Eustachian tube disorders

Eustachian tube disorders are most often related to the middle ear, as this tube connects the middle ear and nasopharynx. This tube was already known in ancient Greece and by the 16th century the Eustachian tube had already been described in detail by Bartholomaeus Eustachius, after whom it was named. Diseases in this organ arise on the basis of the function and dysfunction of the tube, possibly on an inflammatory, obstructive or excessively open basis.

This tube is sometimes called the auditory tube and is roughly 4 cm long in adulthood, its role is to connect the middle ear and nasopharynx and to balance sudden pressure changes between atmospheric pressure and middle ear pressure. Often various inflammations enter the middle ear through this tube and it is the origin of several ear infectious diseases. Also, problems with the tube are sometimes associated with tumours in the nasopharynx or other diseases of the nasopharynx.

Diseases of the Eustachian tube refer either directly to diseases of this tube connecting the middle ear and the nasopharynx, or to diseases that are directly related to the Eustachian tube but manifest either in the middle ear or in the nasopharynx. Children are most affected by diseases of the tube when the tube is still developing, is narrower and shorter and so is particularly prone to blockages and the resulting problems and disorders. Of course, even in adulthood these diseases can be common.

Functions and dysfunctions of the auditory tube

The Eustachian tube admits air from the nasopharynx into the middle ear. One end is located between the eardrum and the cochlea in the middle ear, the other is located between the nasal cavity and the pharynx. Each person has two of these tubes, one for each ear. In addition to the air from the oral cavity flowing into the ear, fluid can flow in return, and the main purpose of this tube is to maintain a balance between the atmospheric pressure in the surroundings and the pressure directly in the middle ear.

The tube consists of a bony and a cartilaginous part, with the bony part forming one-third of the length of the tube and the cartilaginous part forming the remaining two-thirds of the length of the tube. At the junction of these two different parts, the tube is narrowest. The tube can be closed and opened, which a person can influence by the function of the posterior swallowing muscle. This comes in handy if, for example, we have a clog in our ears and need to equalize the pressure. By simply swallowing, air from the nasopharynx gets into the middle ear and a feeling of lightness comes.

In its normal state, the tube is closed due to the approximation of the walls and the shrinkage of the elastic fibres. When chewing food, but also when sneezing or yawning, it opens briefly and allows the exchange of pressures. In addition, it has a drainage function by draining secretions and fluids from the middle ear into the oral cavity. Problems and disorders in the Eustachian tube most commonly arise either as obstructive disorders or as disorders caused by excessive opening of the tube. Obstructive are mechanical or functional.

Mechanical dysfunctions of the tube include, for example, inflammation due to infection or allergy, but also tumours of the nasopharynx, for example. Functional disorders, in turn, arise from permanent dysfunction of the tube walls as a result of excessive fatigue of the fibres or a malfunction of the opening mechanism. Sometimes it is also a combination of both types of disorders. For example, excessive auditory tube opening is associated with hormone levels, stress or the use of certain medications or may be related to radiotherapy.

Inflammation and swelling of the Eustachian tube

A very common problem is inflammation of the Eustachian tube. This inflammation can arise either on an infectious basis or on an allergic basis. In the case of infectious inflammation, the most common causative agent is a bacterial or viral infection from the nasopharynx or middle ear that has entered from these sinuses. In the case of allergic inflammation, it is most often one of the reactions to a common allergy that also manifests itself elsewhere, i.e. it is not a separate type of allergy.

Inflammation is manifested by pain and clamping in the ears, and it is a fairly serious disease that requires longer-term treatment. The most common is bacterial inflammation that enters the Eustachian tube from the nasopharynx or upper respiratory tract and then proceeds to the middle ear, so that both organs are inflamed. Most often this inflammation occurs in children. In addition, the inflammation can also be non-infectious and due to long-term obstruction of the tube, when it is a chronic secretory inflammation.

That is why these two problems, i.e. chronic obstruction and chronic inflammation, can many times be related in the non-infectious nature of inflammation. In this case, surgical treatment and even reconstruction of the conduction mechanism in the middle ear is sometimes necessary. As a result of inflammation, swelling of the Eustachian tube often occurs, but the cause may also be an incipient tumor. In most cases, it is a benign tumour that is relatively easy to remove.

It most often overgrows from the surrounding tissues, for example from the nasopharynx, and although at the beginning it may not be manifested in any way, later on, due to the tumour enlargement, the Eustachian tube is compressed and again dysfunction occurs with regard to the possibility of opening. As a result of the disruption of this function and the permanent closure of the tube, there is also a risk of inflammation and other problems in the middle ear, so that the tumour must also be removed as soon as possible, or radiotherapy or another type of treatment must be used.

In the treatment of allergic inflammation, swelling and blockage of the auditory tube may also occur, in which case antihistamines are taken to relieve the allergic reaction, which should make the cause of the swelling disappear and restore the functionality and mechanism of the tube. Thus, such mechanical dysfunction is relatively easy to deal with, but sometimes permanent swelling can also arise due to functional dysfunction, most commonly due to improper hormone levels, and this may be related to other diseases.

Diseases related to the middle ear

Sometimes Eustachian tube diseases are also related to the middle ear. The most common manifestation of otitis media is the middle ear, and since the middle ear is directly connected to the nasopharynx via the Eustachian tube, infections are very often caused by the passage of bacteria into the middle ear via the Eustachian tube. These bacteria can also cause inflammation in the walls of this tube and so many times otitis media is accompanied by inflammation or blockage of the auditory tube.

Infection in the other direction is also possible, when microorganisms enter the middle ear through the outer ear or, for example, in the case of infection by water or other external influences, and then the inflammation, which is particularly typical of chronic inflammation, passes into the auditory tube. In general, otitis media associated with the Eustachian tube occurs most often in children who have too short an ear canal, so that the inflammation can very easily settle and develop there together with a middle ear infection.

Most often it arises on the basis of a viral infection, but later a secondary bacterial infection is also added, and so antibiotics are used for treatment. In addition to pharmacological treatment, the Eustachian tube can also be relaxed by gargling with salt water, nasal lavage, and during the night when sleeping it is better to keep the head higher than usual to avoid stopping the natural outflow of any secretion from the middle ear into the nasopharynx when lying horizontally.

Problems that can cause a malfunction in the Eustachian tube include leakage and subsequent stagnation of middle ear secretions in this part of the tube, most commonly at the junction of the ossicular and cartilaginous parts of the tube, where the space is thinnest and the walls of the tube are most closely spaced. Similarly, the opposite problem, where there is suction of secretions from the nasopharynx and this subsequently progresses to the middle ear, can be a risk factor for infection in the tube.

Patulous eustachian tube disorders

The condition of the so-called patulous auditory tube, or Eustachian tube, is also a problem. This condition occurs when the tube is excessively permanently patulous, i.e. open/expanded, for example, during physical exertion or when the peritubular extracellular fluid is reduced. It is a disorder caused by several factors, for example hormone therapy, radiotherapy, use of decongestant nasal drops, rapid weight loss or due to stress, i.e. it is an external factor.

As a result of a patulous Eustachian tube, a person has sensations of fullness in the ear, hears various noises and tinnitus, and can even hear his own breathing. Treatment for this condition is either conservative or surgical. When conservative, nitric acid, boric acid or vegetable prepratates are used, the aim being to create a partial obstruction of the tube. If this solution fails, the operative route is taken and usually a catheter is created at the mouth of the tube, which acts obstructively.

Diseases associated with the nasopharynx

In addition to several diseases of the Eustachian tube being associated with or caused by diseases in the middle ear, problems in the nasopharynx and upper airway can also cause problems in this auditory tube. Whether it is the transmission of infections that cause subsequent inflammation in the Eustachian tube, or possibly a tumour growth. In the case of inflammation but also of a tumour, for example, from the nasopharynx, the tube becomes closed, which brings a number of problems.

Closure in this case occurs most often as a subsequent process after swelling of the auditory tube mucosa, with subsequent chronic inflammation as a result of the closure, which must be treated both antibiotically and, in the case of a problematic course, sometimes surgical treatment is also necessary. It is very dangerous if it is an allergic inflammation that has passed here from the nasopharynx, then it is necessary to relieve the allergic reaction and also to administer antihistamines to the affected person.

Swelling and closure of the Eustachian tube cause the inability to affect the pressure in the middle ear, which is the primary function of this organ, so that a person has a feeling of pressure and clamminess in the ears. From the nasopharynx, for example, bacteria or viruses from flu or sinusitis enter the Eustachian tube directly, causing irritation of the mucous membrane, which then swells and closes. In addition, in some cases, in addition to hearing problems, this closure also causes dizziness and vertigo.

Complications can also arise as a result of mucus blockage in various rhinitis and other diseases, if the infection passes into the paranasal sinuses or nasopharynx and from there directly into the Eustachian tube. Tumours near the auditory tube, for example in the nasopharynx or sinuses, are also a problem. Which enlarges, presses on the surrounding tissues and can also cause closure of the tube, resulting in subsequent inflammatory and non-inflammatory problems.