Eustachian tube dysfunction (ETD) – causes, symptoms, diagnosis, treatment, pathology

Eustachian tube dysfunction (ETD) – causes, symptoms, diagnosis, treatment, pathology

The ear can be broken into three sections. The first is the outer ear which is the part
you see called the pinna as well as the ear canal. Next is the middle ear, which is a tiny chamber
that houses the tiny ear bones—the malleus, incus, and stapes. And finally there’s the inner ear, which
contains very special tissue structures called the cochlea which converts sound waves into
electrical impulses for the brain and the semicircular canals which help with balance. Between the outer and middle ear is an eardrum,
also called the tympanic membrane, so no air passes between the two areas. But the middle ear does have another possible
outlet, called the eustachian tube which acts like a valve connecting the middle ear to
the nasopharynx. This tube has three main functions—equalizing
pressure across the tympanic membrane, protecting the middle ear from reflux of fluids going
up from the nasopharynx, and clearing out middle ear secretions. Eustachian tube dysfunction describes situations
when one or all of these functions aren’t happening normally. In an adult, the eustachian tube is a roughly
4 centimeter long part-bone, part-cartilage canal that’s surrounded by four key muscles:
the tensor veli palatini, the levator veli palatini, the salpingopharyngeus, and the
tensor tympani, and it’s those first two that help a lot with opening up the tube. Actions like chewing, swallowing, and yawning
all pull on those muscles to help open up the eustachian tube. The first and most common type of eustachian
tube dysfunction relates to a problem equalizing pressure across the tympanic membrane, and
a classic example is on an airplane. As the plane rises, the air pressure decreases. Since the middle ear chamber is a closed environment,
it’s pressure stays relatively high and the tympanic membrane can begin to bulge a
bit into the outer ear. That increased middle ear pressure pushes
a tiny bubble of air down the eustachian tube and into the nasopharynx where it gets breathed
out. This is sort of like what happens with a burp,
where a bubble of air slips through the esophagus to relieve pressure, in fact, sometimes there’s
a popping sound that can be heard, like an ear burp. Through this process, the middle ear and the
outer ear balance out their pressures. The reverse process happens when a plane lands,
since the air pressure on the ground is relatively high and the middle ear pressure is relatively
low because a tiny bit of air was “burped” out. The volume of air in the middle ear shrinks
a bit creating a slight vacuum, and it can cause the tympanic membrane to bulge a bit
into the middle ear. Again, a small bubble of air can slip into
the middle ear to help bring up the pressure and balance things out. Now in eustachian tube dysfunction, the tube
might not be open because of a functional reason, the most common one being that a cold
or allergies are cause the tube to be swollen and full of secretions which block up the
passageway. Rarely, there might be an anatomic reason
as well, like a large tumor or scarring in the eustachian tube from long-standing inflammation. Regardless of the cause, difficulty balancing
out pressures can cause pain from stretching of the tympanic membrane, as well as making
the ears feel plugged and muffled; and if the inner ear gets affected, it can also cause
problems with balance. The next sort of dysfunction is when the eustachian
tube allows chemicals and bacteria to get into the middle ear. This sometimes happens when individuals are
born with eustachian tubes that stay open most or all of the time rather than being
structurally built as valves. Other times it can happen in infants and children
who naturally have short, floppy eustachian tubes that also don’t do a good job of preventing
substances from refluxing back into the middle ear. This can be a real problem when there is a
lot of positive pressure on the nasopharyngeal end of the tube, which happens with crying
and blowing your nose. Finally, the third sort of dysfunction happens
when the eustachian tube and the tiny cilia within it are unable to clear out middle ear
mucus secretions. Sometimes this can result from toxins like
cigarette smoke which damage the cilia, so that they can’t flick back and forth normally
to move the mucus. The dysfunction can also be associated with
systemic conditions like cystic fibrosis, which cause the secretions to get very thick. Regardless of the cause, stagnant secretions
can get infected, leading to more complications like otitis media—an infection of the middle
ear. Treating eustachian tube dysfunction is done
by relieving the underlying issue, the most common being a simple upper respiratory viral
infection or allergies which can improve with decongestants and sometimes a short courses
of steroids. In some cases, tympanostomy tubes are surgically
placed between the middle and outer ear creating a direct opening between them to allow pressures
to equilibrate more easily. Alright, as a quick recap, the eustachian
tube connects the middle ear to the nasopharynx, and is useful for equalizing pressure across
the tympanic membrane, protecting the middle ear from reflux, and clearing out middle ear
secretions. Eustachian tube dysfunction affects all of
these functions and can cause pain, muffled sound, balance problems, and can also lead
to infections like otitis media.

78 thoughts on “Eustachian tube dysfunction (ETD) – causes, symptoms, diagnosis, treatment, pathology”

  • keep going you are great i learn alot information from your vedio … your vedio make the education very very fantastic.

  • Clear, concise and entertaining way to present relevant information to students and professionals. Hope to see and hear more in the near future!

  • Love u guys. I was fighting with my faulty techniques of studying. U guys have just saved me. Thank u so much.May God bless u.

  • I had a tympanostomy, otherwise known as grommets, when I was 6 years old, because my eustachian tubes were very narrow when I was little and struggled to allow adequate drainage from my middle ear. They're perfectly fine nowadays, though, and through learning the hard way that your ears don't automatically equalise pressure when descending in an aeroplane, I now have complete control over the muscles that open and close my eustachian tubes, and can open and close them on demand.

  • nightmares shadow says:

    so I got eustachian tube dysfunction by getting hit in the face really hard
    what would a specialist be able to do with this problem
    also I get ear infection easily now this is ear infection number 7 lol

  • I once had a really bad ear infection and then the ear pressure in one of my ears felt weird then it went to the other ear. It mostly happens when I yawn or talk and it's been happening to me for five years when it happens I hear my heart beat.

  • Most of the time Eustachian Tube Dysfunction is caused by allergies. And it can happen all of a sudden Flonase, Zyrtec and Suphedrine maximum strength helped me. And changing my diet to gluten free/dairy free. Many doctors will tell you just Zyrtec and Flonase and eventually it will get better it didn't get better for me until I added Suphedrine maximum strength. Sometimes your better off figuring out how to take care of yourself then listening to doctors. Zyrtec, Flonase and Suphedrine maximum strength are all sold over the counter. For Flonase to work for Eustachian Tube Dysfunction you have to use it twice a day at the same time everyday for at least 3 months it won’t work right away. I hope what I've said helps somebody else.

  • This is way worse than it seems to be
    For me its been going on for 6 months and its killing me and nothing makes it better
    All i can do now is to hope that a miracle happens 😔

  • Alisa Lauzon says:

    I apparently need to demand to see a specialist. This sounds like it may be whats been going on for last 6byears. Dr.s just look in. And just say looks normal????

  • KrishCover MuZiK says:

    I'm a medical student n I truly believe that he define it very well n u can cure it by some yoga also..

    Just shut ur mouth n inhale then try to exhale gently but be careful BcZ harder Can cause permanent damage

  • Hi, there are probably millions of people throughout the world suffering from Eustachian dysfunction problem, and the doctors immediately think of allergies. I tried Flonase (for 30 days, taking it religiously as prescribed, positioning the head in the proper way), tried eustachi (device), tried steam, tried netty pot, ephedrine, claritin, Zyrtec, and nothing worked. However, one day after massaging my mid and upper back with an upright massager that goes on the chair, my ears unclogged, after 9 months of being clogged. I realized that my ear problem is MUSCLE TENSION related, and when the muscles relax, the ears unclog. Thus, you may try that, a completely different approach from what you did so far—relax your body and mind. This is what I have been doing for the past 4 months and my symptoms are 95 percent GONE: mouth guard during night is the first thing that I got, since grinding of the teeth and clenching of the jaw during sleep and/or dreams can create muscle tension of the jaw and neck, and those muscles can interfere with Eustachian tube. Then, YOGA exercises every morning for back and neck (you can find them on youtube, but I also took a course offered in my community). Then, my Kaiser Permamente doctor prescribe certain facial exercises (which I will share below) that help tremendously. Then, CITALOPRAM medication against anxiety. I realized that when I am under stress, my ears clog more. I also use humidifier (that ejects cool steam, that’s very important, you don’t want a blower of air, that dries air, as doctors explained to me) every night next to my head. Then meditation (guided meditation), I wish I was more serious about meditation, but I strongly recommend, since it calms down muscles. Check out alternate breathing exercises (it is a part of Yoga routine) on youtube, you have to learn that, and other breathing exercises, since they will calm muscles. Then, I am avoiding sitting and working on my laptop since I realized that that position of the head clogs my ears. Then, I improved posture and I drive car with an improved posture. I almost guarantee that if allergy medications did not help, your muscles are tensed, and perhaps this what I am telling you will help you a lot. My symptoms (ear clogged) were the worst in the morning, but now mornings are 80 percent fine for me (due to the mouth guard, and I always elevated head on several pillows before (which was a mistake), now I rest my neck on only one soft pillow, since it seems to me that elevating head strains muscles of the neck). Driving on a highway was absolutely horrifying since ears clogged a lot, now they don’t clog on higways any longer. It took me 4-5 months to get to 95% freedom from this devastating problem (also my TINNITUS is significantly reduced to almost non existing), and you must be persistent. It will not happen overnight, you need to do these things I told you for a month or so to see the difference. Mouth guard should help in a week or so, though, in terms of reducing the symptoms. I do these exercises twice a day (morning, before Yoga, and once at night):

    Jaw Stretch
    This exercise helps to fully stretch your masticatory muscles, the muscles in your jaw responsible for chewing and grinding. Massage your jaw muscles with your fingertips using small, circular motions. Now open your mouth as wide as you can without pain or discomfort. Hold the stretch for 10 seconds, then release and relax your jaw. Perform 10 repetitions.

    Visualization Exercise
    This helps relax your jaw, shoulder and facial muscles. Sit in a comfortable chair and focus on your breathing. Take a slow, deep inhalation through your nose and exhale out of your mouth. Close your mouth and press your tongue firmly on the roof of your mouth. Relax your tongue. Clench your jaw muscles tightly for a few seconds, then relax. Scrunch your face into an expression that resembles the expression you have when tasting something sour. Relax. Finally, lift your shoulders up to your ears, holding the contraction for a few seconds, then relax completely. Sit for a few moments as you focus on your breath.

    The Yawn-Sigh
    The yawn-sigh exercise relaxes your throat, jaw, face and body. Take a deep yawn as you open your mouth as widely as possible. Stretch your jaw muscles and tighten your shoulders and arms as you inhale. Slowly exhale and relax all of your muscles completely. Perform this exercise several times.
    I also need to emphasize the importance of massaging with your fingers your jaw, your neck, and muscles that go from the jaw up to the temples, including temples and above and around temples. I recommend massaging the entire head. Also, receiving massage of the neck and back (maybe even full body) is something that helps me, you can find good and inexpensive massage therapists in massage schools in your areas.

  • My ears pop every other minute when I hold my nose & blow out I hear louder, but when it eventually clicks again noise is duller. Does anyone have this or know any treatments?

  • my left ear feels clogged & blocked like its swollen from the inside and well the left side of my nose is blocked i feel like there's a lot pf pressure in my left ear that sometimes resaults a spiking & sudden pain at some point my upper teeth & jaw started hurting when i chew i've been using anti-biotic eardrops (polydexa) for 3 days now and there's no progress it feels like the eardrops are not reaching as deep as they should and i can't even close my teeth together since it hurts my jaw please help(the doctor also told me to take oral anti-biotics still no preogerss

  • This was valuable information why don't ENT Consultants explain this!!! I think they should watch the videos and learn something!!!! seen 10 ENT Consultants and 5 Hospitals and going to 2 Years now and they still can't give me an answer to what I have it is a no brainer my Right Ear keeps clogging up and than I get headache migraines, imbalance and pressure issues as well as Tinnitus and Ringing!!! If anyone can help me I am seriously loosing it now!

  • Respected Sir,
    I m suffering from this problem from last 10 months and always heared crackling sound and itching from my both ears which is very very irritating.
    I consult with many ENT doctors but still suffering from this problem.
    Please please sir do the needful from your side .

  • bruh moment screw says:

    I’ve had this for the past year… The tinnitus really kills sometimes and my doctors always say it’s allergies… once it happened mid plane flight and my ears couldn’t pop! Felt like I was gonna die man… Have any of you guys gotten a surgery for this?

  • I wish I knew what I had, nobody can diagnose it, have all the symptoms of menieries but when they look in my ear they say there is no ear infection.

  • great video! this is horrible hidden condition to live with especially when you are young and it interferes with quality of life..:(( doctors can't fix this!!!

  • I've got the Eustrachian Tube Dysfunction now due to a cold,
    and I've tried everything to get well again – decongestants, hot water, steam, vitamins, herbs, oils…
    Nothing works. Anyone else have a solution? Last time I had this I had to take 5 medications and antibiotics
    and still it took a whole week to clear!

  • I’ve had this going on 6 months now in one ear and can’t get it to stay cleared. Does ETD also cause tinnitus because I also have that as well since it started. It was a low hum at first and now it’s high pitched. That’s what really bothers me. I have to clear my ear a lot during the day. Also, hearing loss is present as well. Hoping I get that back. Will the T go away once ETD is resolved?

  • Does anyone get Crackling when they eat crunchy food or drop something or even talk???? it keeps Crackling for 11 days now…I have very bad allergies also, so Idk, taking flonase and mucinex and zyrtec been on forever since 2009 1/2 a pill every night.

  • CubieJewel-Videos says:

    I've been having chronic ear tube problems (right side) since late April this year. I look it up on google to looks some answers for what is causing it to make it stop and I was terrified that I might be getting a benign tumor/brain tumor or Ménière's disease or any other ears disorder…I was thinking that I might have TMJ since my jaw disc is clicking when open or closes my mouth, but no pain, just vibrates (Again, I looked it up on google), but my brother told me that everyone had them jaws clicks… I did go to the doctor and told me that my right ear looks fine (But bubbly fluid, it wasn't there before, but did go away I think.) but…I was not sure… till my brother told me that I hed hypochondria (health anxiety) I did try to unclog my ears by holding my nose, I hear my right ear rings/squeal noise every time I sneeze, hiccup, burping (when covering my mouth) or sometimes swallowing in I was sleeping… Sometimes I hear a squeaking sound when listening to music after the beat sounds, I barely hear any sharp or dull sounds through my right ear… Other times I hear it the ring noise (like a vibration) when hearing it from the fan and when the plane dive by… Sometimes it does give a vibration thumping feeling through my eardrum.

    I'm very terrified at the moment… fearing that I'm might go deaf or being the noise in my ear being permanent… or won’t be cured… Feels like I'm going insane… I just want to get a proper diagnosis to get treatment to stop this… if you going through the same thing as I do or got any bits of advice to get through with helpful tips. Please help me! It will help me get through and find proper diagnoses, I’m still hoping to get CT-Scan or MRI soon and hopefully put this worry to the end… Since this ear pain really interrupts my life… but yeah… health anxiety is a pain including my chronic anxiety myself… I'm only 22.

    Anyway enough ranting, great video.

  • I just used the eustachi and my netti pot. Boy did that change the feeling. I wouldn't say its perfect yet. But a friend recommended the eustachi and said it will take a little while to work since it exercises the eustachian tube. If anything my nasal passage feels more open and less swollen.
    I have had this problem for 6 years. Doctor originally said it was allergies and zyrtec helped but only for a bit.

  • When I was a young worker, I have had scenarios when my work was jeopardized because of hearing loss. According to my medical doctor, the issue was not curable, which triggered my need for personal research. Thru this guideline “Kαmkαmfο tdα” (Google it) for the treatment of hearing loss, I am now able to do my work well without getting bothered by tinnitus. .

  • TheRealAutistic1 says:

    Ive had chronic eustachian tube dysfunction for 6 years now. I've came to ignore it mostly. Mine is so severe that's the only bad part. My ears click and pop every single time I swallow. I also developed a habitual sniffling and opening my jaw wide to yawn. Because when I do this my ears click/pop. I also have a loud jaw popping and my nose clicks. I've suffered ENT problems my whole life. Gotten my nose cauterized 4 times. But out of all the bullshit ETD is far by the worse. To make my life seem more annoying I also have tinnitus as a result from ETD. I also have anxiety and I'm always convinced I may develop a cholesteatoma in both ears.

  • Each time i swallow, i can feel my hot tea go into my ear. My jaw, upper trap & levator scap muscles are all super tight on that side. I suspect food gets in there too as when i lay on the opposite side i can feel particles fall from there down my throat. Sometimes i awaken at night choking on that junk. Now using red & blue lasers with some success. Also suspecting zenker. Suggestions sought & welcomed.

  • I`ve been utilizing this hearing loss solution “Kαmkαmfο tdα” (Google it) for almost 8 weeks and also the difference is very clear. I still have problems with noises in my head but the sounds arrive to my ears very clear. I no longer drive people away because I could keep up with conversation longer due to my improved hearing. I can visit reunions and parties and feel great. I also notice a change in my moods these days. .

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