Dear Dr:
About 2 months ago, I started experiencing slightly swollen glands under my ears, a very, very, slight fever, and a sensation of fullness in the space between my ears and skull. I went to my ENT doctor, who diagnosed my condition as Eustachian Tube Dysfunction. At that time, he prescribed Flonase (a steroid) and Nasalcrom. Since that time, my swollen glands have gone away, and generally, I'm feeling much better. However, i was disheartened to hear my ENT indicate that he has never seen this disorder completely cured. Could you please answer some of these basic questions about ETD for me? I'd really appreciate it...
-Is it curable or just "treatable"?
-Does anyone really know what causes this?
-Are there any sorts of additional things I can do to encourage my body
to get better?
-Will "autoinflation" hurt me at all?
-Are there generic forms of nasal steroids that I could get?
-How does one tell if one's Eustachian's tubes are getting better?
(short of not taking the medication...)
thanks...
Reply: ------------------
I think it would be premature to conclude that the condition responsible for your symptoms will not resolve. The description of your symptoms suggests an eustachian tube dysfunction that resulted from an acute upper respiratory condition.
The eustachian tube is a long narrow channel that communicates the middle ear space with the upper part of the throat. It is a dynamic channel in that it opens and closes due to the action of palatal muscles. It has a lining similar to that of the sinuses and middle ear space in that there is a mucous layer normally in a constant state of flux with the mucous secretions continuously swept from the ear to the upper part of the throat known as the nasopharynx. This "mucociliary" activity is essentially a component of your immune system in that it serves to prevent infection. The eustachian tube also serves to ventilate the middle ear chambers thereby maintaining an air pressure equilibrium between pressure inside the ear with that of the ambient or external environment. In summary then, the eustachian tube acts to maintain normal gas exchange and to prevent bacterial colonization inside the middle ear. The persistent disturbance of either of these two functions is known as eustachian tube dysfunction.
Acute inflammatory conditions of the upper respiratory tract commonly result in various degrees of eustachian tube dysfunction ranging from simple pressure disturbance with negative pressure tension or reduced mobility of the ear drum to the development of fluid in the middle ear with hearing loss. Once eustachian tube dysfunction occurs due to an upper respiratory condition, it may take weeks to months to completely resolve. Treatment measures include antibiotics in the case of active infection, nasal steroid sprays to reduce inflammation and swelling in the nasal passages and nasopharynx, decongestants, and expectorants to thin the secretions in order to improve mucociliary flow. Autoinflation of the ears is also a common recommendation to actively ventilate the ears. Typically swelling and inflammation of the eustachian tube combined with thickening of secretions due to mucociliary stasis, results in an increase in opening pressure of the eustachian tube - the amount of pressure required to open and shut the tube. Under normal conditions, the tube will open during yawning or swallowing, many times imperceptibly because the normal opening pressure is low. When the opening pressure is high during an upper respiratory condition, it sometimes requires a fair amount of effort to open the tube by pinching the nose and blowing to "pop" the ear. This can be done quite safely as long as the autoinflation is not done abruptly with extreme force.
Eustachian tube dysfunction that persists for many months, and in which there is clear support for the diagnosis in physical examination or audiometric testing, may benefit from placement of ventilation tubes in the ear drum.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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