The inability of the eustachian tube to properly regulate air pressure inside the middle ear and/or effectively drain secretions from the middle ear cleft

Occasionally, dysfunction may involve reflux of nasopharyngeal secretions in the middle ear.

Aetiology

These malfunctions may be due to a variety of pathophysiological changes that in some way impede the normal opening and closing of the Eustachian tube.

• Eustachian tube dysfunction (ETD) may be caused by intrinsic swelling of the tube orifice or within the lumen, owing to inflammation (e.g., due to allergy) or infection.
• It may also result from extrinsic compression of the tube by adenoid hypertrophy, tumour, or trauma.
• ETD also may be related to a failure of the muscles associated with Eustachian tube opening, including:
  • Tensor veli palatini (a dilator of the Eustachian tube)
  • Levator veli palatini
  • Salpingopharyngeus (which opens the Eustachian tube with deglutition)
  • Tensor tympani.

PC

• Inability to pop or clear the the ear with changes in barometric pressure (e.g. when on a plane)
• aural fullness - more likely in allergic cause
• autophony - own voice being loud
• ear pain

Investigations

• Nasal endoscopy - may show oedema or obstruction of the eustachian tube
• ENT - tympanometry

Management