Every air-containing cavity in the human body must have a connection (aeration) to the outside world. Thus, this also applies to the middle ear cavity. The connection between the outer world (nasal cavity) and inner world (middle ear cavity) is called the Eustachian tube. You have two of them.
Construction
The Eustachian tube (see drawing) is 3-4 centimeters long and the passage is very narrow.
The walls are lined, all around and along their length, with mucous membrane (compare nose and nasal sinuses). The Eustachian tubes exit at the back of the nasal cavity. At this location, in children up to about age 14, the nasal tonsil (adenoid) sits in the nasal cavity.
Around the entrance of the tube into the nasal cavity are “entrance muscles” that can open and close the tube.
Functioning of the Eustachian tube
Eustachian tube provides:
- protection of the middle ear from nasal cavity fluid;
- aeration of the middle ear (ventilatory function), because the mucous membrane of the middle ear cavity constantly withdraws air from this cavity, so that there is always a threat of negative pressure;
- protection of the middle ear against pathogenic organisms (bacteria, virus);
- protection of the middle ear from pressure swing (protective function) and
- draining fluid and debris (after a middle ear infection, for example) from the middle ear.
Swallowing, yawning, chewing and speaking causes the “entrance muscles” to tighten and relax. This allows the air-filled middle ear to be supplied with fresh air. At the same time, this drains middle ear mucus. If the tubes are functioning properly, you will not notice any of this at all.
What symptoms does a malfunctioning Eustachian tube cause?
If the tubes are not working optimally, the following symptoms may occur:
- clenching or clicking ears
- dull or congested feeling in the ear
- pressure sensations in the ear or head
- hearing impairment
- tinnitus
- earache
These symptoms may be continuous or intermittent. They may also worsen or occur only at certain times, such as when flying and diving.
The ENT doctor speaks of tubular complaints or tubadysfunction.
How does tubal dysfunction occur in a healthy Eustachian tube?
Colds are the most frequent cause of tubal dysfunction.
In addition to swelling of the mucosa of the nose, there is then also swelling of the mucosa in the Eustachian tube. This rarely causes problems in a healthy Eustachian tube, but it does in a tube with a history.
The Eustachian tube is naturally narrow. In some people, this in itself can cause problems. Especially when more is required of the aeration (air pressure exchange), such as during (rapid) climbing or descending (airplane, mountain, bridge, tunnel). Clearing is too slow and this gives the aforementioned tubular complaints. Usually, after some time (minutes-hours), the air pressure in the middle ear will be equal to the outside world again.
Other causes of Eustachian tube dysfunction include:
- allergy,
- reflux of acid from the stomach,
- nasopharyngitis,
- nasal polyps.
How does tubadysfunction occur in an unhealthy Eustachian tube?
If (mainly in early childhood) inflammation develops of the nasal tonsil, the Eustachian tube and/or the middle ear, healing leaves scars. These scars narrow the Eustachian tube (even) more. The clearing function can then become increasingly problematic even in everyday life.
A simple cold aggravates these symptoms (much) faster, more severe and longer lasting.
Claren
Clearing (equalizing ear pressure) can be distinguished into unconscious and conscious clearing.
Unconscious clearance
A properly functioning Eustachian tube ensures that there is no air pressure difference between the middle ear cavity and the outside world (nose). The entrance to the Eustachian tube does this by opening and closing when swallowing, yawning, chewing and speaking.
This is called unconscious clearing and happens without us noticing in a fraction of a second. In case of a (too) fast arising air pressure difference we sometimes experience (usually short = seconds) pressure or a blocked feeling in the ear and/or head. In such a case you can consciously clear your ears and the feeling will be gone in no time. This is normal.
Conscious clearance
Conscious clearance is often necessary in unphysiological conditions (flying, diving, etc.). You are then aware that, for example, swallowing movements, yawning and/or chewing cause the tube entrance to open. This conscious clearance usually takes a little longer (seconds-minutes).
Forcefully blowing air – with your nose pinched shut – into your ears is not wise, as you may blow yourself a middle ear infection.
What to do when flying?
About 1 in 3 people suffer from the Eustachian tube when flying. When ascending and descending, the air pressure difference between middle ear and atmospheric pressure outside the body (aircraft cabin) often cannot be quickly equalized. Simple conscious clearance, such as swallowing, yawning, pressing with nose and mouth closed, to get this done do not succeed.
If you fear tubular symptoms on takeoff, there are four things you can do:
- make sure you are awake;
- Spray xylometazoline nasal spray (Otrivin®) 2 puffs into both nostrils half an hour before takeoff (during boarding);
- chewing gum;
- do tube of Eustachian tube exercises;
- Wear flight plugs with filter;
If you fear tubular complaints when descending, there are five things you can do:
- make sure you are awake;
- Spray xylometazoline nasal spray (Otrivin®) 2 puffs into both nostrils half an hour before dropping;
- chewing gum;
- nose sometimes blow;
- do tube of Eustachian tube exercises;
- Wear flight plugs with filter;
Other tips on flying:
- You can let a baby drink or give a pacifier while dropping so that swallowing motions are made all the time.
Is diving even possible?
If you never have clearance problems in daily life, you can usually dive without any problems.
But if you often fail to clear consciously, then diving is unwise to do. Indeed, when diving, you must be able to clear consciously. Ear pain is bound to become a game-changer otherwise and can sometimes even result in a perforated eardrum.
Swim plugs with and without filter are available. Swimming plugs with filter can be worn when diving. These are custom made, you can make an appointment with us for this.
Treatment of the Eustachian tube
Treatment for a not optimally functioning Eustachian tube depends on the severity of the symptoms and the cause. The symptoms are often unruly.
Nose care
Sometimes it is enough to keep the nose and nasal cavity more clean so that irritating material (crusts, blood, inflammation) does not make the mucous membrane of the Eustachian tube swell.
Medicated
If the tube is not working properly due to mucous membrane swelling (colds, allergies) then usually a medication is sufficient. For colds, xylometazoline (Otrivin®) three times daily for a week is usually sufficient.
Drum tube
In cases of severe symptoms, an eardrum tube is sometimes considered. Your ENT specialist will weigh the pros and cons with you. For example, if you fly a lot because of your profession, a different consideration will have to be made than if you have occasional problems in the tunnel. A tympanic tube also provides restrictions (water contact) that must be weighed in this decision.
Would you like to make an appointment for customization or personal advice? Then contact us, we will be happy to help!
The above information was obtained from: https://www.kno-arts-amsterdam.nl
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