Eustachian tube dysfunction: symptoms, treatment and how long it lasts

Rotherham says treatment depends on the cause and severity, and that often no treatment is needed. Chelsea and Westminster Hospital says if symptoms are mild, they usually resolve on their own.

The first steps are simple techniques that encourage air flow through the tube. Rotherham lists regular nose blowing, good nasal hygiene and auto-inflation (cover one nostril and blow gently through the other).

MyHealth Devon says if simple home management does not help, a pharmacist can advise on nasal steroid sprays, antihistamine tablets, and a short course of nasal decongestants for up to seven days. Chelsea and Westminster says a GP may prescribe steroid nasal sprays for persistent inflammation.

Sources differ a little on medicines: Rotherham lists oral and nasal decongestants, antihistamines and corticosteroids as medical treatments, while Chelsea and Westminster suggests taking antihistamines if the swelling is caused by allergies. Ask a pharmacist which suits you.

These self-care measures are described in NHS trust leaflets. Stop and see a GP if you get significant pain or ear discharge.

• Yawn or open your mouth widely as if yawning; eating and drinking may also mobilise the tube (Chelsea and Westminster, MyHealth Devon).

• Valsalva manoeuvre: take a deep breath, pinch your nose, close your mouth and gently pop your ears. Do not be very forceful (Chelsea and Westminster, MyHealth Devon).

• Auto-inflation devices such as Otovent can be bought from a pharmacist (MyHealth Devon).

• Steam inhalations, or sucking a boiled sweet such as menthol or eucalyptus, to unblock the nose (MyHealth Devon).

• Saline nasal rinses if you have significant nasal congestion (MyHealth Devon).

Rotherham lists the symptoms below. MyHealth Devon adds an abnormal sound of your own voice (autophony) and says discomfort or pain usually comes and goes.

• Ears feel full or blocked.

• Sound appears muffled or like you are underwater.

• A popping or clicking sensation.

• Pain or discomfort.

• Buzzing or ringing in the ears (tinnitus).

• Mild dizziness.

There is no single figure. The sources give different time points for what to expect and when to act.

MyHealth Devon says that if symptoms follow a cold or viral respiratory illness, they will normally get better by themselves when the infection goes away.

Rotherham lists colds and nasal, sinus, ear or throat infections as common causes, because a blocked nose, thick mucus or inflamed, swollen lining can affect the tube. Allergies that affect the nose can add mucus and inflammation. Anything that blocks the tube, such as enlarged adenoids, can cause it, and a change in air pressure during flying can too.

MyHealth Devon says we do not really know why it happens, but it is more common in people with a recent cold or viral respiratory illness, chronic nasal inflammation (hay fever or sinus infections), smokers, acid reflux, a significantly raised BMI, and blockage at the back of the nose including enlarged adenoids or scarring from radiotherapy to the head and neck.

It says ETD affects about 2% of adults but is much more common in children because of the position of the tube near the tonsils and adenoids.

MyHealth Devon says symptoms are common with changes in altitude or pressure and can flare up when flying or scuba diving. Chewing gum, swallowing, sucking a sweet or yawning often help.

If you are prone to blocked ears on flights, it suggests single-use pressure earplugs, chewing gum or eating a sweet, using a nasal decongestant spray or drops half an hour before flying, and gently self-inflating by holding your nose and blowing.

It says not to attempt to go diving with blocked Eustachian tubes, because there is a significant risk of perforating the eardrum.

MyHealth Devon says the diagnosis can normally be made by your GP from the history, symptoms and signs. The most useful investigation is a hearing test, often with tympanometry to measure how flexible the eardrum is.

An ENT specialist may use nasoendoscopy, a thin flexible camera, to look inside the nose and exclude significant underlying causes.

MyHealth Devon says most cases are managed conservatively. In severe or persistent cases, a specialist ENT opinion may be needed. The most common surgical treatment is a grommet, a small hollow ventilation tube placed across the eardrum, often under local anaesthetic.

Rotherham says grommets usually fall out on their own after 6 to 12 months, and T tubes are designed to stay in place more permanently. MyHealth Devon says they normally stay for up to 18 months, and lists risks including falling out early, blockage, ear discharge and a permanent hole in the eardrum.

NICE says evidence on the safety and efficacy of balloon dilation for chronic Eustachian tube dysfunction is adequate to support its use, provided standard arrangements for clinical governance, consent and audit are in place.

MyHealth Devon says that in younger children with signs of poor hearing or speech problems, particularly with a history of recurrent colds or ear infections, you should speak to your GP about a formal hearing test and specialist assessment.

It lists problems the condition can lead to, including fluid behind the ear (glue ear), a retracted eardrum, chronic ear infections and a perforated eardrum.

MyHealth Devon says to consult your GP for symptoms lasting more than 12 weeks that have not responded to self-care, or if you get repeated or long-lasting ear discharge or infection, or significant pain.

Chelsea and Westminster says to see a specialist if symptoms persist over 3 weeks. Your GP can decide on the right route.

Most people are managed by a GP with self-care and a pharmacist. ENT referral is for persistent or severe cases or concerns about speech or development in young children. Private ENT assessment and hearing tests are also available; share any results with your GP.