Dr. Denis Grillo, Ear, Nose & Throat, 07/03/12

The Eustachian tube is a small tube that connects the middle ear, or the inside of the eardrum, with the rest of the head. It is part of a system of organs, including the nose, throat, the middle ear and the mastoid.

It functions as a ventilator of the middle ear space. When it is working well, it keeps the pressure between the middle ear and the environment equal. When it is not working well, negative pressure can build up, and that can lead to discomfort, fullness and even ear pain.

Some of the most common causes of Eustachian tube dysfunction include insufficient swallowing, dryness, mechanical obstruction due to tissues such as adenoids blocking the tube opening, and inflammation reactions that cause tissue swelling and cause the tube not to work well.

Doctors and scientists have been studying the Eustachian tube for hundreds of years, and thought it was a simple tube structure that, when working well, was always open, and when it was not working well, was blocked.

What they discovered in the latter 20th century is that the Eustachian tube opens and closes. Part of the tube structure is bony and does not change much in size, but part of it is cartilage, and it has a valve-like function, and this is where some of the problems seem to occur.

Children have Eustachian tube problems and middle ear problems from adenoids and ear infections. Adults get the problem from flying in airplanes, diving or having sinus infections, allergies or colds.

Adults have fewer problems than infants because the tube is shorter, narrower and more horizontal in children until the age of about 3 to 5 years, and that is why most people grow out of Eustachian tube and middle ear problems as they hit adolescence and puberty.
I think we all have experienced Eustachian tubes when they worked well, and some of us have experienced Eustachian tubes when they have not worked so well.

Most all patients come in and relate experience to me when they swallow, their ears pop and the hearing becomes crisp and clear. That moment the Eustachian tube is open and the pressure is exactly the same as the environment, so the hearing and eardrum performance is not hindered by negative pressure.

Most of the time the tube is closed, and it opens when we yawn or swallow. Certain muscles in the back of the nose and throat area cause that to occur. This occurs many times a day, and we are not even aware of it because it works so well. But when it does not work well, it certainly will get our attention in the form of the ear being blocked or even painful, as well as some diminishment in hearing.

Treatment for Eustachian tube problems usually is resolution of the underlying cause, such as a cold, allergy, sinus infection, or it could come as a result of getting tonsils and adenoids removed, or getting ear tubes.

For people who suffer into adulthood, Eustachian tube surgery has been going on for a number of years. The most recent advancement includes the use of balloons, which dilate the Eustachian tube much like a balloon dilates a heart vessel. In this instance, we are trying to increase airflow, and these newer techniques look to be more promising as past traditional surgeries, which include cutting, have not been as promising. The likely cause is scar tissue that forms when you cut. This can be avoided when using the balloon.

Current research and studies will likely bring better treatment for Eustachian tube dysfunction. Research will likely continue, as it has since Bartholomeus Eustachius first started publishing research on the Eustachian tube in the 1500s.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.