Douglas
Hoffman, M.D., Ph.D.
If you have ever had to "pop" your ears while
flying in an airplane or driving in the mountains, you have
had firsthand experience with your Eustachian tubes. If you
have ever felt ear discomfort in these situations, you have
experienced Eustachian tube dysfunction.
The Eustachian tube connects the middle ear with the back
of the throat. The middle ear is an air-filled space, and the
air pressure in this space under ideal circumstances is the
same as the ambient (outside) air pressure. When the ambient
air pressure changes rapidly, as it does while driving
through the mountains, there is a difference in pressure
between the outside air and the air in your middle ear. If
this pressure difference is great enough, you will feel
pressure, or even pain, in your ears. When people
"pop" their ears they typically swallow or open and
close their jaws. These actions tend to open the Eustachian
tube, allowing the air pressure to equalize between the
outside world and your middle ears.
Most of the time, the Eustachian tubes are not open; it
takes active muscle movement to open them (1).
Unfortunately, many things can inflame the tubes, causing the
tissue lining the tube to swell. Under such circumstances it
becomes difficult or impossible to actively open the tubes.
This is very similar to the problem we have all experienced
breathing through a congested nose: as the tissues lining the
nasal cavity swell, it becomes progressively more difficult
to pull air through the nose.
The Eustachian tubes open into the throat immediately
behind the nasal cavity. Many nasal problems may lead to
inflammation of the Eustachian tube openings. Allergies,
sinusitis, and the common cold primarily affect the nose and
sinuses; because drainage from the nose passes by the
Eustachian tube openings, these nasal/sinus problems can lead
to Eustachian tube dysfunction. Similarly, throat infections
(viral or bacterial) can also cause Eustachian tube
dysfunction (2).
The symptoms of Eustachian tube dysfunction are fullness
and pain in the ears; if persistent, you may experience
hearing loss, ringing in the ears, and dizziness or
unsteadiness. Your doctor may have noted fluid behind your
ear drums, or that the ear drums appear retracted (sucked
in).
The treatment for this problem depends upon the root
cause. Dr. Hoffman will need to determine whether your
Eustachian tube dysfunction is due to a throat, nose or sinus
problem. The treatment will vary depending upon the root
cause, but may involve antibiotics, nasal sprays,
decongestants and/or antihistamines. Only occasionally is
surgical treatment required. This involves making a small cut
in the ear drum and placing a tiny plastic grommet tube into
the cut. The hole in the grommet tube allows air to pass into
the middle ear, thus functionally "replacing" the
Eustachian tube. This procedure is performed using local
anesthesia.
The tube is called a "ventilation tube," which
is a reflection of its function, but it is also frequently
referred to as a "PE tube" for pressure
equalization or polyethylene
(the material from which the first such tubes were
made.)