Last Updated October 11th, 2019
Eustachian tube – Anatomy and function
A tube with triangular to oval-shaped openings on both ends, connecting the middle ear and the nasopharynx is called eustachian tube. Fibrous tissue, bone, and cartilage collectively make up the structure of this tube. The outer portion of the tube is smooth whereas the inner portion of the tube consists of cilia or tentacles. The three parts of the ear include the outer ear, middle ear, and the inner ear.
The outer ear consists of an ear canal and the pinna (outer part of the ear). The middle ear consists of three middle ear bones and the empty space behind the eardrum. Finally, the inner ear consists of the sensory organs of hearing.
The eustachian tube which connects the inner ear and the nasopharynx acts as a pressure equalizing valve by opening with every swallow and yawn. Another main function of the tube is to drain the mucus that is produced in the middle ear.
How does the eustachian tube function?
Pressure equalization, mucus draining from the middle ear, and protecting the middle ear from bacteria and viruses are the three important functions of the eustachian tube. All these three functions are equally important for the normal functioning of the ear. The three main functions are discussed below.
Atmospheric pressure plays an important role in how we hear. You could have experienced blockage in your ears when you are traveling on a hill. This is because of the atmospheric pressure changes with altitude. This change in atmospheric pressure alters the shape of the eardrum and it is not able to capture the sound appropriately due to the pressure. Eustachian tube plays an important role in equalizing this pressure by opening and closing every time we swallow or yawn. If the atmospheric pressure is high, there are chances that it can rupture the eardrum and add to other complications.
Middle ear clearance
As discussed earlier, the inner ear wall is made up of tiny tentacles called cilia. The middle ear is an empty space behind the eardrum where there is a possibility of accumulation of debris. This debris is cleared with the help of cilia which move them closer to the external ear canal. Excess collection of debris can result in blockage and infection in the middle ear canal leading to eustachian tube dysfunction.
Various medical conditions such as sinusitis, otitis media, and cystic fibrosis are known to cause blockage in the middle ear by making the mucus thick. This causes difficulty to remove mucus from the middle ear and leading to blockage and infection. The natural function of the cilia may be disrupted if there is any bacterial or viral infection affecting the middle ear and can take up to one month for normal functioning of the cilia to return.
Protection to the ear
The eustachian tube generally remains closed normally and serves three purposes. Firstly, since the tube is closed, it acts as a barrier and prevents any bacteria or virus to enter the tube. Secondly, it prevents vocalization sound to travel into the middle ear. Thirdly, it dissolves sound pressure coming from a loud sound source to reach the middle ear. Autophony is one of the symptoms experienced by faulty eustachian tube opening where a person would hear his or her own voice and breathing loudly.
Dysfunctions of the eustachian tube
Collection of fluid and mucus in the middle ear leads to blockage of the eustachian tube and leads to eustachian tube dysfunction. When the tube is blocked, there is a negative pressure that is created since the middle ear completely isolated from the external environment. This leads to the eardrum getting pulled inward due to the negative pressure and causes pressure and pain.
A condition of serous otitis media is experienced where the trapped fluid and air in the tube increase the pressure. Since bacteria are readily present on the surface of the outer ear canal, this environment in the middle is conducive for reproduction and growth. The reproduction and growth of bacteria in the middle ear leads to acute otitis media.
Cold and flu symptoms
Common cold and influenza can cause chronic eustachian tube blockage and lead to dysfunction. During a bout of cold or influenza, the nasal lining becomes irritated and inflamed. This narrows the opening of the eustachian tube that is connected to the nasopharynx. Allergic rhinitis, cigarette smoking, and air pollution are important factors that contribute to this problem. Other health conditions such as obesity, nasal polyp, cleft palate, and skull base tumor are some of the rare causes of eustachian tube dysfunction.
Weak immune system
Children are more susceptible to eustachian tube dysfunction since they have narrow openings and the chances of blockage are higher. Children other than underdeveloped eustachian tube also have a weak immune system. This puts them at a higher risk of acquiring cold and flu symptoms. As discussed earlier, cold and flu can irritate the nasal lining and cause inflammation leading to the collection of mucus in the tube and eventually block the opening.
Infants who are breastfed and bottle fed too are not spared due to the anatomy of the eustachian tube. In a healthy adult, the tube generally slopes downward from the middle ear whereas, in infants, it runs horizontally and hence there is a chance that the breastfed or bottle fed milk may end up in the eustachian tube if the position of the child is not tilted with the head slightly upward.
It is thus highly recommended to avoid bottle feeding the child when it is lying down and adequate measures need to be taken to keep the head elevated both during bottle feeding and breastfeeding the child.
Medical Treatment for eustachian tube dysfunction
Medical treatment for eustachian tube dysfunction depends on the severity of the condition. Minor conditions can be treated non-surgically whereas surgical treatment is required when there are anatomical abnormalities. Some of the nonsurgical treatments include:
Treatment with nasal decongestion and antibiotics
Allergic rhinitis and upper respiratory infection are some of the main causes for mucus build up and inflammation of the nasal lining. Nasal decongestion can come handy in this situation. When the mucus is regularly drained from the nasal passages, there are lower chances of accumulation of mucus in the eustachian tube.
Studies have claimed that more than 50% of the eustachian tube dysfunction is caused due to allergic rhinitis and hence finding the trigger and eliminating it would be a wise decision. Decongestants and nasal steroids are the recommended treatment for allergic symptoms. Decongestants can open up the eustachian tube by constricting blood vessels whereas nasal steroids provide immediate relief by decongesting the nasal passages.
Similarly, bacterial infections caused by fluid and water build up in the middle ear can be treated with the use of antibiotics if the infection is not clearing up with over the countermeasures.
Inflation of the Ears
A minor blockage of the tube can be easily treated by blowing into the eustachian tube directly. This can be easily achieved by blowing balloons. Yes, you read it right. Blowing balloons requires you to exert pressure inside your mouth. This pressure is sufficient for the tube to open up. This is considered the easiest and safest maneuver to remove the blockage from the middle ear and can be repeated multiple times until the blockage is cleared.
Following are the surgical treatments that can be undertaken to treat problems related to eustachian tube dysfunction. Surgical treatment is undertaken generally due to anatomical abnormalities and these surgical treatments are discussed below
This is a surgical procedure where a tiny hole is made in the eardrum to release the fluid and pressure from the middle by directly accessing the middle ear. Myringotomy procedure is recommended due to the result of otitis media with effusion. Myringotomy is initiated when there is an acute accumulation of serous fluid inside the middle ear causing severe pain and pressure. The pain associated with this problem is quite severe especially if it is associated with infection and inflammation.
Pressure Equalization Tubes
This is the follow up of the myringotomy surgery. After a small hole is made in the eardrum and relieving the pressure and fluid from the ear canal, a hollow tube made of plastic or metal is placed in the hole. This hollow tube may remain in the ear for six to twelve months depending upon how fast the eardrum heals. When the eardrum gradually heals, the tube is slowly pushed out. The insertion of a pressure equalization tube is undertaken only when a person is experiencing chronic eustachian tube dysfunctions. It should be noted that water should be kept out of the ear when you have a pressure equalization tube. Swimming should be done only with the use of specialized earplugs or should be completely avoided.
Home remedies for a middle ear infection or eustachian tube dysfunction
The home remedies discussed here are over the countermeasures and are not an alternative for medical treatment. Medical treatment by a professional is required to treat severe middle ear infections.
If your middle ear infection is due to bacteria, garlic oil is the best alternative for an antibiotic drug. It is widely known as “nature’s antibiotic.” Use of garlic oil can provide antibiotic effects without the side effect of drugs.
Mullein oil is widely used in several herbal drops to treat ear infections. A combination of herbs and mullein oil can relieve pain associated with a middle ear infection. The effects of mullein oil are as effective as an anesthetic and are even used to treat ear infections in pets.
Warm olive oil provides a soothing effect and relieves the pressure and pain. Make sure to only apply warm and not hot olive oil into the ear canal.
Tea tree oil
Tea tree oil is known for its antibacterial, antifungal, antiseptic, and anti-inflammatory properties. A combination of tea tree oil and olive oil can be applied to the ear canal to provide relief from pain and discomfort.
Powerful anti-inflammatory effects of ginger are quite popular. Ginger juice mixed with olive oil can be applied around the ear to provide relief from inflammation. This mixture should not be applied inside the ear directly.
A flavonoid called quercetin in present in onion which is known for its anti-inflammatory properties. Onion juice can be extracted by heating it to high temperatures. Few people prefer placing half chopped onion on the affected ear to provide relief from symptoms.
This is by far the most commonly used home remedy to relieve inflammation. You can apply a warm cloth that is dipped in warm water to provide a soothing effect and relieve inflammation associated with the infection.
Alcohol and vinegar
Outer ear infections can be relieved with a combination of alcohol and vinegar. Alcohol evaporates the water whereas vinegar kills any bacteria present in the ear.
How do I prevent eustachian tube dysfunction?
Certain precautions can reduce the risk of developing middle ear infection or eustachian tube dysfunction:
- Prevent common colds and flu
- Since cold and flu can be the leading risk factors for a blocked eustachian tube, avoid them as much as possible. Follow healthy hygiene and wash your hand after an outdoor encounter.
- Avoid smoking
- Both first-hand and second-hand smoking are considered unsafe. Try to stay away from people who tend to smoke often.
- Bottle-feed your baby always in an inclined position
- Extra care needs to be taken while bottle feeding a baby due to their underdeveloped ears. Always keep your infant inclined with the head up while breastfeeding or bottle feeding.
- Consider vaccinations
- Seasonal flu vaccines are available in the market for yearly administration. Talk to your doctor and consider taking one.
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