Eustachian Tube Dysfunction Treatment

Our ear, nose and throat (ENT) specialists offer a wide range of treatment options for eustachian tube dysfunction. Treatments range from nasal decongestants to surgery. We work with you to determine the most effective treatment plan that will offer a successful long-term outcome.

Eustachian tube dysfunction: Treating allergies and nasal decongestion

Identifying and treating nasal allergies may help to reduce the swelling in the lining of the eustachian tube. There are a number of different ways we can treat allergies, and we will discuss the options with you:

• Identifying the particular allergen you are sensitive to and eliminating it from the environment
• Giving allergy shots, though it may take a long time to notice beneficial effects
• Giving intranasal steroids to reduce inflammation of the mucosal lining of the nose. We usually recommend a two-week trial to see if the medication is helpful.
• Prescribing decongestants, which constrict blood vessels and help open the eustachian tube by reducing swelling of the lining of the nose. These medications work immediately and can be taken as needed. Keep in mind that:
  • Oral medications work for about four hours and should not be used around bedtime because they may make it difficult to get to sleep.
  • Nasal spray preparations work well and directly decongest the nose; however, because the body rapidly gets used to the medication, they should only be used for up to three days in a row.
  • Antihistamines work to reduce the body's inflammatory response to allergens. These medications may be helpful for some patients and can be taken as needed.

Self-inflation of the ears to treat eustachian tube dysfunction

You may be able to improve your symptoms pinching your nose closed and “popping” your ear. This helps by forcibly air through the eustachian tube into the middle ear. You can also achieve the same effect by blowing up balloons. The pressure required to expand a balloon is usually enough to push air up the eustachian tube.

This is a very useful maneuver and may be repeated as often as necessary, whenever a sense of pressure or fullness in the ear develops. Do not perform this when you have a cold or any nasal discharge because it may drive infected mucous into the middle ear and cause an ear infection.

Surgical treatment for eustachian tube dysfunction

The primary goal of surgical treatment is to bypass the eustachian tube in order to ventilate the middle ear. Surgery can restore hearing, relieve pressure sensation in the ear and reduce the tendency for middle ear infections.

Types of surgery include:

Myringotomy - We make a tiny incision in the eardrum and suction out any fluid in the middle ear. In adults, the incision often stays open long enough to allow the swelling in the Eustachian tube lining to resolve. After the eardrum heals (usually within one to three days), fluid in the middle ear fluid may begin to re-accumulate if the Eustachian tube lining has not recovered.

Pressure equalization tubes - During this procedure we will:

1. Make an incision in the eardrum and suction out any middle ear fluid
2. Insert a tiny hollow tube made of plastic or metal into the eardrum

Over time, the tube is pushed out as the eardrum heals. A pressure equalization tube usually provides middle ear ventilation for six to 12 months. Often, the eustachian tube will have recovered by this time, and we will not need to replace the tubes. If you have a more chronic condition, however, we can use longer lasting tubes. In adults, the procedure takes about five minutes and can be performed in the office using a topical anesthetic. In children, we will use a light general anesthetic.

Caring for pressure equalization tubes

It is important to keep water out of your ears when you have pressure equalization tubes. This means:

• Using earplugs or a cotton ball smothered in petroleum jelly while bathing
• Wearing custom earplugs fit to your ear when going swimming

Water that gets into the ear canal can carry bacteria through the tube into the middle ear space and cause an ear infection. This is called a purulent drainage (white, green or yellow pus) from the ear. We treat this type of ear infection with antibiotic eardrops.

The other risk of either a myringotomy or a pressure equalization tube is that the incision may not heal. This may eventually require surgery (tympanoplasty) to patch the hole.