One of the most common questions I am asked as the resident audiologist among my friends and family is some variation of “My ear has felt like it needs to pop for days. What can I do??” That feeling of your ear needing to “pop,” or being blocked, or sounding like you are underwater, is almost always attributed to your Eustachian tube. So, what is your Eustachian tube, where is it, and what does it do? Time for a quick anatomy lesson on how to treat eustachian tube hearing loss.
What is the Eustachian tube?
Your ear is comprised of three parts: outer, middle, and inner. Your outer ear is the portion we can see, as well as your ear canal leading to the ear drum. Behind the eardrum is the middle ear, which contains three small bones known as ossicles that move together to transmit sound via another membrane to the inner ear. The inner ear contains not only the hearing organ, the cochlea, but also your vestibular system, which is responsible for balance and equilibrium.
As you can see from the diagram above, the Eustachian tube begins in the middle ear, and it connects to your nasopharynx (your nose and throat). Typically, the Eustachian tube is closed, but it does open periodically when you yawn, swallow, or chew. Its function is to maintain the equilibrium in the middle ear space, which is meant to be an air-filled cavity. This regular opening and closing of the Eustachian tube allow the middle ear to remain dry.
What is Eustachian tube hearing loss?
If something happens to cause the Eustachian tube to not maintain this regular opening and closing, or if it is blocked, it can result in ear pain or discomfort as a result. Other symptoms can include tinnitus (ringing in the ears), a tickling sensation, clicking or popping, and dizziness or vertigo.
This is commonly reported when flying, particularly during takeoff or landing. If the Eustachian tube does not open and close, the eardrum may become retracted, and you may have a sensation of your ear being blocked. This is why people are often encouraged to drink, swallow, yawn, chew gum, or suck on hard candy during flights to proactively promote the movement of the Eustachian tube.
If Eustachian tube hearing loss persists, the middle ear space can collect fluid, known as “serous otitis media.” The fluid in and of itself is not harmful, though if it sits for a long period of time and/or is there in conjunction with an upper respiratory or sinus infection, the fluid can become infected. This is more common in children than in adults, in part because the Eustachian tube is often at more of a 180-degree angle in children and gradually angles into a descent as we age.
This means that the Eustachian tube is more prone to being blocked simply because gravity is not working in its favor. It also means that any bacteria present in the nasopharynx have an easier pathway into the middle ear. When children have recurrent ear infections to the point where they may be impacting their hearing and, in turn, their speech and language development, there is often a recommendation for pressure-equalization (PE) tubes. This is a brief outpatient procedure in which small incisions are made in the eardrums. Tiny tubes are placed inside to allow airflow through the outer ear rather than relying on the Eustachian tube to maintain equilibrium.
Less commonly than the Eustachian tube being blocked, it can remain open for long periods of time. Some of the symptoms of this would be similar, such as the ears feeling full or clogged and hearing your own voice more loudly and with more reverberation. This condition, known as abnormal patency of the Eustachian tube, is annoying but does not cause hearing loss.
Can Eustachian tube dysfunction cause hearing loss?
The hearing loss that would be caused by Eustachian tube dysfunction, whether in children or adults, would be conductive in nature. A conductive hearing loss refers to one with a cause in the outer and/or middle ear, where the inner ear is functioning normally. Conductive hearing losses are often temporary or fluctuating, depending on the cause. In this case, Eustachian tube hearing loss with or without otitis media would cause temporary conductive hearing loss with varying degrees. You might notice the blocked or “needing to pop” sensation, as well as a feeling that you are hearing your own voice more loudly.
How is Eustachian tube dysfunction diagnosed?
Audiologists have a diagnostic tool called tympanometry to assess the movement of the eardrum, or tympanic membrane. The audiologist would first inspect the ears via otoscopy to ensure the ear canals are clear and the tympanic membrane is visible. A small probe is placed in the opening of the ear, and a low-frequency tone is introduced as a vibration to move the eardrum. The sensation feels a bit like takeoff or landing in an airplane; the pressure change is noticeable, but it should be brief and not overly uncomfortable.
The resulting tracing, known as a tympanogram, should look like a mountain, showing that the eardrum is able to move back and forth normally. With Eustachian tube hearing loss, results of tympanometry would either show that the eardrum is retracted into the middle ear space (negative pressure), being pushed laterally into the ear canal (positive pressure), or not moving at all as a result of fluid present in the middle ear space.
The audiologist would then complete a diagnostic hearing test to determine whether there is any hearing loss present as a result of the Eustachian tube hearing loss. As mentioned, this hearing loss would be conductive in nature though these issues can occur in conjunction with hearing loss at the level of the inner ear, in which case the hearing loss would be referred to as “mixed.” Depending upon the cause of the Eustachian tube hearing loss, you would expect the conductive component to be temporary.
What can I do to alleviate Eustachian tube hearing loss?
If you notice these symptoms, the first thing to try is intentional chewing, swallowing, and yawning, which are the actions which typically cause the Eustachian tube to open and close.
If these are not working, you can try something called the Valsalva maneuver. You will take a deep breath in, plug your nose, close your mouth, and try to gently pop your ears by starting to exhale with your nose and mouth closed off. You do not want to be overly fast or forceful with the exhaled breath but try to introduce some pressure to encourage the Eustachian tube and sinuses to open and close.
You may also try a nasal spray or decongestant, particularly if you are experiencing other symptoms of congestion in the sinuses because the system is fully connected. If you have a cold, allergies, or a sinus infection, nasal sprays and decongestants are probably your best bet. Still, you may also have to wait for the other symptoms to subside before noticing full relief from the Eustachian tube hearing loss. It can take a week or two for this to occur. If your symptoms persist beyond a couple of weeks, you should consult your provider. If left untreated, it can result in ear infection, perforated tympanic membrane, and, rarely, cholesteatoma, which can cause permanent damage to the middle and inner ear.
In extreme cases of chronic Eustachian tube hearing loss, your provider may recommend a surgical procedure such as the placement of PE tubes, as discussed above. A myringotomy involves making incisions in the eardrums without the placement of PE tubes, which would drain the fluid. The eardrum is self-healing, but the incision would remain open long enough for the fluid to drain and the middle ear space to become appropriately dry. There is a newer procedure known as Eustachian tuboplasty, or Eustachian tube dilation, which involves the endoscopic placement of a balloon in the Eustachian tube. The balloon is inflated and deflated to try to expand the Eustachian tube to allow it to equalize pressure more easily.
Can I avoid Eustachian tube dysfunction?
Unfortunately, there is no foolproof way to fully avoid Eustachian tube hearing loss, just like you cannot avoid getting a seasonal cold every now and then. If you find that you are prone to these symptoms, be proactive when flying by taking a decongestant and ensuring that you are chewing/swallowing during takeoff and landing. You can also purchase specialized earplugs designed to avoid “airplane ear.” Drinking lots of water and avoiding extreme temperatures can also help to prevent ear-related issues.
If you are concerned about this for your child, encourage the baby to drink or use a pacifier during takeoff and landing. Slightly older children can benefit from chewing gum or sucking a lollipop. Remember that this issue is more common in children due to anatomical differences, so if your child cries or expresses discomfort when flying, it could just be temporary and not a sign of anything serious or chronic. If the symptoms persist for longer than a week or two, consult your child’s pediatrician.
Erin Edwards received her Doctor of Audiology degree from Towson University in 2015 and her Ph.D. in Education and Leadership from Pacific University in 2022. She has worked with patients of all ages in a variety of settings and has a specific interest in cochlear implants, the relationship of hearing loss and dementia, and interdisciplinary healthcare.