Note to patients: I am writing this because a new technique (balloon Eustachian tuboplasty) has been “advertised” as a “cure-all” for this disorder, but is only appropriate for a minority of patients.
Eustachian tube dysfunction (ETD) is so common that just about everyone has had this trouble at some point in their lives. The symptoms range from simple difficulty clearing the ears during a cold or allergy season, to chronic Eustachian tube blockage causing constant middle ear fluid, infections, hearing loss and damage to vital structures.
ETD occurs in infants and children due to immature formation of the tube itself or blockage of the tube opening due to enlarged tonsils and adenoids. In adults, the causes of this disorder are less predictable. Chronic sinus infections, nasal blockage and allergies can cause ETD in adults. Adults who had their adenoids removed as children might have experienced scarring of the Eustachian tube opening and therefore have constant ear blockage the rest of their lives.
The Eustachian tube in adults is about an inch long. Its opening is in the nasopharynx (area where back of nose meets throat) and it courses upward at 45 degrees to open into the middle ear cavity (see diagrams).
The symptoms of ETD range from plugged ears, especially worsened during change in altitude or pressure (often descent in planes, driving up and down mountain passes). This plugging may be just a nuisance, or escalate into eardrum retraction and the formation of middle ear fluid, causing significant hearing loss and pain. Advanced symptoms include severe hearing loss, perforation of the eardrum, and chronic infection of the middle ear and mastoid.
Eustachian Tube Dysfunction in Infants/Children
Until age 6-10, ETD is common in children because the tube has not developed fully, and because adenoid and tonsil enlargement and infection can cause chronic ET blockage and recurring ear infection or fluid. Less commonly in children, allergy or sinus infections can cause chronic ETD. The treatment is to try to identify the cause, and correct it if possible (remove adenoids, tonsils, place ventilation tubes in eardrum). It is imperative to prevent collections of fluid behind eardrums in infants and children, because the resultant hearing loss impairs language development and complicates education.
Eustachian Tube Dysfunction in Adults
When adult patients have recurrent Eustachian tube blockage, and accumulations of fluid behind the eardrum, I try to identify the cause of this before recommending treatment. Often chronic sinusitis can cause ETD in adults. Careful examination in clinic and a sinus scan can show sinus disease, and either medication or surgery can resolve this problem. I can’t guarantee that correction of nasal and sinus conditions will improve Eustachian tube function, but it usually does.
There are adult patients who, as children, underwent removal of tonsils and adenoids. Frequently, the opening of the Eustachian tube from adenoid removal can be scarred or damaged during childhood adenoid removal. Sadly, this can result in long-term trouble with ETD and frequent ear infection as an adult.
Last, but not least, certain adults have unexplained Eustachian tube dysfunction and chronic ear disease as a result.
TREATMENT OF EUSTACHIAN TUBE DYSFUNCTION IN ADULTS
If nose blockage or sinus infection are the cause of ETD and ear plugging, we focus on treating the sinus and nasal problems first. If severe nasal and sinus allergy is a problem, nasal steroid sprays, saline nasal rinses and oral antihistamines can improve Eustachian tube airflow. On occasion, nasal or sinus surgery can help greatly with these problems.
If ETD is severe, and fluid behind the eardrum gathers and will not resolve with medications, ear tubes (“tympanostomy tubes”) can be inserted in clinic quickly. We place these tubes very commonly, and they automatically help keep the ears healthy, and improve hearing. Even with tube placement, it is still important that I try to find the actual cause of ETD and correct it if possible.
For the last 10 years, I have been performing procedures to open, dilate or widen the Eustachian tube through the nose with fiber optics.
A procedure termed “Eustachian balloon tuboplasty” has recently been popularized . Sadly, in my opinion, this procedure is being used all too frequently, even for persons in whom other solutions are more appropriate. A slim balloon catheter can be inserted into the Eustachian tube through the nose with fiber optic guidance and the balloon inflated to “dilate” the tube.
Regardless of what you might read in the popular medical writings, the success rate of this is 50/50. We do not know how long the success lasts if it occurs at all. It is a promising technique, but is NOT appropriate for most patients with this condition.
BOTTOM LINE: Eustachian tube problems in adults are complex issues with many possible causes. As is the case with most medical conditions, it is imperative to assess each individual responsibly. Almost always, we can help resolve these stubborn issues. The key goals are to preserve integrity of the delicate ear structures, provide proper ventilation of the middle ear, and protect the all-important function of hearing!