LESSON 72

Eustachian tube dysfunction

Name: Eustachian tube dysfunction
Uploaded: 2026-11-04T03:15:00+03:00
Duration: 10 min 33 s
Description: In this lesson, we look at the subtypes of Eustachian tube dysfunction: a tube that fails to open and negative middle ear pressure, eardrum retraction, type C and type B tympanograms, links with adenoid hypertrophy and cleft palate, and the patulous Eustachian tube. We also discuss assessment tools and treatment options.

Year 1
Spring semester
Otorhinolaryngology
Outer and middle ear disorders
Duration: 10:33

In this lesson, we look at the subtypes of Eustachian tube dysfunction: a tube that fails to open and negative middle ear pressure, eardrum retraction, type C and type B tympanograms, links with adenoid hypertrophy and cleft palate, and the patulous Eustachian tube. We also discuss assessment tools and treatment options.

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Hello, and welcome to the AIHEAR Audiology Academy.
In this lesson, we learn about Eustachian tube dysfunction and the consequences of negative pressure in the middle ear.
We will compare a tube that does not open with one that does not close, and see links with adenoid hypertrophy and cleft palate.
The cartilaginous part of the Eustachian tube is closed at rest; it opens briefly with swallowing and yawning via the tensor veli palatini.
This opening ventilates the middle ear, while staying closed protects it from nasopharyngeal secretions and sounds.
Eustachian tube dysfunction is a disturbance of this balance between opening and closing.
If the tube cannot open enough, the middle ear cannot be ventilated; if it stays open too much, its protective role is lost.
We covered the structure and functions of the tube in the Eustachian tube lesson; here we focus on the clinical side of its dysfunction.
An international consensus statement published in two thousand fifteen groups Eustachian tube dysfunction into three subtypes.
The most common is the type in which the tube does not open enough; it is called obstructive or dilatory dysfunction.
In the second type, symptoms appear only when ambient pressure changes quickly, as in flying or diving.
The third is the patulous type, in which the tube stays open more than normal; we will cover it separately at the end of the lesson.
According to the consensus, diagnosing the dilatory type requires symptoms together with evidence of negative middle ear pressure.
Upper respiratory infections swell the tube's mucosa; this is the most common cause of temporary dysfunction.
Chronic nasal inflammation, such as allergic rhinitis, can also impair function by keeping the mucosa swollen.
Adenoid hypertrophy, or enlarged adenoids, can narrow the tube opening and act as a source of germs.
In cleft palate, the tensor veli palatini, the muscle that opens the tube, cannot attach normally, so the tube does not open well.
Children with Down syndrome have a narrow tube and low muscle tone, which is why middle ear problems are very common in them.
In adults, a rare but important cause is a mass in the nasopharynx that blocks the tube opening.
Large adenoid tissue mechanically narrows the tube opening and keeps nasopharyngeal germs close to the tube.
So recurrent otitis media and effusion are common in children with adenoid hypertrophy.
Otitis media with effusion is very common in infants with unrepaired cleft palate; sources usually put the rate at about ninety percent.
Even after the palate is repaired, tube function does not always improve right away; middle ear problems can last for years.
In these children, hearing is monitored at regular intervals along with tympanometry, and results are shared within the team.
If the tube cannot open, the middle ear mucosa keeps absorbing gas from the space, and the pressure drops.
Negative pressure pulls the tympanic membrane inward; this is called retraction of the eardrum.
On otoscopy, the malleus handle looks shortened and more horizontal, and its lateral process becomes prominent.
The light reflex may be distorted or lost.
With long-standing negative pressure, the eardrum thins, can stick to middle ear structures, and retraction pockets can form.
The person feels fullness, blockage and crackling when swallowing; hearing is usually mildly reduced.
In a normal middle ear, the tympanogram peak is around zero decapascals.
With negative pressure, the peak shifts to the negative side; by Jerger's criterion, a peak below minus one hundred decapascals is type C.
If negative pressure lasts, the mucosa secretes fluid into the space, and the curve can flatten into type B.
Negative pressure alone usually causes a mild conductive loss; when fluid builds up, the loss increases a little.
As tube function improves, this sequence often reverses: first a type C curve, then a type A curve.
When Eustachian tube dysfunction is suspected, tympanometry and pure-tone audiometry are done together.
The report gives not only the curve type but also the numeric peak pressure, so change can be tracked at check-ups.
In children, an age-appropriate hearing test is recommended when effusion lasts three months or longer.
Negative pressure and effusion can fluctuate over time, so regular monitoring is more valuable than a single measurement.
Results are shared with the physician, who makes the treatment decision in light of these findings.
In a patulous Eustachian tube, the tube stays open even at rest; the most typical complaint is autophony.
The person hears their own voice echoing loudly and unpleasantly in the ear and may also hear their own breathing.
There may also be a feeling of fullness, so the condition is easily confused with a tube that does not open.
Symptoms ease when lying down or bending the head forward, because blood vessels around the tube fill and close it.
Rapid weight loss, pregnancy and hormonal changes are known associations; in many patients no clear cause is found.
Hearing is usually normal; on otoscopy, the eardrum may be seen moving in and out with breathing.
Nasal decongestants given for a supposed blocked tube can worsen symptoms in a patulous tube, so the right distinction matters.
Both types can cause ear fullness, but blockage and crackling when swallowing point more to a tube that does not open.
Hearing one's own voice and breathing echoing, on the other hand, is a hallmark of a tube that does not close.
When the tube does not open, the tympanogram is often type C or type B.
When the tube does not close, peak pressure is usually normal; deep breathing may cause fluctuations in the curve that follow respiration.
These findings are only clues; the differential diagnosis belongs to the physician.
To track symptoms in numbers, the seven-item Eustachian Tube Dysfunction Questionnaire, or ETDQ-7, can be used.
Each item is scored from one to seven, so the total ranges from seven to forty nine; cutoff values vary between studies.
Tympanometry is the most practical objective test, showing middle ear pressure and the likelihood of fluid.
A change in peak pressure before and after swallowing, Valsalva and Toynbee maneuvers shows that the tube can open.
If there is a perforation or a tube in the eardrum, pressure is applied to the canal and the person tries to equalize it by swallowing.
This method is called the inflation and deflation test.
No single test fully shows tube function; symptoms and findings are evaluated together.
The treatment decision belongs to the physician; dysfunction after a cold in particular often resolves on its own.
Treating underlying nasal problems, such as allergic rhinitis, can support tube function.
In children, autoinflation, which opens the tube by inflating a special balloon through the nose, can be used.
For long-lasting effusion, the physician may recommend a ventilation tube, in selected children together with adenoidectomy.
In selected adults with chronic obstructive dysfunction, the tube can be widened with a balloon, called balloon dilation.
A tip from practice: effusion is very common in children, but one-sided effusion in an adult means something different.
In an adult with no clear cause such as a cold, note a one-sided type B tympanogram with a conductive loss.
Though rare, this can be the first sign of a mass in the nasopharynx blocking the tube opening.
Refer the person to a physician for a nasopharyngeal exam and state the finding clearly in your report.
Eustachian tube dysfunction is divided into three subtypes: dilatory, triggered by pressure change, and patulous.
Colds, allergies, adenoid hypertrophy and cleft palate impair tube opening.
A tube that fails to open causes negative pressure, eardrum retraction and a type C tympanogram; if it lasts, fluid builds up.
In a patulous tube, hearing one's own voice echoing is typical; symptoms ease when lying down, and hearing is often normal.
Test yourself: A person hears their own voice and breathing echoing and feels better lying down. What should you suspect?
The correct answer is B: a patulous Eustachian tube.
The tube stays open even at rest, so voice and breathing reach the middle ear directly; lying down fills the area and eases symptoms.
In the next lesson, we move from the ear to speech and see how breath, voice and articulation produce speech.
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Prerequisites

LESSON 67 Types of Otitis Media : Acute, Effusive, Chronic