Eustachian tube dysfunction

What it is: Failure of the Eustachian tube (connects middle ear to nasopharynx) to properly open or close, leading to pressure dysregulation in the middle ear.

ET Functions: Equalize pressure, protect middle ear, drain secretions.

Muscles Opening ET: Primarily Tensor Veli Palatini and Levator Veli Palatini.

Two Main Types:

• Obstructive ETD (Common): Tube fails to open.
  • Causes: URI (most common), allergies, sinusitis, adenoid hypertrophy (kids), nasopharyngeal carcinoma (red flag: unilateral ETD in adults), GERD.
  • Patho: Negative middle ear pressure -> fluid (Otitis Media with Effusion - OME), TM retraction.
• Patulous ETD (Less Common): Tube stays open.
  • Causes: Significant weight loss, neuromuscular issues.
  • Symptoms: Autophony (hearing own voice/breathing loudly).

Key Symptoms (Obstructive ETD):

• Ear fullness/pressure, "clogged" feeling.
• Muffled hearing (conductive).
• Popping/crackling sounds.
• Ear pain (otalgia).
• Worse with pressure changes (flying, diving).

Otoscopy Findings (Obstructive ETD):

• Retracted TM.
• Decreased TM mobility (pneumatic otoscopy).
• Air-fluid levels or bubbles (OME).
• Dull/opacified TM.

Diagnosis:

• Mainly clinical (history & otoscopy).
• Tympanometry: Confirms middle ear pressure/fluid (Type C or B).

Management Principles:

• Conservative: Valsalva, yawning, swallowing.
• Treat Underlying Cause: Decongestants (short-term for URI), intranasal steroids (allergies).
• Surgical (if refractory/complicated):
  • Tympanostomy tubes: For persistent OME, recurrent AOM, significant TM retraction.
  • Adenoidectomy (if hypertrophied).

Major Complications (from chronic obstructive ETD):

• Otitis Media with Effusion (OME): Non-infected fluid; conductive hearing loss -> speech delay in kids.
• Acute Otitis Media (AOM): Bacterial infection (S. pneumo, H. flu, M. cat).
• Chronic Otitis Media.
• TM Retraction Pockets.
• Cholesteatoma: Erosive keratin debris collection; serious, requires surgery.
• Conductive Hearing Loss.

Key Associations:

• Children: More prone due to ET anatomy; adenoids common factor.
• Craniofacial anomalies: (e.g., Down syndrome, cleft palate) -> higher ETD risk.
• Barotrauma: Risk with ETD.