Ask the Doctors - How can I keep my Eustachian tubes open?

Dr. Robert Ashley, MD

Dear Doctor: My hearing loss is related to my Eustachian tubes: They stay closed. I can open them and improve my hearing by holding my nose and blowing, but the effect lasts only a short time. Hearing aids don’t help. What can I do?

First, let’s consider the size and location of the Eustachian tubes, one on each side of your head. Only half a centimeter wide, each one starts behind the nose and travels through cartilage and bone toward the middle ear, an air-filled chamber bordered on one side by the ear drum. The pressure within the middle ear should be equal to the air pressure outside, and the Eustachian tube is the only way for the body to equalize these pressures. This gas pressure homeostasis is necessary for optimal hearing.

The most common reason that the Eustachian tube closes is from inflammation within the tube and secretions that can block the tube from opening. With the tube closed, the middle ear has no way for the air to go in or out. When that happens, the air in the middle ear gets absorbed by the surrounding structures, creating a negative pressure in the middle ear. The sensation is similar to how your ears feel at the bottom of a pool. This negative pressure makes it even more difficult for the Eustachian tube to open, increasing to the point where fluid starts to fill the middle ear. In severe cases, blockage of the Eustachian tube can lead to vertigo and balance problems.

Now let’s look at the possible causes for a closed Eustachian tube. In my experience, the most common cause is chronic nasal congestion, either from allergies or environmental irritants. Infection of the adenoids or the sinus or nose also are likely causes; to determine this, an ear, nose and throat doctor would visualize the adenoids to assess their condition.

Chronic nasal swelling is another potential culprit. If that’s the case, medications such as nasal steroids, leukotriene inhibitors and antihistamines could decrease the swelling, opening up your Eustachian tubes and thus improving your hearing. Note that one study, however, did not show significant change in Eustachian tube dysfunction with the use of a common steroid delivered via nasal spray, Nasocort. In addition, the over-the-counter expectorant, guaifenesin, could thin secretions sufficiently in the Eustachian tube to help clear the tube.

Essentially, the treatment depends on the cause. For inflammation and closure of the Eustachian tube caused by infection, antibiotics can help. For inflammation caused by acid reflux, which can lead to inflammation in the nasopharynx, look for ways to decrease acid reflux. If adenoids are blocking the Eustachian tube, the adenoids can be surgically removed.

Talk to your doctor about your symptoms. Eustachian tube dysfunction can be treated and, because symptoms can worsen, it should not be ignored.

Robert Ashley, MD, is an internist and assistant professor of medicine at the University of California, Los Angeles.

Ask the Doctors is a syndicated column first published by UExpress syndicate.