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As I mentioned yesterday I was diagnosed with ETD by my Nose, Ear and Throat doctor--knowing very little (actually nothing!!) I decided to google it and this is what came up.
Eustachian Tube Dysfunction (ETD)
Timothy C. Hain, MD.
The eustachian tube connects the middle ear to the throat. IIts purpose is to equalize middle
ear pressure with environmental pressure. When your ear "pops" on a high-speed
elevator or in an airplane, the reason is that the eustachian tube has opened
and equalized pressure.
Occasionally people develop symptoms when the eustachian tube does not
equalize pressure. In other words, it is closed when it should be
open. This may involve pain or fullness. It may be a particular problem
and source of severe pain when flying on airplanes, ascending tall buildings, or
diving. In many cases, however, this may be alleviated by use of special ear
plugs. Fullness in the ears can be a very troublesome symptom that can also
arise from TMJ (jaw joint) disturbances, migraine, and Meniere's disease.
Another variant of eustachian tube dysfunction is when the eustachian tube is
chronically open, called a "Patulous" eustachaian tube. This
causes a "man in a barrel" sensation when one talks.
Finally, sometimes the eustachian tubes opens and closes rhythmically,
causing a clicking noise. This is usually due to palatal myoclonus, which is discussed elsewhere.
Causes of ETD:
Disturbances of eustachian tube function are generally called "ET"
dysfunction or ETD.
- Eustachian tube function changes with age, and some disorders may derive
from this (Suzuki et al, 2003). - Allergies are common causes of ETD.
- Eustachian tube function may be poor for several months after a bout of otitis media (Caye-Thomasen and Tos 2004).
Diagnosis of ETD:
Diagnosis is generally made from history. Someone who reports that they have
fullness in their ears, which clears when they swallow or "pop" them, has ETD of
the most common kind -- the ET is not opening when it should. One can prove that
the ET opens or not, using tympanometry. This is simply a method
of recording pressure in the ear.
The patulous (open too much) eustachian tube is also diagnosed by noting that
people have autophony (hear their own voice in their ear), an abnormal resonance
to the voice (due to the tube being open), or the simple expediant of watching
the ear drum move while the person breathes. The Japanese recently described
another method involving testing hearing with masking noises inserted into the
nose (Hori et al, 2006). While clever, diagnosis is generally so easy that
procedures are unnecessary.
Treatment:
Treatment of ETD is not very sophisticated or effective.
For the usual type of ETD (closed), medications for allergy such as
decongestants, systemic or local antihistamines and nasal topical steroids are
commonly tried. We are particularly fond of using "Astelin", which is a
prescription antihistamine nasal spray, as well as kits that involve irrigation
of the nose with salt water.
Occasionally, people with severe symptoms due to ET dysfunction may have a
ventilation tube placed in their ear drum. This relieves the symptoms of ET
dysfunction but creates a perforation in the eardrum which reduces hearing to a
small extent as well as provides a potential entry point for infection. However,
in most cases, it is worth it to find out if symptoms respond to ventilation of
the ear.
Methods of treatment aimed at "patulous" (abnormally open) eustachian
tubes include Premarin nose drops or nasal spray (compounded 25 mg in 30 cc NS),
and insufflation of boric acid and salicylate powder as described by Bezold.
These agents are intended to close eustachaian tubes, and would not be
appropriate for persons who have plugged eustachian tubes rather than abnormally
open ones.
As a last resort, a patulous eustachian tube may be closed surgically and a
perforation created in the eardrum. However, it is difficult to imagine a
situation where this would be desirable.
Acknowledgements:
Graphics are courtesy of Northwestern University, and are used with
permission.
References:
- Caye-Thomasen, P. and M. Tos (2004). "Eustachian tube gland changes in acute
otitis media." Otol Neurotol25(1): 14-8. - Hori A and others. Audiometry with nasally presented masking noise. Otology
and Neurology, 27:596-599, 2006 - Silverstein H, and others. Direct application of dexamethasone for the
treatment of chronic eustachian tube dysfunction. ENT journal, Jan 2003, 28- - Suzuki C, Sando I, Balaban CD, Kitagawa M, Takasaki K. Difference in
attachment of the tensor veli palatini muscle to the eustachian tube cartilage
with age. Ann Otol Rhinol Laryngol 2003 May;112(5):439-43
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