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Home ⟩ Hearing Health ⟩ Eustachian tube dysfunction (ETD): Middle Ear Condition

Eustachian tube dysfunction (ETD): Middle Ear Condition

Katy Waterman, audiologist and mentor at The Hearing Care Partnership. Katy Waterman  |  Published 29 January 2025  | 6 mins read

A doctor holding a magnifying glass in front of a human ear anatomy model.

Eustachian tube dysfunction (ETD) is a common middle ear condition that can cause your ears to feel blocked, or like you’re underwater, as well as pain, pressure, and hearing issues. Typically, ETD clears up on its own after a few days. However, if it’s a recurring problem or a more severe case, a trip to the doctor may be required.

If you suspect you have Eustachian tube dysfunction, you can find out everything you need to know, from symptoms and causes to treatments, right here.

The Eustachian tube explained

The Eustachian tube can be found in each ear connecting the middle ear (the space behind the ear drum) to the pharynx (the back of the nose). This narrow tube provides air to the middle ear, equalising air pressure and preventing pressure and fluid buildup. While the tube is normally closed, it opens every time you sneeze, yawn, swallow, or chew.

What is Eustachian tube dysfunction (ETD)?

Eustachian tube dysfunction, or ETD for short, is a middle ear condition in which the tube doesn’t open and close as it normally should. When the tube becomes blocked, equalisation of air pressure cannot easily be obtained because air cannot get through to the middle ear. This can prevent the drainage of fluid, which puts more pressure on the eardrum, causing pain and hearing issues. Generally, ETD is more common in children, but it can affect anyone.

A woman experiencing vertigo, appearing disoriented and unsteady.

What are the symptoms of Eustachian tube dysfunction?

Symptoms of Eustachian tube dysfunction may affect one or both of the ears and can include:

If you’re experiencing any of these symptoms, we recommend booking a free hearing test to determine if you have ETD.

What causes Eustachian tube dysfunction?

Eustachian tube dysfunction can happen for a variety of reasons, such as:

  • Common colds and sinus infections are the most common causes of ETD, as a blocked nose can also block the tube or cause the tube lining to become inflamed and swollen. Typically, ETD caused by a cold is mild and will clear up after a week.
  • Glue ear occurs when the middle ear fills with a glue-like mucus, and the Eustachian tube becomes congested, preventing air ventilation behind the ear drum. It is most common in children and babies.
  • Allergies affecting the nose, such as hay fever or allergic rhinitis, can cause inflammation around the Eustachian tube, resulting in persistent symptoms.
  • Ear barotrauma can cause ETD during altitude changes, such as flying on a plane, scuba diving, hiking, or travelling through mountains. These situations can create a pressure imbalance between the middle ear behind the ear drum and the outside environment because the tube can’t react fast enough.

 

Long-term (chronic) Eustachian tube dysfunction

Although most cases of ETD will resolve themselves within a couple of weeks, others may experience symptoms for several months. This is known as long-term or chronic Eustachian tube dysfunction. Some of the most common causes of chronic ETD include:

  • Chronic sinusitis, which means an inflammation of the sinuses, has lasted for 12 weeks or more.
  • Changes to the nose and throat caused by smoking.
  • Persistent rhinitis.
  • Allergies.
  • Enlarged adenoids.

However, the cause of ETD is often unknown.

 

Eustachian tube dysfunction risk factors

While anyone can experience Eustachian tube dysfunction, some people are more prone to the condition than others if they exhibit the following risk factors:

  • Having allergies can cause more mucus, increasing the risk of congestion.
  • Smoking damages the protective hairs that direct mucus from the middle ear, increasing the chances of mucus building up and blocking the Eustachian tubes.
  • Obesity increases the risk of fatty deposits building up around the Eustachian tubes.

The condition is also more common in children, as their Eustachian tube anatomy is smaller, which results in mucus and germs becoming more easily trapped in the middle ear. Plus, as their immune systems are still developing, they’re more at risk of colds and infections leading to ETD.

Treatment options for Eustachian tube dysfunction

The good news is that symptoms of ETD usually go away on their own once the initial cause, such as a cold, has cleared up. But if you want to help speed up the process or if you suffer from long-term ETD, there are multiple treatment options to explore.

A woman mid-yawn, with her eyes closed and mouth open

Home remedies

For mild cases of Eustachian tube dysfunction, try these simple home remedies:

  • Yawning
  • Swallowing
  • Chewing gum
  • Nasal balloon (Otovent), which can be bought over-the-counter
  • Breathing out while holding your nose and breath – however, this should be carried out with caution so as not to risk the chances of ocular hypertension or glaucoma
  • For minor symptoms in babies and toddlers, give them a bottle or a dummy to suck
A woman holding a tablet in one hand, poised to take her medicine, with the pill close to her mouth.

Medications

There are also over-the-counter medications you can use, including:

  • Antihistamine tablets
  • Decongestant nasal sprays or drops
  • Saline sprays
  • Steroid sprays
  • Pain relievers
A medical diagram illustrating the myringotomy surgical procedure.

Surgery

In more severe or chronic cases, surgery is sometimes required to relieve the pressure and pain in your ears and restore your hearing. There are two types of surgery available for ETD, which are:

  • Myringotomy: a procedure that involves making a small incision in the eardrum to remove fluid from the middle ear to help the swollen or inflamed tube decrease to its normal size.
  • Ear tubes: During a Myringotomy, surgeons may place a tube, commonly known as a grommet, into the incision, which can help provide ear ventilation for up to a year.

Your doctor will recommend the best treatment.

Takeaway

Eustachian tube dysfunction, or ETD, is a common ear condition that can cause pain, pressure and hearing issues in either one or both of the ears. Common colds and sinus infections are the main causes of ETD, but they can also be caused by allergies or changes in altitude. In most cases, the condition will clear up on its own or with some over-the-counter medication. In severe or chronic cases, surgery may be suggested by your doctor. 

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Eustachian tube dysfunction FAQs

Here, we answer your most commonly asked questions about Eustachian tube dysfunction.

For mild cases, eustachian tube dysfunction should last for a week or so. Once the cause of the condition, such as a common cold, has cleared, your ETD symptoms should also ease. However, if you experience long-term (chronic) ETD, your symptoms may persist for a month or longer.

It is generally advised not to fly if you have an ear infection, such as ETD, as it could cause you more pain and pressure and risk damaging the middle ear.

A possible symptom of Eustachian tube dysfunction is temporary tinnitus due to the increase of fluid in the middle ear. However, it should disappear once the infection has cleared. If you’re still experiencing tinnitus after ETD, there may be an underlying cause which you should speak to your doctor about.

No, Eustachian tube dysfunction doesn’t directly cause fatigue. However, a sinus infection or a common cold does. So, if the cause of ETD is due to these illnesses, you may feel more tired than usual.