What is the Eustachian tube?
The Eustachian tube ‘ET’ is an anatomical structure connecting the middle ear cavity to the nasopharynx. It is needed because for the ear to work properly, the air pressure in the middle ear (behind the eardrum) needs to be the same atmospheric pressure as the outside environment. However, there is a continuous slow absorption of gases through the middle ear and mastoid mucosa, and so there is a continuous need for air to be replaced.
Under normal conditions the tube is closed. Through the action of specific palatal muscles the tube opens to allow air to flow between the back of the nose and the middle ear cavity. This occurs naturally during swallowing or yawning causing a soft crackling sound that our brain tends to ignore unless we specifically tune in to it.
What are the symptoms of poor Eustachian tube function?
Poor Eustachian tube function can result in muffled hearing, crackling sounds, and pressure sensation. Patients may report discomfort experienced during atmospheric pressure changes such as during descent when flying, or scuba diving. These chronic symptoms may significantly affect quality of life..
Chronic Eustachian tube problems are also associated with chronic ear disease that can predispose to infection and hearing loss.
How do we diagnose Eustachian tube dysfunction?
The diagnosis of Eustachian tube dysfunction is based on symptoms of feeling of fullness in one or both ears, deafness, tinnitus, and importantly pain on change of pressure. Some patients describe an inability to equalise pressure despite auto-valsalva (trying to ‘pop’ their ears). Further evidence is needed to confirm the diagnosis. This includes audiometry (hearing tests) and tympanometry (pressure tests). The latter must show abnormal middle ear pressure to confirm the diagnosis, whereas often the hearing itself is spared.
Initial Treatment options:
In the first instance we would try to treat any factors that may be contributing to poor Eustachian tube function e.g. inflammation at the back of the nose.
The use of auto-inflation devices e.g. Otovent nasal balloon aim to use pressure to open the Eustachian tube. In some cases, surgery in the form of ventilation tubes (grommets) may be indicated.
Eustachian Tube Balloon Tuboplasty
A new and potentially long term treatment now exists for patients who fail to respond to conventional treatment or if no obvious cause is found to treat.
Balloon tuboplasty is a novel treatment adopted from the successful balloon sinuplasty principle. Under a general anaesthetic a catheter with an integral balloon is inserted through the nose into the Eustachian tube opening and advanced into the cartilaginous segment. The balloon is then inflated and kept in situ for 2 minutes before being removed. The procedure is done under a general anaesthetic and is performed on a day care basis. There is minimal discomfort in the post-operative period and patients can generally resume normal activities after 24 hours.
Balloon tuboplasty has been approved by NICE and the FDA.Leave a reply