Eustachian Tube Dysfunction

Question 1

Presentation of eustachian tube dysfunction

Answer 1

• Reduced or altered hearing
• Popping noises/sensations in the ear
• Fullness
• Otalgia or discomfort
• Tinnitus
• Worse when the external air pressure changes - flying, climbing a mountain or scuba diving

Question 2

Condition associated with eustachian tube dysfunction

Answer 2

URTI
Hayfever
Smoking

Question 3

Investigations for eustachian tube dysfunction

Answer 3

Otoscopy - normal

If persistent/ severe or problematic:

• Tympanometry
• Audiometry
• Nasopharyngoscopy
• CT scan to assess for structural pathology

Question 4

Tympanometry

Answer 4

1. Insert a device into the external auditory canal
2. Creates different air pressures in the canal
3. Send a sound in the direction of the tympanic membrane
4. Measure the amount of sound reflected back off the tympanic membrane
5. Plot a tympanogram (graph) of the sound absorbed (admittance) at different air pressures

Question 5

Admittance

Answer 5

The amount of sound absorbed by the tympanic membrane and middle ear which is not reflected back to the device

Question 6

Admittance in Eustachian tube dysfunction

Answer 6

Air pressure in the middle ear may be lower than the ambient air pressure because new air cannot get in through the tympanic membrane to equalise the pressures.

Therefore peak admittance (most sound absorbed) with negative ear canal pressures

Question 7

Management of Eustachian tube defects

Answer 7

No treatment - wait for it to resolve spontaneously (e.g., recovering from the viral URTI)

Valsalva manoeuvre (holding the nose and blowing into it to inflate the Eustachian tube)

Decongestant nasal sprays (short term only)

Antihistamines and a steroid nasal spray - allergies/ rhinitis

Surgery may be required in severe or persistent cases

Otovent

Question 8

Otovent

Answer 8

Over the counter device where the patient blows into a balloon using a single nostril, which can help inflate the Eustachian tube, clear blockages and equalise pressure

Question 9

Surgical options for eustachian tube defects

Answer 9

Treating underlying pathology - adenoidectomy (removal of the adenoids)

Grommets

Balloon dilatation Eustachian tuboplasty