What is Eustachian tube dysfunction?
The Eustachian tube runs between the back of the nose and the middle ear (the airtight box behind your eardrum). This tube is generally closed, but by opening it — such as when you swallow, yawn or blow out against closed nostrils — you allow air to travel up it and equalise the pressure between the middle ear and the outside world. This happens automatically and regularly in everyday life if the system is working normally, so that you wouldn’t be aware of it happening.
If the tube is blocked (or for some other reason not working properly), air cannot pass into the middle ear. As there is no other route, the pressure in the middle ear becomes less than that in the outside world and starts to cause symptoms in that ear. This is termed Eustachian tube dysfunction (ETD).
The most common cause of ETD is inflammation in the nose and the Eustachian tube, caused by a lingering cold or flu or by long-standing sinusitis. This may be due to inflammation of the nasal lining associated with allergies.
What symptoms may I experience?
- A feeling of fullness, or the ears feeling blocked.
- Muffled or impaired hearing.
- Popping, clicking or pain in the ears.
- Noises in the ears (tinnitus).
- Worsening problems in situations where the air pressure around you changes — such as flying, passing through a tunnel, going in a lift or scuba diving.
How is ETD treated?
Until the arrival of balloon technology, ETD was a frustrating condition to treat for both patient and ENT Surgeon. Happily — particularly if the symptoms follow a cold or flu infection — they will often settle after a period of up to three months or so. In those patients whose symptoms persist beyond three months, however, the treatment options were limited, and often consisted of trials of one or more of the following:
- Eustachian tube exercises, such as persistent blowing out against closed nostrils, yawning, chewing sugar-free gum, or the use of a Eustachian tube opening device called an Otovent (where you blow up a balloon through your nose using a custom-made nozzle inserted up the nostril).
- Intranasal steroid drops or sprays, in the hope that reducing inflammation of the nasal lining (and of the opening and lining of the Eustachian tube) will resolve matters. This may be combined with antihistamines in cases thought to be associated with allergy.
- Short courses of nasal decongestants such as Otrivine or Vicks Sinex.
- The insertion of ventilation tubes (grommets) into the eardrum of the affected ear — see our Glue Ear and Grommets leaflet.
Unfortunately these measures often don’t work, which is where balloon Eustachian tuboplasty offers real new hope for sufferers of this debilitating condition.
How does balloon Eustachian tuboplasty (BET) work?
Under a short general anaesthetic, a small endoscope is inserted up the nostril and the opening to the Eustachian tube is identified on the affected side(s). A custom-made balloon is then passed directly up into the Eustachian tube under direct vision, to a distance of two centimetres. The balloon is inflated to an exact preset pressure and left in the inflated position for two minutes. It is then deflated and all instruments are withdrawn from the nose — nothing is left inside the nose or the Eustachian tube. This procedure expands the Eustachian tube and restores its open pathway.
How long does it take, and how long should I expect off work?
The procedure takes about 30 minutes and is performed as a day case (in and out of hospital the same day). You should plan to take the day of the procedure and the following day off work (i.e. 48 hours). Occasionally other procedures such as septoplasty (to straighten the nasal partition and improve access for the BET instruments) may be necessary, and this may prolong the recovery period. We will be able to advise you of this at the time of your assessment in outpatients, before you book your BET operation.
Is BET safe and effective?
The balloon equipment has been used in the sinuses for over ten years around the world with very good results, particularly where the frontal (forehead) sinuses require opening. The same equipment is now used in the Eustachian tube, and the results from many series of patients around the world have been very encouraging. These have consistently shown that BET is superior to the more conservative measures used to treat ETD, and — most importantly — that it is a safe procedure with no significant complications reported. This equipment and technique has NICE approval.
How do I know if BET is right for me?
If you have one or more of the symptoms listed above, and they have been persistent for three months or more, then BET may help you.
Below is a validated questionnaire that we use to assess the severity of your symptoms. Fill it in and see what you score — if your problems are in the moderate or severe range, then BET may be an option, and we would be happy to talk to you about it if you make an appointment to see us in outpatients.
Eustachian Tube Dysfunction questionnaire
As part of your assessment prior to potential treatment for ETD, how much of a problem has each of the following been for you over the past month? Rate each from 1 (no problem) to 7 (severe problem).
| Over the past month… | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
|---|---|---|---|---|---|---|---|
| Pressure in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Pain in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| A feeling that your ears are clogged or “under water”? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Ear symptoms when you have a cold or sinusitis? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Crackling or popping sounds in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Ringing in the ears? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| A feeling that your hearing is muffled? | 1 | 2 | 3 | 4 | 5 | 6 | 7 |