The Eustachian tube connects the middle ear to the nasal cavity. It is normally closed, and opens up with swallowing, chewing, or yawning. It plays three important roles: (1) protecting the middle ear from microbes; (2) equalizing pressure between the middle and outer ears to allow the ear drum to function properly; (3) drain any middle ear secretions. Yawning or chewing gum on the plane to “pop” the ears illustrates how the Eustachian tube helps equalize middle and outer ear pressure.

Eustachian tube dysfunction occurs when these functions are compromised, and is believed to be due to processes that cause the mucosal lining of the Eustachian tube to swell up and close it. Some causes include cigarette smoke, allergies, and viral illnesses (e.g. common cold, influenza). Symptoms include ear pain, pressure, ringing, crackling, impaired hearing, and sometimes dysequilibrium. Long-standing Eustachian tube dysfunction can result in middle ear damage, including otitis media, and middle ear atelectasis.

The diagnosis will be made by an otolaryngologist. Non-surgical treatments like nasal rinsing, decongestants, smoking cessation, allergy testing and treatment, nasal corticosteroids, and simethicone may be considered. Surgical procedures like balloon dilatation of the Eustachian tube, or tuboplasty may be needed in some patients.