Ear Problems? Your Eustachian Tube May Be To Blame
I just finished a busy week taking care of my patients in the office. This week ear complaints seemed to prevail - not that these are uncommon problems. Ear problems seem to cause a lot of issues for both children and adults. In an otherwise healthy, but bothersome ear, the common cause is often a problematic tunnel called the "eustachian tube," so let's focus of the eustachian tubes and strategies for prevention and treatment of conditions related to them.
First though, a brief on ear anatomy.
Anatomy of the Ear
The ear is divided into the outer, the middle and the inner ear.
- Outer Ear: The outer ear consists of the floppy cartilage-sculpted structure that we see adorning our head as well as the canal that leads to the ear drum.
- Middle Ear: The middle ear structures are found deeper and consist of the ear drum, the three bones that pick up vibrations from the ear drum to create sound and the eustachian tube. The middle ear is basically a chamber behind the ear drum. It is filled with air that circulates and is kept at the same pressure as the outside world thanks to the eustachian tube. This tube extends from the middle ear to a place in the back of the throat near where the nasal passages also connect.
- Inner Ear: The inner ear is made up of the cochlea, a coiled apparatus that connects with the middle ear via a tiny opening. It also connects to the brain. The inner ear contains sensitive hairs in the coils of the cochlea that respond to movement. This yields our sense of position and movement.
The Sensitive Eustachian Tube
The eustachian tube serves an important function in keeping air circulating in the middle ear. A reasonable pressure is necessary for sound signals to be properly conducted and perceived by our brain. Fluid is generated and circulates through the middle ear to remove debris that could cause problems. For this system to work it is essential that the tubes remain open. Unfortunately, the eustachian tubes are prone to a variety of factors:
- Dry Air: Air circulates by this area that can dry and irritate tissue.
- Mucous Drainage: Mucous comes down from the nasal passages that can block or inflame the tube opening.
- Food: Food passes by the area that can cause injury.
- Infection: This area is also susceptible to infection from bacteria and viruses (the common cold, pharyngitis, laryngitis, dental infections).
- Air Pressure: Lastly, the tubes are sensitive to sudden changes in pressure (flying, ascending mountains, diving).
Symptoms of Eustacian Tube Problems
Most ear-related symptoms can be caused by eustachian tube dysfunction:
- Pain: Plugging of the eustachian tube can cause a build-up of pressure (air or fluid) and this can lead to pain as it strains the ear drum.
- Trouble Hearing: Hearing can decline with fluid accumulation or increased pressure in the middle ear since the ear drum does not vibrate like it should.
- Infection: With fluid in the middle ear canal that does not circulate, infection can develop, worsening the pain.
- Dizziness: Finally, increased pressure in the middle ear can spill into the inner ear, wrecking havoc on the finely balanced system and causing vertigo, an unpleasant "room spinning" type of dizziness.
When the eustachian tube is plugged, treatment should focus on not only the consequences of the blockage but also the cause.
- Antibiotics: Infection can be treated with antibiotics, but as middle ear infections will often resolve on their own (especially if the eustachian tube blockage resolves), antibiotics are considered optional in most cases.
- Anti-Inflammatory, Acetaminophen, or Heat: Pain can be relieved with an anti-inflammatory medication, acetaminophen or heat.
- Chewing Gum: My favorite remedy to help with opening up and relieving pressure from eustachian tube dysfunction is chewing gum. The jaw bone sits just below the eustachian tube and by rhythmically moving the jaw, a "milking" action is applied to the tube relieving pressure.
- Side-to-Side Jaw Movement: Sometimes pressure can be relieved by moving the jaw wide open or side to side.
- Plug Nose and Try to Blow: Pressure can also be relieved by carefully plugging the nose and blowing against this, forcing air up into the eustachian tubes. If the eustachian is plugged due to inflammation, an anti-inflammatory medication or a nasal steroid medication can be used to calm this down and open back up. Use caution with this one, however, because it can occasionally precipitate vertigo by pushing that pressure into the inner ear.
- Decongestant: If congestion has caused the tube to close, a decongestant can help.
In most, the tubes are at a significant angle and gravity helps keep the tubes open and circulating, but certain people are susceptible to anatomy-related eustachian tube problems:
- Children: In children due to the shape of their skull and in certain people, the tubes are more horizontal, promoting back-flow and other problems.
- People with Allergies: Persons with chronic, untreated allergies are also susceptible due to the chronic congestion and irritation of the eustachian tube opening.
For children and susceptible people, preventative measures are important to ensure that problems do not develop. When faced with sudden changes in pressure (airplane take-off/landing, driving in the mountains, diving) it is helpful to proactively chew gum. For infants, feeding during this time is helpful as their jaw moves much like with gum chewing). In the face of a cold or congestion, aggressive treatment can help ward off further eustachian-related problems.