Eustachian Tube Dysfunction

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[edit] Eustachian tube dysfunction

Introduction: Eustachian tube dysfunction is very common, particularly in small children aged 1 to 6 years. In that age the anatomy of the middle ear and of the ventilation mechanism through the Eustachian tube is very small and as a result is more prone to clinical problems. Allergies can also contribute to this problem by swelling of the lining of the mucous membranes inside the middle ear and the Eustachian tube, but allergies tends to be a more important factor in the age group of 3 to 4 years or older. The adenoids tend to grow a lot in childhood and can contribute in some children to pressure onto the inner opening of the Eustachian tube, which can lead to a problems in equalizing the pressure in the middle ear, which in turn can lead to hearing problems. When things are congested in this area, infections with viruses or with bacteria can happen easier.

Symptoms:

The child may simply have recurrent ear infections and recurrent throat and tonsil infections. When the child is teething there may be a runny nose and a mild fever, but these viral infections tend to come one after the other when there is a Eustachian tube dysfunction. The child may not eat well and complain about an ear ache or pressure. The hearing may be dull, but can be normal.

Diagnosis:

The physician examines the ear and finds a bulging ear drum or a flat or drawn-in ear drum. Each individual is unique and it may take some time of listening to the subtle signs the child exhibits. It helps when the child is able to talk and tell in simple language, whether the hearing is OK, whether there is pain, whether the child hears a click in the ears with swallowing (normal) or not (abnormal) etc. It takes sometimes several referrals (pediatrician, ENT specialist and allergist) before a clear answer emerges regarding the contributing factors regarding a Eustachian tube dysfunction. Audiology tests (hearing tests) are valuable, if the ear drum looks normal, but the child feels that something is not right.

Treatment:

1. If a child has chronic recurrent otitis media (middle ear infection), this is happening for a reason. It could be that the adenoids are large; there could be underlying allergies with allergic rhinitis and swelling of the Eustachian tube with blockage and subsequent effusion (fluid build-up) in the middle ear that gets infected. It is interesting that in a Finnish study there was a 50% reduction of chronic recurrent otitis media cases in children less than 5 years following a yearly influenza vaccination program (Ref.2).

2. When a chronic effusion is in the middle ear, the ENT specialist usually recommends an ear tube that is placed through the center of the ear drum, a procedure called tympanostomy tube insertion. This normalizes the pressure in the middle ear right away, allows any fluid that may have accumulated to drain. On the other hand, if a vacuum with in drawing of the ear drum was present before the surgery, the ear tube allows the pressure to equalize. After about 6 months the majority of ear tubes simply fall out and the small stabbing wound ion the center of the ear drum heals over within a few days. During this time the Eustachian tube dysfunction had time to heal itself and the previous abnormality often won’t return. However, if it does return the ENT specialist may decide to insert another ear tube. In the past the Politzer maneuver was used to pump air into the nostril and push the Eustachian tube open. The ear tube treatment is a much more gentle method and tends to give more reliable results.

Complications:

If a Eustachian tube dysfunction is overlooked, the child may not respond to sounds and words and would be slow with language development. This could mimic a learning disability although it really is due to a neglected hearing impairment. In order to distinguish this from true learning difficulties it is important to do audiometry testing to analyze the hearing loss. If there are bacterial super infections for which antibiotics are used frequently, there can be side-effects like Clostridium difficile, which can cause a very resistant diarrhea and dehydration. An early referral to an ear/nose/throat specialist is recommendable.

References: Ref.1: Cummings: Otolaryngology: Head & Neck Surgery, 4th ed., Copyright © 2005 Mosby, Inc. Ref.2: Adkinson: Middleton's Allergy: Principles and Practice, 6th ed., Copyright © 2003 Mosby, Inc.