Eustachian Tube Dysfunction

Otolaryngologists at Brigham and Women’s Hospital (BWH) provide comprehensive and innovative medical and surgical services for patients with eustachian tube disorders.

About Eustachian Tube Dysfunction

The eustachian tube is a small canal that connects the middle ear to the back of the nose and upper throat. It serves as a mechanism to equalize air pressure in the middle ear with outside pressure. Eustachian tube dysfunction (ETD) occurs when the tube fails to open (stuck closed) during swallowing or yawning resulting in a difference between the air pressure inside and outside the middle ear. This condition, mostly commonly seen in young children, can cause ear pain and sometimes difficulty hearing.

Causes of Eustachian Tube Dysfunction

  • The most common cause is an infection of the nose such as a cold or sinusitis
  • Enlarged adenoids and tonsils, especially in children
  • Allergies
  • Smoking and pollution
  • Nose polyps or nasal tumors
  • Cleft palate

Symptoms of Eustachian Tube Dysfunction

  • Pulling or tugging on the ear (for young children especially)
  • Discomfort or pain in the ear
  • Ears feel full or clogged
  • Ringing or popping noises in the ears
  • Hearing loss
  • Dizziness or a sensation of spinning known as vertigo
  • Symptoms that cannot be relieved by swallowing, yawning, or chewing

Medical Treatment for Eustachian Tube Dysfunction

  • Nasal or oral decongestants
  • Oral antihistamines
  • Nasal steroids to relieve nasal congestion and enable the eustachian tube to open
  • Pain medications such as acetaminophen or ibuprofen

Surgical Treatment for Eustachian Tube Dysfunction

If medical treatment fails or symptoms recur, surgery of the eustachian tube may be indicated.

  • Placement of a pressure equalization tube (PET) in the eardrum (myringotomy and PET placement).
  • Balloon eustachian tuboplasty: a new minimally invasive treatment option for eustachian tube dysfunction which consist of dilating the eustachian tube with a pressure filled balloon.

Learn more about ear tube insertions.

Patulous Eustachian Tube

Patulous or patent eustachian tube dysfunction occurs when the tube fails to close and remains open (stuck open or patulous). The open eustachian tube allows sounds to be transmitted directly to the middle ear, for example, patients experience autophony (the hearing of self-generated sounds including one’s own breathing, voice, or heartbeat).

Causes of Patulous Eustachian

  • Sudden and fast weight loss: fatty tissues surrounding the eustachian tube help maintain the tube closed. When a dramatic weight loss occurs, these surrounding fatty tissues shrink, disrupting tube function.
  • Other causes:
    • Dehydration from vigorous exercising, reducing the water content of the fatty tissues surrounding the eustachian tube.
    • Pregnancy: hormonal changes may cause patulous eustachian tube
    • Hormonal therapy in general
    • Caffeine consumption
    • Radiation therapy to or adjacent to the eustachian tube

Symptoms of Patulous Eustachian Tube

  • Autophony: hearing one’s own voice abnormally loud. This is also present in superior semicircular canal dehiscence syndrome
  • Ear blockage or fullness
  • Symptom relief by lying down
  • Hyperacusis: hearing sounds as abnormally loud
  • Tympanophonia: hearing one’s own breathing sounds, heart sounds or any sound emanating from the upper body. This will not be present in superior semicircular canal dehiscence syndrome
  • A feeling of “head-in-the-barrel” sensation
  • Eardrum movement while breathing

Treatment for Patulous Eustachian Tube

  • Medical treatment includes avoidance of triggers such as caffeine consumption (or decrease in amount), rehydration during vigorous exercise, or changing hormonal therapy
  • If medical treatment fails or symptoms recur, surgery to correct or modify the opening of the eustachian tube might be indicated
    • Bulking the opening of the eustachian tube (also called submucosal augmentation to close the valve)
    • Insertion of intraluminal shim to help close off the patulous opening

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have eustachian tube dysfunction and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by otolaryngologist, anesthesiologists and nurses who specialize in surgery for patients with eustachian tube dysfunction. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by experienced surgical and nursing staff.

Learn more about your hospital stay, patient-centered care and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to BWH’s world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

Otolaryngology-Head and Neck Surgery Appointments and Locations


Learn more about disorders of the ear, nose and throat in our health library.

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