Eustachian tube dysfunction (blocked ears)

The Eustachian tube connects the space behind the ear drum (middle ear cavity) with the back of the throat (nasopharynx). When functioning normally it allows us to maintain equal air pressure on both sides of the ear drum. This is important since the pressure outside the ear drum will vary with ambient conditions such as altitude or submersion underwater. When we “pop” our ears we are increasing the air pressure behind the ear drum via the nasopharynx, and this prevents the increasing outer pressure from rupturing the ear drum.

The Eustachian tube is also important in allowing drainage of fluid and secretions from the middle ear and thereby preventing middle ear infections (“otitis media”).

Eustachian tube dysfunction (ETD) is a common condition in which this tube is not working properly, often temporarily due to an upper respiratory tract infection like the common cold or an allergy such as hay fever.

ETD affects about 2% of adults but it is much more common in children due to the proximity of the Eustachian tube to the tonsils and adenoids (which tend to be larger in children whilst they are developing their immune system).

This can lead to problems with the ear, including:

  • fluid behind the ear (glue ear)
  • a retracted ear drum, leading to pain (otalgia) and a sensation of dull or blocked hearing
  • chronic ear infections (chronic otitis media)
  • a perforated ear drum

Symptoms

Common symptoms include:

  • a sensation of fullness or blockage of the ear
  • popping or crackling sounds
  • discomfort/pain of ears which usually comes and goes
  • reduced or muffled hearing (often like you are underwater)
  • ringing in the ears (tinnitus)
  • abnormal sound of your own voice (autophony)

Causes

The eustachian tube is narrow and can become blocked, or not open properly. We don’t really know why it happens, but ETD is more common in people with:

  • a recent cold or viral respiratory illness
  • chronic nasal inflammation, including hay fever or sinus infections
  • smokers
  • acid reflux
  • significantly raised body mass index (BMI)/obese patients
  • blockage at the back of the nose (including enlarged adenoid tissue or scarring from radiotherapy to the head and neck)

ETD symptoms are common with changes in altitude or pressure, so can flare up when flying or scuba diving. These symptoms are often temporary and simple actions including chewing gum, swallowing, sucking on a sweet or yawning often help.

Self-care & prevention

If your symptoms have been associated with a cold or viral respiratory illness, symptoms will normally get better by themselves when the infection goes away.

  • Yawning or opening your mouth widely as if you were yawning, eating and drinking may all help mobilise the Eustachian tube to allow some air travel through the tube.
  • The Valsalva manoeuvre can be done to push air into middle ear; take a deep breath, pinch your nose and close your mouth, and gently pop your ears. Do not be very forceful. Auto-inflation devices, such as the Otovent, can be bought from your local pharmacist and help to do this.
  • Steam inhalations with menthol, eucalyptus, or other oils in boiling water in the sink with a towel over the head or any other kind of inhalation device.
  • Sucking a boiled sweet such as menthol or eucalyptus to unblock the nose.
  • Saline (salt water) nasal rinses (nasal douching) may be helpful if you are experiencing significant nasal congestion.
From your pharmacist:

If simple home management does not alleviate your symptoms you may wish to consult with a pharmacist. The following treatments are available over the counter and may be helpful in managing the symptoms of ETD:

  • nasal steroid sprays
  • antihistamine tablets
  • a short course of nasal decongestants (up to seven days), either tablets or a nasal spray.
Prevention:

Like all things, prevention is better than cure. Some simple things can be done if you’re prone to your ears feeling blocked or clogged, especially during an airplane flight:

  • When travelling, use “Earplanes” which are single use earplugs that buffer the pressure changes which happen during an aeroplane flight
  • By chewing gum or eating a sweet, you’re changing pressures in the mouth and moving the muscles which in turn activates the eustachian tube
  • Nasal decongestant spray or drops (such as Otrivine) can help by using them half an hour before flying. You can also try to self-inflate the tubes by holding your nose and gently blowing, then releasing

Do not attempt to go diving with blocked eustachian tubes as there is a significant risk that you will perforate (burst) your ear drum.

When to consult your GP

If you have persistent symptoms (for more than 12 weeks), that have not responded to conservative measures as above, or if you get other symptoms such as repeated or long-lasting ear discharge/infection or significant pain, you should consult your GP.

In younger children with signs of poor hearing or speech problems, particularly where there is a history of recurrent colds or ear infections, you should consult your GP regarding the role of a formal hearing test (audiology) and specialist assessment.

Investigations

Normally the diagnosis of Eustachian tube dysfunction can be established by your GP based on the history, symptoms, and signs. However, this can sometimes be difficult, particularly in younger children where the condition is most common.

Since ETD is usually temporary and self-limiting condition, specialist referral and investigation are often not warranted.

The main basis for seeking a specialist opinion is where there are concerns of associated speech or developmental delays in younger children.

The most useful investigation is a hearing test often coupled with tympanometry (see under hearing tests for adults) to measure how flexible the ear drum is.

Nasoendoscopy may also be used (a thin, flexible fibreoptic camera) by an Ear Nose & Throat specialist to look inside your nasal cavity and to exclude any significant underlying causes.

Referral & surgical treatment

In most cases Eustachian tube dysfunction can be managed conservatively and does not require specialist investigation or treatment. However, in severe or persistent cases or where there is evidence of speech/developmental delays in younger children a specialist ENT opinion may be required.

Grommets

The most common surgical treatment for persistent/problematic Eustachian Tube Dysfunction is the insertion of a grommet. A grommet is a small hollow ventilation tube inserted across the ear drum through a small slit made in the eardrum. This procedure allows fluid to drain from the middle part of the ear, and allows air in.

This procedure can often be done under local anaesthetic. Grommet insertion is a common, quick, and safe procedure. These tubes normally stay in place for up to 18 months before your body naturally pushes them out.

The specific risks include:

  • the grommet falling out sooner than expected
  • the grommet lasting longer than 18 months
  • tube blockage
  • chronic ear discharge/infection
  • a permanent hole in the ear drum after the grommet has fallen out. This might cause an infection and repeated grommet insertion may be needed.

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended you will be referred for to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.