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>> Eustachian tube dysfunction
is a disorder of the eustachian tube.
The eustachian tube connects the back of the nose
to the middle part of the ear.
It generally allows us to be able to have equal pressure
on both sides of the eardrum.
So problems of eustachian tube dysfunction
can actually exist across a spectrum,
meaning that there can be problems
where the eustachian tube is too closed or too open.
And it's really important when you're seeing your doctor
that they can help differentiate between those two,
because they're different between open and too closed,
the treatment approaches are the exact opposite.
Eustachian tube dysfunction
is diagnosed by a combination of a good history,
a good exam, and a couple of different targeted tests.
For the history, it's important that your doctor
ask not just about the fullness and pressure,
what makes it better, what makes it worse,
but also to get an understanding if there's anything else
that comes alongside that fullness and pressure.
For example, are you having times
where you hear your breathing
or your voice kind of echoing inside your head
because that may be consistent with a very specific type
of eustachian tube dysfunction or problem.
When we think about the exam,
it's important that they get a really good look at your ear.
They may ask you to do a couple of maneuvers
while they're examining your ear.
And then another important part of that exam
is being able to get an actual look
at the opening of the eustachian tube
in the back of the nose.
We do that by doing a scope exam,
which is something that's part of routine practice
for Ear, Nose and Throat doctors,
and can have us get a good understanding of,
is the eustachian tube opening?
Is it closing?
Is there anything else that's going on
in terms of inflammation or swelling in the area?
And then in terms of testing, it's very helpful
to be able to have a good hearing test or audiogram,
as well as a test that's called a tympanogram,
which is where they get a sense of,
is there any negative pressure or fluid behind the eardrum.
Combined with that history,
that physical and that additional testing,
it can help us make
a diagnosis of eustachian tube dysfunction,
but more importantly,
the specific type of eustachian tube dysfunction,
and understand what treatment options may be available.
Treatment for eustachian tube dysfunction
really all goes back to understanding
what type of eustachian tube dysfunction problem
that we're dealing with.
If we're dealing with eustachian tube dysfunction problem,
where it's too closed, and there's problems
with negative pressure or fluid buildup behind the ear,
sometimes we first focus
on addressing some of the underlying issues,
things like allergies or stopping smoking,
but if those are not enough and the problems persist,
then we think about things like a tube in the eardrum
to help equalize the pressure
on both sides of the eardrum,
kind of bypassing the function of the eustachian tube.
When tubes are not enough
or they're not an option for other reasons,
we start to think about things like balloon dilation
of the eustachian tube.
Balloon dilation of the eustachian tube
is actually a fairly new procedure.
Something that was first approved in the United States
in 2017, and has some pretty good proven benefit
for people who are suffering with fullness and pressure.
If it is due to a problem with the eustachian tube
being too closed.
The procedure, balloon dilation of the eustachian tube,
is something that is done as an outpatient surgery.
It's generally a pretty short surgery,
but it does require general anesthesia.
It's something that can be done,
like I said, as an outpatient basis,
and has a pretty short recovery period,
and people do well.
For people who have problems
where the eustachian tube is too open,
it's important that we differentiate that
from the problem being too closed
because balloon dilation of the eustachian tube
in that setting, when the eustachian tube is too open,
can actually make symptoms worse.
So again, that decision to understand,
first, is it eustachian tube dysfunction,
and then to understand
what type of eustachian tube dysfunction,
is critical, ensuring the best patient outcomes.
So options, if the problem
is that the eustachian tube is too open,
we actually start with a lot of just medical
kind of topical treatments.
And generally, those symptoms can be managed
with just some topical treatments, and can avoid surgery.
But for those patients where that's not enough,
there are procedures that we do offer,
that again, are done in outpatient setting
under general anesthesia.
A short procedure
where we help try to close the eustachian tube
so that it can function a little bit more normally.
And again, that recovery period is also pretty short.
We have some great options available,
but all of it goes back
to being able to get the right diagnosis
to inform your treatment plan.
Eustachian tube dysfunction is not a new problem,
it's something that has really gone unaddressed
for a long time within Ear, Nose and Throat.
But it's exciting that we have new solutions
and new options for patients who are suffering
with fullness and pressure in the ears,
and causes related to eustachian tube dysfunction.
At Johns Hopkins, we take a thorough approach
to eustachian tube dysfunction,
in terms of getting a good history,
to be able to really feel confident in the diagnosis,
and particularly the type of use eustachian tube problem
that we're dealing with,
as well as the exam that you receive,
in terms of specialized techniques in order to differentiate
the different types of eustachian tube dysfunction,
and then the procedures and those treatments that we offer
have also been informed by the best evidence,
both coming from here at Johns Hopkins
and with our collaborators,
both nationally and internationally.
Combining, just as Johns Hopkins does,
that clinical care with research
is at the heart of what we do at Johns Hopkins.
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