their eardrum. This relieves ETD symptoms in many cases but creates a perforation in the eardrum which occasionally fails to heal following tube removal. Since there is no test to predict which patients will experience relief, tube placement is typically used as a last resort in patients suffering considerably from their symptoms.

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