Eustachian Tube Dysfunction:
Eustachian tubes connect the middle ear cavity to the nasopharynx or the posterior most part of the nasal cavity. Eustachian tube dysfunction is quite common amongst children, particularly in certain races and environments. The problem is much less common in adults because of anatomical differences that take place during puberty. Most cases of adult Eustachian tube dysfunction is due to allergies and needed to be treated accordingly. Very rarely one-sided Eustachian tube dysfunction is from an obstructing mass in the nasopharynx and needs to be evaluated by an expert otolaryngologist. When allergy management and other conservative measures fail tympanostomy tubes could be placed either in the tympanic membrane or between the tympanic membrane and wall of the ear canal, also known as subannular tube, to allow for ventilation of the middle ear. Currently there are studies on the way to evaluate Eustachian tube balloon dilation as a possible treatment instead of tympanostomy tubes. The Comprehensive Hearing Center at George Washington is one of the six centers currently involved in this multicenter trial.
Otitis Media or Middle Ear Infection:
Infections of the middle ear known as otitis media are quite common particularly in children. However, there are also overly diagnosed and more commonly overly treated by antibiotics. Many patients presenting with ear pain, commonly caused by problems with the temporomandibular joint, are routinely prescribed antibiotics for presumed otitis media or middle ear infection. It is very uncommon to have otitis media in an adult without hearing loss and sometimes drainage of pus from the ear canal. If ear pain is not accompanied by hearing loss, otitis media might not be the cause of the problem. Also many times people develop fluid in the middle ear after common cold which causes dampening of hearing. However this fluid is not infected and does not need to be treated with antibiotics. Studies have not shown that steroids by mouth, steroid nasal sprays, or nasal decongestants make a difference in long-term treatment of fluid in the middle ear, particularly in children. Usually time is all needed along with occasional popping of the ears to clear the fluid. The congealed fluid that has been present for few weeks could be evacuated surgically by making a very small incision in the eardrum.
Patulous Eustachian Tube:
This is a relatively common condition particularly in its transient form. In this condition, the Eustachian tube is constantly open and creates a constant communication between the nasopharnx and the middle ear. Patients feel a constant hollow feeling in their ear particularly when they are upright. When they lay or bend down, the nasal mucosa and turbinates become engorged so less air passes through the nasopharynx and patients feel better. The condition is very common amongst people who lose weight very quickly and is also felt while exercising since the nasal passages open widely.
Since this condition is the other end of the spectrum from Eustachian tube dysfunction anything that makes the nose congested will treat the disorder and anything that makes the nose less congested (such as nasal sprays) would make it worse. In most cases the condition is self limited and will resolve over time. If not, there are medical and surgical options to treat it.