Eustachian tube dysfunction happens when the small channel linking your middle ear to the back of your nose does not open properly. Your ear can no longer air itself, so it feels blocked or full, or it keeps popping. It is very common, and it is usually short-lived, for example during a cold.

What is the Eustachian tube and what does it do?

Behind your eardrum is an air-filled space called the middle ear. The Eustachian tube connects it to the nose. It is normally closed and opens briefly when you swallow or yawn.

It balances the pressure in your ear with the air outside, refreshes the air and lets mucus drain away. That is why your ears “pop” when a plane descends.

What are the symptoms?

A blocked or “cotton wool” feeling in the ear.
Pressure or fullness, sometimes with mild pain.
Clicking or popping when you swallow or yawn.
Slightly muffled hearing.
Discomfort when flying, diving or climbing to altitude.

A temperature or discharge from the ear is not typical. If you have either, it may be a middle ear infection.

Why does it happen?

The most common cause is swelling or blockage of the tube. It is more likely with:

Colds, allergic rhinitis and sinus problems.
Large adenoids in children.
Fast pressure changes: flying, diving, mountains.
Cigarette smoke.

Sometimes the opposite happens and the tube stays too open (patulous Eustachian tube). You then hear your breathing inside your ear. This is different, and blowing exercises can make it worse, so tell us if it applies to you.

How is it diagnosed?

Your history and an examination are usually enough:

Otoscopy: we look at the eardrum for retraction or fluid.
Tympanometry: a quick, painless test of how well the eardrum moves.
Hearing test: if your hearing seems worse.
Nasal endoscopy: a thin camera through the nose lets us see the tube opening, the adenoids and the nose.

How is it treated?

It often settles by itself once a cold or allergy clears. If not, these are the options:

Treat the cause

Treating allergy, congestion or sinus problems often helps the ear. To clear the nose, we prefer continuous-mist seawater sprays to syringe rinses, which in clinic we have seen bring on middle ear infections.

Exercises to open the tube

Swallowing, yawning and chewing gum can help. In children with fluid behind the eardrum, autoinflation with a nasal balloon may slightly shorten the time with fluid. In adults the evidence is much weaker, so it can be tried if there is no reason not to. We explain it step by step in exercises to unblock your ears.

Persistent fluid in children

If fluid lasts more than about 3 months and your child’s hearing is affected, we may consider grommets (ear tubes). See middle ear infection.

Balloon dilation of the tube

This technique widens the tube with a small balloon. Some studies and expert panels support it for carefully selected adults who have had symptoms for more than 3 months that affect daily life. However, results are not firm and it can have complications, such as leaving the tube too open. For this reason we do not offer it routinely. If you think you may be a candidate, talk to us.

What usually does not help

Antibiotics, antihistamines and decongestant tablets have not been shown to help a blocked ear without infection.

Advice

Do not blow your nose very hard or force air out against a blocked nose.
Swallow, yawn or chew gum during take-off and landing.
Avoid flying or diving with a heavy cold if you can.
Do not smoke, and avoid smoky places.
Treat allergies if you have them.
Do not put anything in your ear.

When should I seek urgent help?

Go to A&E or call 112 (in Spain) or your local emergency number if you have:

Sudden hearing loss in one ear.
Severe dizziness or unsteadiness with nausea.
Severe ear pain, bleeding or discharge.
A drooping face.

Book an appointment soon if the blockage lasts more than 4-6 weeks, if your hearing is affected, or if a child seems to hear or speak less well.

Frequently asked questions

Is a blocked Eustachian tube serious? Usually not. It often clears by itself in days or weeks. See a doctor if it lasts or if you have warning signs.

Why do my ears block when I fly? Pressure changes faster than the tube can balance it. Swallowing, yawning or chewing gum helps.

Can I fly with a blocked ear? With a heavy cold, it is better to wait. If you cannot, use the exercises to open the tube, and check with us first if you have pain.

Is it the same as an ear infection? No. There is no infection in Eustachian tube dysfunction. Sometimes fluid collects behind the eardrum, which can become glue ear.

Does it go away? Often, yes, once the cause is dealt with. If it is long-standing, it can be managed with simple measures and check-ups.

What if I hear my breathing inside my ear? Tell us. It may be a patulous tube, and blowing exercises are not suitable.

References

For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.

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