Eustachian tube dysfunction

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Eustachian tube dysfunction
Specialty ENT surgery
Symptoms Aural fullness, ears popping, pressure, a feeling the ears are clogged, crackling, ear pain, tinnitus, autophony, muffled hearing [1]
Complications Otitis media, cholesteatoma [1]
TypesDilatory, baro-challenged induced, patulous [1]
Causes Common cold, influenza, allergic rhinitis, sinusitis [1]
Differential diagnosis Endolymphatic hydrops, temporomandibular joint dysfunction, superior canal dehiscence syndrome, labyrinthine fistula [1]

Eustachian tube dysfunction (ETD) is a disorder where pressure abnormalities in the middle ear result in symptoms. [2]

Contents

Signs and symptoms

Symptoms include aural fullness, ears popping, a feeling of pressure in the affected ear(s), a feeling that the affected ear(s) is clogged, crackling, ear pain, tinnitus, autophony, and muffled hearing. [1]

Diagnosis

While Eustachian tube dysfunction can be hard to diagnose, due to the Eustachian tubes and the nasopharynx not being easily visible, usually a tympanometry is indicated, along with findings on an otoscopy. For cases of baro-challenge induced Eustachian tube dysfunction, diagnosis usually relies on the history of the patient and their reported symptoms, as otoscopy and tympanometry is sometimes normal at normal ambient pressure. [1] Opening pressure has been proposed as a method for preoperative and intraoperative evaluation of any obstructive process within the Eustachian tube. [3] As well, Valsalva CT scanning using advanced 64 slice or higher machines has been proposed as a way of diagnosing and localizing anatomic obstruction within the Eustachian tube. [4]

Types

Four subtypes have been described: [1]

  1. Anatomic obstruction within the proximal cartilaginous eustachian tube. [5]
  2. Dilatory Eustachian tube dysfunction: Functional, dynamic (muscle failure), or anatomical obstruction of the Eustachian tube
  3. Baro-challenge induced Eustachian tube dysfunction: Eustachian tube dysfunction which generally features a normal otoscopy and normal tympanometry
  4. Patulous Eustachian tube dysfunction

Causes

Eustachian tube dysfunction can be caused by a number of factors. Some common causes include the flu, allergies, a cold, and sinus infections. [6] In patients with chronic ear disease such as cholesteatoma and chronic discharge, studies showed that they have obstructive pathology at the ear side of the Eustachian tube. [7] [5] Given that proximity of that part of the Eustachian tube to the tympanic cavity, the site of frequent infections during childhood, it is logical to conclude that this segment of the tube experiences fibrosis and stenosis from recurrent infections. This is a possible explanation for the increased frequency of chronic ear disease in disadvantaged populations who lack access to medical care including antibiotics and tympanostomy tubes. [8]

Treatment

First-line treatment options are generally aimed at treating the underlying cause and include attempting to "pop" the ears, usually via the Valsalva maneuver, the use of oral or topical decongestants, oral steroids, oral antihistamines, and topical nasal steroid sprays, such as Flonase. [9]

If medical management fails, myringotomy, which is a surgical procedure in which an incision is made in the eardrum to drain pus from the middle ear or to relieve pressure caused by a large buildup of fluid, is indicated, and usually accompanied by the insertion of a tympanostomy tube. [10]

Tentative evidence supports the use of balloon dilation of the Eustachian tube. [11] In 2018, researchers published a prospective, multicenter, randomized, controlled trial demonstrating efficacy of this technique. [12] Dilatation of the eustachian tube using balloon catheter has gained attention as a method of treating eustachian tube obstruction. There are two methods of performing this procedure depending on the route of the catheter introduction and the area of the Eustachian tube to be dilated. [13] [14] [15]

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, a feeling that phlegm is oozing out from the back of the nose to the throat along with a necessity to clear the throat frequently and frequent attacks of cough.

<span class="mw-page-title-main">Cholesteatoma</span> Medical condition

Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of their erosive and expansile properties. This can result in the destruction of the bones of the middle ear (ossicles), as well as growth through the base of the skull into the brain. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal.

<span class="mw-page-title-main">Eardrum</span> Membrane separating the external ear from the middle ear

In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air to the ossicles inside the middle ear, and then to the oval window in the fluid-filled cochlea. Hence, it ultimately converts and amplifies vibration in the air to vibration in cochlear fluid. The malleus bone bridges the gap between the eardrum and the other ossicles.

<span class="mw-page-title-main">Eustachian tube</span> Tube connecting middle ear to throat

In anatomy, the Eustachian tube, also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately 35 mm (1.4 in) long and 3 mm (0.12 in) in diameter. It is named after the sixteenth-century Italian anatomist Bartolomeo Eustachi.

<span class="mw-page-title-main">Valsalva maneuver</span> Technique for equalising pressure in the middle ears

The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air out as if blowing up a balloon. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to clear the ears and sinuses when ambient pressure changes, as in scuba diving, hyperbaric oxygen therapy, or air travel.

Stapedectomy is a surgical procedure in which the stapes bone is removed from the middle ear and replaced with a prosthesis.

A myringotomy is a surgical procedure in which an incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube may be inserted through the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of a tube, the incision usually heals spontaneously within two to three weeks. Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure.

<span class="mw-page-title-main">Tympanostomy tube</span> Medical device inserted into the eardrum

Tympanostomy tube, also known as a grommet or myringotomy tube, is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a myringotomy and is performed under local or general anesthesia. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. When it is necessary to keep the middle ear ventilated for a very long period, a "T"-shaped tube may be used, as these "T-tubes" can stay in place for 2–4 years. Materials used to construct the tube are most often plastics such as silicone or Teflon. Stainless steel tubes exist, but are no longer in frequent use.

Balloon sinuplasty is a procedure that ear, nose and throat surgeons may use for the treatment of blocked sinuses. Patients diagnosed with sinusitis but not responding to medications may be candidates for sinus surgery. Balloon technology was initially cleared by the U.S. Food and Drug Administration in 2005 and is an endoscopic, catheter-based system for chronic sinusitis. It uses a balloon over a wire catheter to dilate sinus passageways. The balloon is inflated with the goal of dilating the sinus openings, widening the walls of the sinus passageway and restoring normal drainage.

Silent sinus syndrome is a spontaneous, asymptomatic collapse of an air sinus associated with negative sinus pressures. It can cause painless facial asymmetry, diplopia and enophthalmos. Diagnosis is suspected based on symptoms, and can be confirmed using a CT scan. Treatment is surgical involving making an outlet for mucous drainage from the obstructed sinus, and, in some cases, paired with reconstruction of the orbital floor. It is slightly more common in middle age.

<span class="mw-page-title-main">Perforated eardrum</span> Injury leading to a hole in the eardrum

A perforated eardrum is a hole in the eardrum. It can be caused by infection, trauma, overpressure, inappropriate ear clearing, and changes in middle ear pressure. An otoscope can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally, or require surgery.

<span class="mw-page-title-main">Functional endoscopic sinus surgery</span> Surgery to enlarge the paranasal sinus drainage pathways

Functional endoscopic sinus surgery (FESS) is a procedure that is used to treat sinusitis and other conditions that affect the sinuses. Sinusitis is an inflammation of the sinuses that can cause symptoms such as congestion, headaches, and difficulty breathing through the nose.

<span class="mw-page-title-main">Subglottic stenosis</span> Medical condition

Subglottic stenosis is a congenital or acquired narrowing of the subglottic airway. It can be congenital, acquired, iatrogenic, or very rarely, idiopathic. It is defined as the narrowing of the portion of the airway that lies between the vocal cords and the lower part of the cricoid cartilage. In a normal infant, the subglottic airway is 4.5-5.5 millimeters wide, while in a premature infant, the normal width is 3.5 millimeters. Subglottic stenosis is defined as a diameter of under 4 millimeters in an infant. Acquired cases are more common than congenital cases due to prolonged intubation being introduced in the 1960s. It is most frequently caused by certain medical procedures or external trauma, although infections and systemic diseases can also cause it.

<span class="mw-page-title-main">Laryngotracheal stenosis</span> Medical condition

Laryngotracheal stenosis refers to abnormal narrowing of the central air passageways. This can occur at the level of the larynx, trachea, carina or main bronchi. In a small number of patients narrowing may be present in more than one anatomical location.

A mastoidectomy is a procedure performed to remove the mastoid air cells, air bubbles in the skull, near the inner ears. This can be done as part of treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. In addition, it is sometimes performed as part of other procedures or for access to the middle ear. There are classically 5 different types of mastoidectomy:

<span class="mw-page-title-main">Tympanic membrane retraction</span> Medical condition

Tympanic membrane retraction describes a condition in which a part of the eardrum lies deeper within the ear than its normal position.

Endoscopic ear surgery (EES) is a minimally invasive alternative to traditional ear surgery and is defined as the use of the rigid endoscope, as opposed to a surgical microscope, to visualize the middle and inner ear during otologic surgery. During endoscopic ear surgery the surgeon holds the endoscope in one hand while working in the ear with the other. To allow this kind of single-handed surgery, different surgical instruments have to be used. Endoscopic visualization has improved due to high-definition video imaging and wide-field endoscopy, and being less invasive, EES is gaining importance as an adjunct to microscopic ear surgery.

Muaaz Tarabichi is a Syrian otolaryngologist, lecturer, researcher, and author. He is recognized around the world as the father of endoscopic ear surgery. He is the co-founder of Tarabichi Stammberger Ear and Sinus Institute. He was elected as the chairman of the International Advisory Board of the American Academy of Otolaryngology–Head and Neck Surgery.

Tubomanometry is a technique for assessing the eustachian tube opening function, and sometimes to determine a treatment plan. This technique was familiarised by D. Estève et al in 2001.

Middle ear barotrauma (MEBT), also known to underwater divers as ear squeeze and reverse ear squeeze, is an injury caused by a difference in pressure between the external ear canal and the middle ear. It is common in underwater divers and usually occurs when the diver does not equalise sufficiently during descent or, less commonly, on ascent. Failure to equalise may be due to inexperience or eustachian tube dysfunction, which can have many possible causes. Unequalised ambient pressure increase during descent causes a pressure imbalance between the middle ear air space and the external auiditory canal over the eardrum, referred to by divers as ear squeeze, causing inward stretching, serous effusion and haemorrhage, and eventual rupture. During ascent internal over-pressure is normally passively released through the eustachian tube, but if this does not happen the volume expansion of middle ear gas will cause outward bulging, stretching and eventual rupture of the eardrum known to divers as reverse ear squeeze. This damage causes local pain and hearing loss. Tympanic rupture during a dive can allow water into the middle ear, which can cause severe vertigo from caloric stimulation. This may cause nausea and vomiting underwater, which has a high risk of aspiration of vomit or water, with possibly fatal consequences.

References

  1. 1 2 3 4 5 6 7 8 Schilder AG, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, et al. (October 2015). "Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis". Clinical Otolaryngology. 40 (5): 407–11. doi:10.1111/coa.12475. PMC   4600223 . PMID   26347263.
  2. ↑ Tysome JR, Sudhoff H (2018). "The Role of the Eustachian Tube in Middle Ear Disease". Advances in Oto-Rhino-Laryngology. 81: 146–152. doi:10.1159/000485581. ISBN   978-3-318-06314-1. PMID   29794454.
  3. ↑ Tarabichi M, Kapadia M (October 2016). "Preoperative and Intraoperative Evaluation of the Eustachian Tube in Chronic Ear Surgery". Otolaryngologic Clinics of North America. Endoscopic Ear and Eustachian Tube Surgery. 49 (5): 1135–47. doi:10.1016/j.otc.2016.05.004. PMID   27468635.
  4. ↑ Tarabichi M, Najmi M (March 2015). "Visualization of the eustachian tube lumen with Valsalva computed tomography". The Laryngoscope. 125 (3): 724–9. doi:10.1002/lary.24979. PMID   25376511. S2CID   29964314.
  5. 1 2 Tarabichi M, Najmi M (November 2015). "Site of eustachian tube obstruction in chronic ear disease". The Laryngoscope. 125 (11): 2572–5. doi:10.1002/lary.25330. PMID   25958818. S2CID   7223491.
  6. ↑ "Eustachian Tube Dysfunction". Family Doctor. American Academy of Family Physicians. Retrieved 18 August 2019.
  7. ↑ Linstrom CJ, Silverman CA, Rosen A, Meiteles LZ (November 2000). "Eustachian tube endoscopy in patients with chronic ear disease". The Laryngoscope. 110 (11): 1884–9. doi: 10.1097/00005537-200011000-00022 . PMID   11081604. S2CID   24591911.
  8. ↑ Tarabichi M (January 2010). "Endoscopic transcanal middle ear surgery". Indian Journal of Otolaryngology and Head and Neck Surgery. 62 (1): 6–24. doi:10.1007/s12070-010-0007-7. PMC   3450149 . PMID   23120674.
  9. ↑ "Eustachian Tube Dysfunction". McGovern Medical School - Otolaryngology - Head and Neck Surgery. The University of Texas Health Science Center at Houston (UTHealth). Retrieved 23 August 2019.
  10. ↑ "Treatments for Eustachian Tube Dysfunction". Stanford Health Care. Stanford Health Care. Retrieved 19 August 2019.
  11. ↑ Huisman JM, Verdam FJ, Stegeman I, de Ru JA (January 2018). "Treatment of Eustachian tube dysfunction with balloon dilation: A systematic review". The Laryngoscope. 128 (1): 237–247. doi: 10.1002/lary.26800 . PMID   28799657. S2CID   3561126.
  12. ↑ Poe D, Anand V, Dean M, Roberts WH, Stolovitzky JP, Hoffmann K, et al. (May 2018). "Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial". The Laryngoscope. 128 (5): 1200–1206. doi: 10.1002/lary.26827 . PMID   28940574. S2CID   4968887.
  13. ↑ Tarabichi M, Najmi M (July 2015). "Transtympanic dilatation of the eustachian tube during chronic ear surgery". Acta Oto-Laryngologica. 135 (7): 640–4. doi:10.3109/00016489.2015.1009640. PMID   25762371. S2CID   39239009.
  14. ↑ Kapadia M, Arsiwala Z, Tarabichi M (September 2019). "Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique". World Journal of Otorhinolaryngology - Head and Neck Surgery. 5 (3): 152–159. doi:10.1016/j.wjorl.2019.08.006. PMC   6849365 . PMID   31750428.
  15. ↑ Kapadia M, Tarabichi M (October 2018). "Feasibility and Safety of Transtympanic Balloon Dilatation of Eustachian Tube". Otology & Neurotology. 39 (9): e825–e830. doi:10.1097/MAO.0000000000001950. PMID   30124616. S2CID   52041093.
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