Eustachian tube dysfunction in adults: from symptoms to treatment

Around one in every 100 adults in the UK has Eustachian tube dysfunction. Allergies and illnesses, such as a cold or sinusitis, are the most common causes of Eustachian tube dysfunction. It occurs when negative pressure develops in the middle part of your ears — the same feeling you may experience when you’re on a plane at take off or landing.

Eustachian tube dysfunction prevents enough air reaching your middle ear, which causes discomfort due to the build up of negative pressure in the middle ear. As the name suggests, this is due to a problem with the Eustachian tube, a tube that runs from the middle ear to the back of your throat. 

What are the symptoms of Eustachian tube dysfunction?

The main symptoms are a feeling of pressure in your ears as if they are blocked, feeling as if you’re underwater and so can’t hear clearly, discomfort and pain. Some people may also develop tinnitus ie buzzing or whistling sounds coming from inside your ears rather than the outside world. 

These symptoms worsen whenever you catch a cold or develop sinusitis, or when you experience altitude changes eg travelling by plane or even going up and down hills in a car. 

If you persistently experience any of these symptoms and/or they are affecting your lifestyle, see your GP. 

How to treat Eustachian tube dysfunction at home

In most cases, Eustachian tube dysfunction can be managed at home. There are several different things you can try. 

Steam inhalation can ease symptoms by getting more warm air into your nose and subsequently your Eustachian tubes. 

There are also two different devices you can try: the Otovent® and the Ear Popper®. 

The Otovent® consists of a balloon with a special tube attached at one end. The opening of the tube is placed into one of your nostrils. You then blow up the balloon through your nose. This helps open up the Eustachian tube.

The Ear Popper® is a more expensive device that is battery operated. It is inserted into one of your nostrils and shoots tiny jets of air into your nose to get more air into your Eustachian tube.

You can also try over-the-counter nasal sprays that contain steroids. These can also be prescribed by your GP. 

If you know that you only experience symptoms of Eustachian tube dysfunction when flying, try these approaches just before and just after flying to reduce or prevent your symptoms. 

If these treatments aren’t effective, your GP can refer you to an Ear, Nose and Throat (ENT) surgeon. After discussing your symptoms your ENT surgeon will recommend an appropriate treatment. 

Treatments for Eustachian tube dysfunction

Your ENT surgeon may recommend Eustachian tube balloon dilatation, an innovative treatment introduced over the last few years. It involves inserting a balloon catheter into your nose ie a thin, inflatable tube. The balloon catheter is guided to your Eustachian tube where it is inflated and held for several minutes. It is effective in up to 70% of patients and can be performed under local or general anaesthesia. It is a quick day case procedure, with minimal complications, and you can return to work the next day. 

If balloon dilatation isn’t successful, your doctor may then recommend grommet surgery. This is a more invasive procedure where a thin, hollow plastic tube is inserted into your middle ear through your eardrum. This completely bypasses your Eustachian tube. 

Unlike in children, where grommet surgery to treat glue ear comes with a very low risk of complications, in adults, grommet surgery is more likely to cause problems. Sometimes, the resulting complications are worse than the symptoms of Eustachian tube dysfunction, which is why grommet surgery is usually only recommended when all other treatments have failed. 

Complications of grommet surgery in adults can include autophony, where your own voice sounds different to you than it did before surgery, tinnitus, or in some cases, a perceived reduction in hearing. 

Do you need surgery for Eustachian tube dysfunction?

If you’re concerned that you may have Eustachian tube dysfunction, it is important to see your GP, who may refer you to see an ENT surgeon, if appropriate. 

Many of the symptoms of Eustachian tube dysfunction can be caused by other conditions eg pressure in your ear may be caused by neck arthritis or postural issues with your neck. This makes it important to see an ENT doctor who specialises in Eustachian tube dysfunction to reduce the risk of a misdiagnosis. 

Misdiagnosis is one potential reason why surgery for Eustachian tube dysfunction may be unsuccessful. An experienced ENT surgeon will be able to thoroughly investigate your symptoms to determine whether or not you have Eustachian tube dysfunction and whether surgery is appropriate. 

Author biography

Mr Sameer Khemani is a Consultant ENT Surgeon at Spire Gatwick Park Hospital and Surrey and Sussex NHS Trust, specialising in tonsillectomy and adenotonsillectomy, Eustachian tube balloon dilatation, obstructive sleep apnoea and snoring, and grommets insertion. He graduated from Guy's and St Thomas' Hospital Medical Schools, London and trained at a number of prestigious surgical centres, including University College Hospital, Charing Cross Hospital and the Royal National Throat, Nose and Ear Hospital. He also holds a Masters in Surgical Education with distinction from Imperial College London.