Ask the doctors: Eustachian tube dysfunction causes blockage
Q: A year ago, I had fluid in my eustachian tubes that didn’t clear. I ended up needing drainage tubes and sinus surgery. Both tubes are now clogged with thick gunk, and my hearing is worse. What would cause this? Is there anything that can stop it from happening?
A: The blockage you described is a form of eustachian tube dysfunction. It is a disorder of the middle ear that can cause discomfort or pain and, as you have experienced, may interfere with hearing. To understand what is happening, as well as possible treatment options, we should begin with a bit of anatomy.
Our ears are made up of three sections. The visible portion is the outer ear, also known as the auricle or pinna. Its curves help funnel sound waves into the ear canal and toward the middle ear. This is an air-filled space bookended by the eardrum on one side and the inner ear on the other.
In between are the three smallest bones in the body, known as the ossicles. Working together, they amplify vibrations captured by the eardrum and transmit them to the inner ear. There, nerves and specialized structures process the vibrations and send them to the brain. The brain then interprets them as sound.
The middle ear is the site of the eustachian tube. It's a small canal that connects the middle ear to the nasal passages of the upper throat. Because it can open and close, the eustachian tube equalizes air pressure within the middle ear. It also drains excess fluid. The eustachian tube can become blocked. This can happen due to physical malfunction, malformation, fluid buildup or pressure imbalance.
In most cases, excess fluid clears on its own. When it doesn’t, it can lead to diminished hearing, painful pressure and a higher risk of infection. The drainage tubes you received, known as tympanostomy tubes, are a common solution.
The fact the fluid in your middle ear has persisted or come back suggests ongoing inflammation. This may signal a new or ongoing throat or sinus infection. It can also occur due to allergies or acid reflux. Environmental pollutants and smoking are known irritants. Structural problems can also be at play.
It is possible for accumulating pressure to adversely affect the delicate membrane of the eardrum. Thickened fluid can also impair the function of the ossicle. Each of these can impair hearing. This makes it important to consult with an otolaryngologist (an ear, nose and throat specialist). They will gather your medical history and examine the middle ear.
They may test eardrum mobility, measure pressure and fluid, and gauge the degree of hearing loss. Treatment options include medications to address sinus issues and replacing the drainage tubes. In some cases, balloon dilation of the eustachian tube may be performed.
Although a return of symptoms can be frustrating or even alarming, it is not unusual. It usually means that the cause of the inflammation hasn’t been solved. But there’s good news! With the right treatment, even stubborn cases of eustachian tube dysfunction can be well-managed.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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