Eustachian Tube Dysfunction

The Eustachian Tube connects the middle ear to the back of the nose (see Diagrams — Upper Respiratory Tract and Anatomy of the Ear).  If this gets congested from a cold or allergies, pressure can build up in the middle ear.  It’s like what happens during airplane take-offs and landings, and can hurt to varying degrees.

We can sometimes diagnose this by examining the ear with an otoscope (the instrument hanging on exam room walls), & noticing that the ear drum looks “retracted.”ย  Lots of clinicians fail to appreciate the subtlety.ย  However, Eustachian Tube Dysfunction is so common, that if a patient has ear pain and no other cause seems apparent, I treat with Allergy Medication.ย  Patients tend to get better, so maybe I’m right (or maybe placebo worked, or maybe they would have gotten better anyway).ย  I donโ€™t give decongestants, because I donโ€™t know of any proof that they work.ย  And I never recommend common nasal sprays or drops like Afrinยฎ, Neo-Synephrineยฎ, etc; they work fine, but after 3-4 days the nose is so accustomed that it can be impossible to stop them (see Rhinitis Medicamentosa).ย 

If you have ear pain, & your provider says โ€œeverythingโ€™s normal,โ€ ask โ€œIs the TM retracted?โ€  [โ€œTMโ€ is common medical jargon: abbreviation for “tympanic membrane,” i.e. ear drum].  A โ€œretracted TMโ€ looks pulled back, almost horizontal, because of negative pressure behind it.  Ear discomfort PLUS a retracted TM almost always signifies Eustachian Tube Dysfunction.

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