The Eustachian tube connects each middle ear (an air-filled cavity behind your ear drum) with the back of the throat. The normal position of the Eustachian tubes is closed, however, they open when we swallow or yawn. If you want to know how they do that, they are attached to the tensor veli palatini muscles in your soft palate which is activated automatically whenever you yawn or swallow.
What causes the Eustachian Tube to block?
ETD can be caused by a middle ear infection, resulting in the build-up of fluid behind the eardrum causing the eardrum to become retracted. Other common causes include during or after a cold, allergies, sinus infections, soar throat, chest infection, altitude changes, or infected adenoids (two small pads of tissue, close to the Eustachian tubes, that are believed to play a role in immune system activity). If the Eustachian tube is blocked or does not open properly, air cannot get into or escape from the middle ear resulting in unequal pressure on either side of the eardrum, The feeling is perceived by many and blockage of the ear due to ear wax. This can cause mild pain, discomfort, popping and/or blocked sensation, hearing loss, tinnitus or dizziness. The other sign of it is that you hear crackling in your ear when swallow water.
How to treat Eustachian Tube Dysfunction
ETD generally resolves by itself without treatment. However, there are a number of ways to provide relief and these are described below. If symptoms are severe or persistent for more than two weeks then it is recommended to seek the advice of your GP.
There are a number of methods that help equalise this pressure in the ears which can be carried out at home. Each or a combination of these techniques may need to be done multiple times in order to provide relief.
NOTE: We advise against practising ear equalisation techniques if you have a current or recent middle ear infection, unless on the advice of your GP or other medical doctors.
Congestion relief spray and gargling warm water
Congestion relief of your ET can be provided by over-the-counter decongestant nasal sprays such as Sterimar Congestion Relief. This can be used 3-5 times daily. Relief should be felt within 2-3 days, after which the frequency of use can be reduced until relief is maintained. In addition to the nasal spray gargling half a glass of warm water with half a teaspoon salt would help clean up the clog at your Eustachian tubes. When you gargle a saline solution you are washing the entrance of your Eustachian tube that in essence should be open now due to gargling. The nasal spray can be handy if you are not in a position to gargle repeatedly. Please make sure that the water you use for gargling is clean and not hot. If symptoms persist, seek the advice of your GP.
Equalisation techniques for Eustachian Tube Dysfunction
Valsalva manoeuvre: Take a breath inwards, close your mouth, pinch your nose and gently blow outwards through your nose until you feel your ears pop.
Toynbee manoeuvre: Take a sip of water, pinch your nose and swallow the water with your nose pinched.
Lowry manoeuvre: This technique is a combination of the Valsalva and Toynbee methods. It involves pinching the nose, closing the mouth, gently breathing outwards and swallowing at the same time.
Jaw wriggling technique: Open your mouth and wriggle your jaw from side to side until your ears pop.
Another alternative is to use the Otovent, or Eustachi which increases pressure in the nose and opens the Eustachian tube. This allows pressure equalisation and if fluid is present behind the eardrum, it allows this to be cleared. An otovent kit can be bought from a pharmacy or can be obtained by special order without a prescription. The kit generally consists of a plastic device and balloons. It does not matter which nostril is used or if you only feel blocked on one side, this technique can be safely followed.
Surgical Treatment For Eustachian Tube Dysfunction
Myringotomy ("Grommets")
In the case of frequent middle ear infections, a referral may be made to an Ear, Nose and Throat (ENT) surgeon. The surgeon may recommend an operation to make a tiny incision in the eardrum (known as a myringotomy) and insert a ventilation tube (tympanostomy tube or "grommet") into the ear drum. This will allow fluid to drain from the middle ear, and for the air pressure to equalise on either side of the eardrum. Ear ventilation tubes usually fall out on their own after six to nine months. After this surgery, it is important to keep the ears dry, as otherwise if any water gets into the ear canal it can cause a middle ear infection.
Balloon Dilatation of the Eustachian tube
This is a relatively new operation (only available since 2011 in America, and FDA approval was only granted late in 2016). During the procedure, a balloon is passed through the nose and inserted into the Eustachian tube and then water is used to inflate the balloon to 10 bar for 2 minutes. This stretches the Eustachian tube and can potentially cure Eustachian tube dysfunction. Often, a grommet operation will be performed before this surgery as a test to increase the likelihood of success with balloon dilation. The criteria for this operation and the pre-operation tests are far more stringent than for myringotomy, but one advantage is that patients don't need to avoid getting their ears wet afterwards.
Here's a video by Dr Cliff on unclogging your ears:
But What If It's Just Ear Wax?
The blocked sensation you get from ear wax can be very similar to the symptoms of Eustachian tube dysfunction. With ETD, the hearing in one or both ears often "pops" in and out. This can be very similar to the sensation of intermittent hearing loss when ear wax moves around in the canal as it moves from a wide point to a narrow point of the canal and back again. If you think you have ear wax then why not book an appointment at one of our ear wax removal London clinics?
What would video otoscopy show in the case of an ETD?
Often a video otoscopy shows a healthy and normal eardrum. In some cases, there may be a fluid behind the ear, often with bubbles of air. Please see below for a sample.
References
Schilder AG, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, Norman G, Pennings RJ, Poe D, Silvola JT, Sudhoff H, Lund VJ. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol. 2015 Oct;40(5):407-11. doi: 10.1111/coa.12475. PMID: 26347263; PMCID: PMC4600223.
Philip Fireman, Otitis media and eustachian tube dysfunction: Connection to allergic rhinitis, Journal of Allergy and Clinical Immunology, Volume 99, Issue 2,
1997, Pages s787-s797, ISSN 0091-6749, https://doi.org/10.1016/S0091-6749(97)70130-1.
Fischer JL, Riley CA, Hsieh M-C, Marino MJ, Wu X-C, McCoul ED. Prevalence of Eustachian Tube Dysfunction in the US Elderly Population. Otolaryngology–Head and Neck Surgery. 2020;163(6):1169-1177. doi:10.1177/0194599820932541
Hwang SY, Kok S, Walton J. Balloon dilation for eustachian tube dysfunction: systematic review. The Journal of Laryngology & Otology. 2016;130(S4):S2-S6. doi:10.1017/S0022215116008252
