Harvey's Garden

Eustachian tube dysfunction

2 min read

  • 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.

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