II. Definition
- Failed pressure equalization via the eustachian tube, typically at its valve-like opening in the nasopharynx
III. Causes
- Upper Respiratory Infection
- Allergic Rhinitis
- Environmental irritants (e.g. Tobacco smoke)
- Gastroesophageal Reflux
- Pregnancy (esp. third trimester)
- Conditions affecting ciliary function (e.g. primary ciliary Dyskinesia)
- Mass lesions
- Adenoid hypertrophy
- Nasopharyngeal carcinoma
IV. Symptoms
- Sense of ear fullness or plugging of the affected ear
- Muffled Hearing
- Valsalva does not clear ear discomfort (and may cause pain)
- Tinnitus or crackling Sensation in the affected ear
- Vertigo or sense of Dysequilibrium
V. Signs
- Tympanic Membrane retraction
- Tympanic Membrane does no move (or moves poorly) with provocative maneuvers
VI. Diagnostics
VII. Differential Diagnosis
VIII. Management
- No single measure is uniformly effective
- Watchful waiting for spontaneous resolution over time is consistently effective
- Empiric measures such as Intranasal Corticosteroids alone may not speed resolution
- Valsalva Maneuver
- Patient may gently clear eustachian tubes as done by scuba divers
- Hold nose and blow against a closed mouth
- Treat underlying causes
- Upper Respiratory Infection (e.g. Nasal Saline, Guaifenesin, Decongestants)
- Allergic Rhinitis (e.g. Intranasal Corticosteroids)
- Esophageal Reflux (e.g. lifestyle changes, Proton Pump Inhibitor)
- Refractory cases or prolonged cases
- Consider differential diagnosis (see above)
- Tympanostomy Tube
IX. References
- Poe et. al. in Park (2015) Eustachian Tube Dysfunction, UpToDate, Wolters Kluwer, accessed 11/22/2015
- Meek in Myers (2015) Middle Ear, Eustachian Tube..., EMedicine, accessed 11/22/2015
- http://emedicine.medscape.com/article/858777-overview#showall