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Eustachian Tube Dysfunction and Middle Ear Infections - Causes, Diagnosis, and Treatment

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Middle ear infection leads to fluid build-up behind the eardrum, which results in clogging of the tube connecting the throat to the middle ear.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Vinay. S. Bhat

Published At November 9, 2022
Reviewed AtFebruary 13, 2024


Our ear comprises three parts that are outer, middle, and inner ear. The middle ear helps in the transformation of sound signals from the outer ear to the inner ear. The middle ear is connected to the throat by the tube that is called the Eustachian tube. This tube functions to equalize the pressure by opening while sneezing, coughing, and yawning. Bacterial or viral infections that affect the middle ear lead to a build-up of fluid behind the eardrum resulting in clogging or blocking of the Eustachian tube, which is referred to as Eustachian tube dysfunction. The Eustachian tube protects the middle ear from the attack of any infection and maintains adequate ventilation. The dysfunction occurs due to swelling of the Eustachian tube as a result of fluid build-up in the middle ear (causing the middle ear infection and swelling).

What Are the Causes of the Middle Ear and Eustachian Tube Dysfunction?

Various causes of the middle ear and Eustachian tube dysfunction are:

  • Bacterial infection.

  • Viral infections like cold and flu.

  • Upper respiratory tract infections.

  • Sinusitis (infections of the empty cavities present within the skull bone).

  • Acid reflux disease can result in ETD (eustachian tube dysfunction).

What Are the Signs and Symptoms of the Middle Ear and Eustachian Tube Dysfunction?

  • Ear ache.

  • Discharge from the ears.

  • Pressure changes in the ear.

  • The presence of fullness in the ear.

  • Loss of balance.

  • Mild to severe hearing loss.

  • Dizziness.

  • Headaches.

  • Vertigo (spinning sensation in the head).

  • High fever.

  • Ringing sensation in the ears (tinnitus).

  • Popping of ears while yawning.

What Are the Different Types of Eustachian Tube Defects?

  • Patulous Eustachian Tube Defects: It is due to the continuous opening of the Eustachian tube resulting in hearing our own voice loudly while sneezing, yawning, and breathing.

  • Obstructive Eustachian Tube Defects: These occur when the Eustachian tube does not open properly due to fluid build-up behind the eardrums, like in cases of middle ear infections.

  • Baro-Challenged-Induced Eustachian Tube Dysfunction: It occurs due to extreme pressure changes in the ears due to which the Eustachian tube does not open properly, like while traveling in an airplane or at high altitudes.

How to Diagnose the Middle Ear and Eustachian Tube Dysfunction?

Different diagnostic modalities are:

  • History and Clinical Examination: Complete history of the patient is recorded for the presence of underlying symptoms like recurrent ear infections, ear discharge, dizziness, and fever. Clinical examination of the ears is done by an ENT (ear, nose, and throat) specialist with the help of an otoscope (an apparatus with attached light used to examine ears) to check for any ear discharge or ear swelling present.

  • Tympanometry: It is a procedure done with the help of a probe that induces pressure changes in the ears. The vibratory function of the eardrum in response to the pressure changes is recorded in the graph (tympanogram), which is assessed later. This test helps to diagnose a middle ear infection and Eustachian tube dysfunction.

  • Pure Tone Audiometry Test: It is done to check the type and severity of the hearing loss.

  • Computed Tomographic (CT) Scans: These scans help to detect any obstruction in the Eustachian tube or narrowing of the tube.

How to Manage Middle Ear and Eustachian Tube Dysfunction?

Treatment modalities for middle ear and Eustachian tube dysfunction are:

Conservative Management:

  • Valsalva Maneuver: Close your mouth and pinch your nostril and blow the air slowly to unclog the Eustachian tube. High blood pressure and heart patients should avoid this technique.

Drug Therapy:

  • Analgesics: Pain medications like Ibuprofen are prescribed for relieving ear pain.

  • Antibiotics: Antibiotics are prescribed to treat the underlying ear infection.

  • Steroids: Corticosteroid drugs are prescribed to the patient for the reduction of swelling or inflammation within the ears.

Surgical Management:

  • Myringotomy: It is a surgical procedure in which a small cut is placed in the eardrum to facilitate drainage of the excess fluid from the ears, thereby relieving the pressure from the ears.

  • Pressure Equalization Tubes: In this procedure, a small ear tube is placed in the eardrum after making a cut for a period of one year to equalize the pressure within the ears and provide adequate ventilation to the middle ears. As the eardrum heals, the ear tube is pushed back and removed.

  • Balloon Dilatation of Eustachian Tube: In this method, a balloon catheter (tube) is placed in the Eustachian tube, and dilation of the Eustachian tube is done by an endoscopic (a telescope-like apparatus used to see inner structures) approach to improve its functions.

What Are the Complications Associated With Middle Ear and Eustachian Tube Dysfunction?

  • Hearing Loss: Recurrent ear infections and fluid build-up in the ears can lead to perforation of the eardrum resulting in permanent hearing loss.

  • Delay in Speech and Language Development: Hearing loss in children results in a delay in speech and language development, which affects their communication skills, thereby affecting their social life.

  • Spread of Infection: Ears are in close proximity to the brain. Infections from the ears can spread to the brain resulting in meningitis (swelling of the outer covering of the brain) or brain abscess (fluid accumulation in the brain).

  • Mastoiditis: It occurs due to the spread of the infection from the ear to the mastoid bone (present behind the ears), resulting in swelling of the mastoid bone (mastoiditis) or accumulation of pus in the mastoid air cells (mastoid abscess).

  • Perforated Eardrum: Repetitive ear infections can lead to perforation of the eardrum resulting in hearing and balance loss.


Middle ear infections are very common among children in the age group below three years of age and can also affect adults in fewer cases. Long-standing middle ear infection results in a fluid build-up within the ears, which also results in swelling of the tube connecting the middle ear to the throat (Eustachian tube). Early diagnosis and management of ear infections are very crucial for preventing middle ear and Eustachian tube swelling. Any delay in the diagnosis and management can lead to complications like hearing loss, loss of balance, and the spread of infection from the ears to the brain that can be fatal.

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Dr. Vinay. S. Bhat
Dr. Vinay. S. Bhat

Otolaryngology (E.N.T)


ear infection
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