Eustachian Tube Dysfunction

Question 1

What is the Eustachian Tube?

Answer 1

-This is the tube which connects the middle ear and the throat
- It works by equalising the air pressure in the middle ear and draining the fluid

Question 2

What are the causes of Eustachian tube dysfunction?

Answer 2

• Viral Upper Respiratory Tract Infection
• Allergies
• Smoking

Question 3

How does Eustachian Tube Dysfunction Present?

Answer 3

• Reduced or altered hearing
• Popping noises or sensations in the ear
• Pain or discomfort
• A fullness sensation in the ear
• Tinnitus

Question 4

When do symptoms tend to get worse?

Answer 4

• When the external air pressure and the middle ear pressure cannot equalise to the outside pressure
• e.g. flying, climbing a mountain or scuba diving

Question 5

What investigations would you do for Eustachian Tube Dysfunction?

Answer 5

• Tympanometry
• Audiometry
• Nasopharyngoscopy
• CT scan (assess structural pathology)

Question 6

What is Tympanometry?

Answer 6

• Inserting a device into the external auditory canal
• Creating different air pressures in the canal
• Sending a sound in the direction of the tympanic membrane
• Measuring the amount of sound reflected back off the tympanic membrane
• Plotting a tympanogram of the sound absorbed at different air pressures

Question 7

What is the normal absorption of sounds in the ear?

Answer 7

• Sound is absorbed best when the air pressure of the ear canal matches the ambient air pressure
• The ambient air pressure is equal to the pressure in the middle ear

Question 8

What is the absorption of sounds when there is Eustachian tube dysfunction?

Answer 8

• The air pressure in the middle ear may be lower than the ambient air pressure because new air cannot get through the tympanic membrane to equalise the pressures
• The tympanogram will show peak admittance with negative ear canal pressures

Question 9

What is the Managment of Eustachian Tube Dysfunction?

Answer 9

• No treatment (resolves spontaneously e.g. fromURTI)
• Valsalva Manoeuvre (holding the nose and blowing into it to inflate the Eustachian tube)
• Decongestant Nasal Sprays
• Antihistamines and a steroid nasal spray for allegries/ rhinitis
• Surgery

Question 10

What is Otovent?

Answer 10

• An over counter device where the patient blows into a balloon using a single nostril
• This helps to inflate the Eustachian tube, clears the blockage and equalises the pressure

Question 11

What are the surgical options for Eustachian tube dysfunction?

Answer 11

• 1. Removing other pathology = Adenoidectomy
• 2. Grommets ( these are tubes inserted into the tympanic membrane by an ENT surgeon, allows air/ fluid to flow from the middle ear to drain through the tympanic membrane to the ear canal)
• 3. Balloon Dilatation Eustachian tuboplasty (involves inserting a deflated balloon into the Eustachian tube, inflating it for a short period of time (2 minutes) to stretch the Eustachian tube, then deflating and removing it