Eustachian tube dysfunction

Eustachian tube dysfunction (ETD) is defined as pressure abnormalities in the middle ear which result in symptoms.[2]

Eustachian tube dysfunction
SpecialtyENT surgery
SymptomsAural fullness, ears popping, pressure, a feeling the ears are clogged, crackling, ear pain, tinnitus, autophony, muffled hearing[1]
ComplicationsOtitis media, cholesteatoma[1]
TypesDilatory, baro-challenged induced, patulous[1]
CausesCommon cold, influenza, allergic rhinitis, sinusitis[1]
Differential diagnosisEndolymphatic hydrops, temporomandibular joint dysfunction, superior canal dehiscence syndrome, labyrinthine fistula[1]

Signs and symptoms

Symptoms include aural fullness, ears popping, a feeling of pressure in the affected ear(s), a feeling that the affected ear(s) is clogged, crackling, ear pain, tinnitus, autophony, and muffled hearing.[1]

Diagnosis

While Eustachian tube dysfunction can be hard to diagnose, due to the Eustachian tubes and the nasopharynx not being easily visible, usually a tympanometry is indicated, along with findings on an otoscopy. For cases of baro-challenge induced Eustachian tube dysfunction, diagnosis usually relies on the history of the patient and their reported symptoms, as otoscopy and tympanometry is sometimes normal at normal ambient pressure.[1] Opening pressure has been proposed as a method for preoperative and intraoperative evaluation of any obstructive process within the eustachian tube.[3] As well, Valasalva CT scanning using advanced 64 slice or higher machines has been proposed as a way of diagnosing and localizing anatomic obstruction within the Eustachain tube.[4]

Types

Four subtypes have been described:[1]

  1. Anatomic obstruction within the proximal cartilaginous eustachian tube.[5]
  2. Dilatory Eustachian tube dysfunction: Functional, dynamic (muscle failure), or anatomical obstruction of the Eustachian tube
  3. Baro-challenge induced Eustachian tube dysfunction: Eustachian tube dysfunction which generally features a normal otoscopy and normal tympanometry
  4. Patulous Eustachian tube dysfunction

Causes

Eustachian tube dysfunction can be caused by a number of factors. Some common causes include the flu, allergies, a cold, and sinus infections.[6] In Patients with chronic ear disease such as cholesteatoma and chronic discharge, studies showed that they suffer obstructive pathology at the ear side of the eustachain tube.[7][5] Given that proximity of that part of the eustachiant tube to the tympanic cavity, the site of frequent infections during childhood, it is logical to conclude that this segment of the tube experiences fibrosis and stenosis from recurrent infections. This is a possible explanation for the increased frequency of chronic ear disease in disadvantaged populations who lack access to medical care including antibiotics and tympanostomy tubes.[8]

Treatment

First-line treatment options are generally aimed at treating the underlying cause and include attempting to "pop" the ears, usually via the Valsalva maneuver, the use of oral or topical decongestants, oral steroids, oral antihistamines, and topical nasal steroid sprays, such as Flonase.[9]

If medical management fails, myringotomy, which is a surgical procedure in which an incision is made in the eardrum to drain pus from the middle ear or to relieve pressure caused by a large buildup of fluid, is indicated, and usually accompanied by the insertion of a tympanostomy tube.[10]

Tentative evidence supports the use of balloon dilation of the Eustachian tube.[11] Recently, Dennis Poe and co-workers published prospective, multicenter, randomized, controlled trial demonstrating efficacy of this technique.[12] Dilatation of the eustachian tube using balloon catheter has gained attention as a method of treating eustachian tube obstruction. There are two methods of performing this procedure depending on the route of the catheter introduction and the area of the Eustachian tube to be dilated. Dennis Poe have popularized the transnasal introduction and the dilatation of the distal (nose side) eustachian tube. Muaaz Tarabichi pioneered the transtympanic (trans-ear) introduction of the balloon catheter and the dilatation of the proximal part (the ear side) of the cartilaginous eustachian tube.[13][14][15]

References
  1. Schilder AG, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, et al. (October 2015). "Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis". Clinical Otolaryngology. 40 (5): 407–11. doi:10.1111/coa.12475. PMC 4600223. PMID 26347263.
  2. Tysome JR, Sudhoff H (2018). "The Role of the Eustachian Tube in Middle Ear Disease". Advances in Oto-Rhino-Laryngology. 81: 146–152. doi:10.1159/000485581. ISBN 978-3-318-06314-1. PMID 29794454.
  3. Tarabichi M, Kapadia M (October 2016). "Preoperative and Intraoperative Evaluation of the Eustachian Tube in Chronic Ear Surgery". Otolaryngologic Clinics of North America. Endoscopic Ear and Eustachian Tube Surgery. 49 (5): 1135–47. doi:10.1016/j.otc.2016.05.004. PMID 27468635.
  4. Tarabichi M, Najmi M (March 2015). "Visualization of the eustachian tube lumen with Valsalva computed tomography". The Laryngoscope. 125 (3): 724–9. doi:10.1002/lary.24979. PMID 25376511.
  5. Tarabichi M, Najmi M (November 2015). "Site of eustachian tube obstruction in chronic ear disease". The Laryngoscope. 125 (11): 2572–5. doi:10.1002/lary.25330. PMID 25958818.
  6. "Eustachian Tube Dysfunction". Family Doctor. American Academy of Family Physicians. Retrieved 18 August 2019.
  7. Linstrom CJ, Silverman CA, Rosen A, Meiteles LZ (November 2000). "Eustachian tube endoscopy in patients with chronic ear disease". The Laryngoscope. 110 (11): 1884–9. doi:10.1097/00005537-200011000-00022. PMID 11081604.
  8. Tarabichi M (January 2010). "Endoscopic transcanal middle ear surgery". Indian Journal of Otolaryngology and Head and Neck Surgery. 62 (1): 6–24. doi:10.1007/s12070-010-0007-7. PMC 3450149. PMID 23120674.
  9. "Eustachian Tube Dysfunction". McGovern Medical School - Otolaryngology - Head and Neck Surgery. The University of Texas Health Science Center at Houston (UTHealth). Retrieved 23 August 2019.
  10. "Treatments for Eustachian Tube Dysfunction". Stanford Health Care. Stanford Health Care. Retrieved 19 August 2019.
  11. Huisman JM, Verdam FJ, Stegeman I, de Ru JA (January 2018). "Treatment of Eustachian tube dysfunction with balloon dilation: A systematic review". The Laryngoscope. 128 (1): 237–247. doi:10.1002/lary.26800. PMID 28799657.
  12. Poe D, Anand V, Dean M, Roberts WH, Stolovitzky JP, Hoffmann K, et al. (May 2018). "Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial". The Laryngoscope. 128 (5): 1200–1206. doi:10.1002/lary.26827. PMID 28940574.
  13. Tarabichi M, Najmi M (July 2015). "Transtympanic dilatation of the eustachian tube during chronic ear surgery". Acta Oto-Laryngologica. 135 (7): 640–4. doi:10.3109/00016489.2015.1009640. PMID 25762371.
  14. Kapadia M, Arsiwala Z, Tarabichi M (September 2019). "Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique". World Journal of Otorhinolaryngology - Head and Neck Surgery. 5 (3): 152–159. doi:10.1016/j.wjorl.2019.08.006. PMC 6849365. PMID 31750428.
  15. Kapadia M, Tarabichi M (October 2018). "Feasibility and Safety of Transtympanic Balloon Dilatation of Eustachian Tube". Otology & Neurotology. 39 (9): e825–e830. doi:10.1097/MAO.0000000000001950. PMID 30124616.
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