II. Definition

  1. Failed pressure equalization via the eustachian tube, typically at its valve-like opening in the nasopharynx

III. Causes

  1. Upper Respiratory Infection
  2. Allergic Rhinitis
  3. Environmental irritants (e.g. Tobacco smoke)
  4. Gastroesophageal Reflux
  5. Pregnancy (esp. third trimester)
  6. Conditions affecting ciliary function (e.g. primary ciliary Dyskinesia)
  7. Mass lesions
    1. Adenoid hypertrophy
    2. Nasopharyngeal carcinoma

IV. Symptoms

  1. Sense of ear fullness or plugging of the affected ear
  2. Muffled Hearing
  3. Valsalva does not clear ear discomfort (and may cause pain)
  4. Tinnitus or crackling Sensation in the affected ear
  5. Vertigo or sense of Dysequilibrium

V. Signs

  1. Tympanic Membrane retraction
  2. Tympanic Membrane does no move (or moves poorly) with provocative maneuvers
    1. Pneumatic Otoscopy
    2. Valsalva Maneuver

VI. Diagnostics

VIII. Management

  1. No single measure is uniformly effective
    1. Watchful waiting for spontaneous resolution over time is consistently effective
    2. Empiric measures such as Intranasal Corticosteroids alone may not speed resolution
      1. Gluth (2011) Arch Otolaryngol Head Neck Surg 137(5):449-55 [PubMed]
    3. Valsalva Maneuver
      1. Patient may gently clear eustachian tubes as done by scuba divers
      2. Hold nose and blow against a closed mouth
  2. Treat underlying causes
    1. Upper Respiratory Infection (e.g. Nasal Saline, Guaifenesin, Decongestants)
    2. Allergic Rhinitis (e.g. Intranasal Corticosteroids)
    3. Esophageal Reflux (e.g. lifestyle changes, Proton Pump Inhibitor)
  3. Refractory cases or prolonged cases
    1. Consider differential diagnosis (see above)
    2. Tympanostomy Tube

IX. References

  1. Poe et. al. in Park (2015) Eustachian Tube Dysfunction, UpToDate, Wolters Kluwer, accessed 11/22/2015
  2. Meek in Myers (2015) Middle Ear, Eustachian Tube..., EMedicine, accessed 11/22/2015
    1. http://emedicine.medscape.com/article/858777-overview#showall

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