In eustachian tube dysfunction the tube that connects the middle ear to the back of the nose does not open and close properly, so pressure in the middle ear cannot equalize. It often follows a cold, allergies or flying, and most cases settle on their own within weeks.
Key symptoms
- Feeling of fullness or pressure in the ear
- Muffled hearing
- Popping, crackling or clicking
- Mild ear pain, worse with flying or diving
- Hearing your own voice or breathing loudly (patulous form)
What you find on exam
- Otoscopy: retracted eardrum or fluid behind it
- Pneumatic otoscopy: reduced eardrum movement
- Tuning forks: mild conductive pattern
- Nose and throat: congestion, allergy signs, large adenoids in children
Tests
- Tympanometry: negative pressure or a flat curve
- Audiogram if hearing loss persists
- Nasal endoscopy for one-sided persistent fluid in an adult, to exclude a nasopharyngeal mass
Treatment basics
- Watchful waiting; most resolve in weeks
- Autoinflation: gentle Valsalva, chewing, yawning, nasal balloon
- Nasal steroid spray such as fluticasone for allergies; decongestants only for a few days
- Ear tubes or balloon dilation of the tube by ENT for persistent cases
Red flags
- One-sided persistent middle ear fluid in an adult (possible nasopharyngeal cancer)
- Sudden hearing loss, vertigo or facial weakness
- Severe ear pain with fever or discharge
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.