What you should know about eustachian tube dysfunction

Nearly 11 million adults have been affected by eustachian tube dysfunction. Learn the causes, symptoms, and treatment for ETD.

Eustachian tube dysfunction is a condition that many people may experience at some point in their lives. However, it can sometimes go undiagnosed and untreated. The condition affects the ears and can lead to symptoms that range from mild to severe. 

Most cases of ETD are treatable and rarely lead to complications. However, it’s important to consult a healthcare provider for any problems that are affecting hearing or causing severe pain. A healthcare provider can determine whether a more serious medical condition is the underlying cause. 

Continue reading to learn more about ETD, the symptoms of ETD, and the available treatment options.

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What is eustachian tube dysfunction?

ETD encompasses several problems that can affect the eustachian tube, which is the tube that connects the middle ear to the back of the upper throat. The overall prevalence of ETD in the United States is around 5%, or nearly 11 million affected adults. 

The eustachian tubes have three main functions:

  1. They’re normally filled with air and help equalize pressure between the middle air and the atmosphere. 
  2. They help drain fluid and secretions from the middle ear to the throat. 
  3. They help prevent bacteria from traveling from the upper throat to the middle ears and causing an infection. 

The eustachian tubes have a valve-like structure at the opening in the middle ear, which helps to prevent the backflow of air and fluid into the middle ear. As the muscles in the wall of the eustachian tube contract, they open the valve and allow air to flow into or out of the middle ear, equalizing pressure. As the muscles relax, the valve closes and helps to prevent the backflow of air or fluid. 

If the valves of the eustachian tubes fail to work properly, various problems, such as middle ear infections or hearing problems, can develop. There are three main types of ETD that a person may experience. These include:

Patulous ETD

This type of ED occurs when the valve of the eustachian tube fails to close. If the tube remains open most of the time, air and sound can travel from the back of the upper throat to the ears.

Obstructive ETD 

This type of ETD occurs when the eustachian tube becomes partially or completely blocked. A blocked eustachian tube can result in negative pressure in the middle ear. 

Baro-challenge-induced ETD

This type of ETD occurs when the eustachian tube valve doesn’t open properly due to changes in air pressure. It can occur during air travel, scuba diving, skydiving, or driving in the mountains or at a high altitude. 

Eustachian tube dysfunction symptoms

ETD can cause various symptoms, depending on the type of ETD. In general, the most common symptoms of ETD include: 

  • Popping or crackling sounds in the ear 
  • A feeling of pressure in the ear
  • Muffled hearing
  • Ears feeling full or congested 
  • Tinnitus (ringing in the ear) 
  • Hearing difficulties 
  • Ear pain or discomfort
  • Vertigo or dizziness

People with ETD may experience diseases of the middle ear, such as otitis media with effusion, or excess fluid in the middle ear. In severe cases, hearing loss or permanent damage to the eardrum and middle ear can occur. The risk of serious symptoms of ETD is usually higher with long-term blockage of the eustachian tubes. 

Not everyone with ETD will experience the same symptoms of eustachian tube dysfunction, and the severity of symptoms can vary. People with patulous ETD may also experience the ability to hear echoes of their own voice or breathing, in addition to a feeling of fullness in the ear. 

A healthcare provider will diagnose ETD based on an assessment of these symptoms, a complete medical history, and various tools or exams. They may observe the eardrum (tympanic membrane) for changes in response to breathing. 

What causes eustachian tube dysfunction?

Eustachian tube problems can have various causes. The most common causes of ETD include inflammation, excess mucus, and fluid buildup in the tube. Allergic rhinitis (hay fever) and upper respiratory tract infections, such as the flu and common cold, can cause inflammation and blockage of the tube. 

Acid reflux or gastroesophageal reflux disease (GERD) can also cause ETD. The reflux of stomach acid into the esophagus can cause irritation and swelling in the throat, which can then extend to the eustachian tubes.

Other causes of ETD include structural changes or abnormal growths in the tube, weight changes such as weight gain or weight loss, autoimmune or neuromuscular diseases, and sinus infections. Stress and anxiety can also kick up stress-related hormones that can affect the balance of pressure and fluid in the inner ear. 

Certain people may be more at risk of ETD than others. These groups of people include:

  • Young children: Younger age is a risk factor for ETD. Children typically have shorter and narrower eustachian tubes than adults, which makes them more susceptible to blockages from mucus or inflammation. In addition, children often have more frequent colds and ear infections than adults, which can lead to more fluid buildup in the tube. 
  • People with allergies: Adults and children with allergies are more likely to experience mucus, inflammation, and congestion, which can contribute to ETD.
  • People with recent respiratory tract infections: A respiratory infection like the flu or common cold can cause inflammation and mucus buildup, which can cause ETD. 
  • People who frequently travel by airplane: People who travel by plane experience frequent altitude changes, which can lead to baro-challenge-induced ETD. 
  • People who’ve had their adenoids removed: The adenoid glands are situated in the nasopharynx or upper part of the back of the throat. The removal of these glands can be a risk factor for ETD. 
  • People with a history of smoking: Smoking can cause inflammation and irritation in the eustachian tubes. It can also cause damage to the small hairs (cilia) in the inner ear. 
  • People who are overweight or experience rapid weight loss: Excess weight can lead to fatty deposits around the eustachian tube, which can increase the risk of blockages. In addition, weight loss is a risk factor for patulous ETD, especially weight loss that occurs over a short period of time. 
  • People with GERD: Acid reflux is a known risk factor for ETD. Stomach acid can travel up the throat and reach the middle ear, leading to inflammation and irritation that can cause a blockage. 

Eustachian tube dysfunction treatment

The treatment for ETD will depend on the underlying cause and the severity of symptoms. Treatment may involve over-the-counter (OTC) medications, prescription drugs, surgical procedures, and home remedies. In some cases, a combination of treatments may be recommended. 

Oral decongestants

Oral decongestants, such as Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine), can help decrease nasal congestion and swelling in the inner ear. 

Decongestant nasal sprays

A decongestant spray, such as Afrin (oxymetazoline), can help reduce inflammation in the nasal passages to improve eustachian tube function.


Antihistamines, such as Zyrtec (cetirizine) and Claritin (loratadine), can help treat ETD symptoms caused by allergies, including swelling and nasal congestion. 

Nasal steroid sprays

Nasal steroids, such as Flonase (fluticasone) and Nasacort (triamcinolone), can also help provide relief for ETD symptoms caused by allergies. 

Prescription medications

In some cases, a healthcare provider may prescribe prescription drugs, such as antibiotics or corticosteroids, to treat a bacterial infection or inflammation causing ETD. 

Home remedies 

Some home remedies, such as using a humidifier or avoiding irritants such as tobacco smoke, may help improve ETD symptoms.

Self-massage and other self-care techniques

You can gently massage the area behind the ear, swallow and yawn, or chew gum to help improve ETD symptoms caused by altitude changes. These techniques help by promoting the opening and closing of the tubes.

Breathing techniques

The Valsalva maneuver is a breathing method that can be used to “pop” the ears and open the eustachian tubes. It involves taking a deep breath and bearing down as if trying to have a bowel movement. This maneuver may help open the tubes and equalize pressure between the middle ear and the outside environment.


In severe cases of ETD, a surgical procedure may be necessary. Surgical procedures for ETD include:

  • Eustachian tube balloon dilation: This is a minimally invasive procedure in which a small balloon is inserted into the eustachian tube and inflated to widen the tube.
  • Tympanoplasty: This procedure involves reconstructing or repairing the eardrum and the middle-ear bones to improve hearing and eustachian tube function.
  • Adenoidectomy: The removal of the adenoids, which can cause blockages in the Eustachian tubes, may improve ETD symptoms. 
  • Mastoidectomy: This procedure involves removing bone in the skull behind the ear to improve eustachian tube function.
  • Myringotomy: This procedure involves making a small incision in the eardrum to relieve pressure and promote fluid drainage from the middle ear. A small tube may be placed in the incision to keep it open and allow for continued ventilation of the middle ear.

It’s important to consult a healthcare provider when determining the best medical treatment for ETD symptoms. If symptoms don’t improve after treatment, speak with your healthcare provider. Treatment for ETD may carry risks and cause side effects, and the best course of treatment will depend on an individual’s situation. 

When to see a doctor

ETD symptoms can be mild and temporary. However, if you experience serious discomfort or pain, consult a healthcare provider. In addition, you should make an appointment with your healthcare provider if symptoms don’t seem to go away after one to two weeks or longer. 

Not getting a particular treatment may lead to severe consequences, such as permanent damage or hearing loss. Your healthcare provider may refer you to an ear, nose, and throat doctor for an appropriate diagnosis and treatment. 


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