Typical Symptoms of a Eustachian Tube Dysfunction (also called Tube Dysfunction)

The symptoms of a Eustachian tube dysfunction can vary, but the most common ones are:

1. Feeling of pressure in the ear
   Due to the lack of ventilation in the middle ear, either negative or positive pressure develops. This pulls the eardrum inward or pushes it outward, causing an uncomfortable sensation like a vacuum or an unpleasant "pressure" in the ear. The pressure can also increase when moving quickly from higher to lower altitudes (e.g., during flying or diving).

2. Reduced hearing ability (hearing loss)
   Negative or positive pressure in the middle ear can deform the eardrum and limit its mobility. This leads to impaired sound transmission, which can cause noticeable hearing loss, particularly at low frequencies. Hearing usually returns to normal once pressure equalization occurs.

3. Ear pain (associated with negative or positive pressure)
   The pressure difference between the middle ear and the external environment can cause ear pain. This often occurs due to negative pressure, which strains the structures of the middle ear and irritates the mucous membranes. The pain can appear suddenly and worsen when swallowing or yawning too quickly.

4. Crackling or popping noises in the ear
   When the tube suddenly opens, a sound like "popping" or "crackling" may occur. This often happens while swallowing, chewing, or yawning when the pressure in the middle ear is rapidly equalized. It can feel uncomfortable, especially if the tube is partially blocked or only partially opening. These sounds originate in the Eustachian tube due to the activity of the tube muscles, which are often more pronounced in affected individuals, as narrower tubes require greater mechanical effort for pressure equalization.

5. Ear noises (tinnitus)
   Another symptom of Eustachian tube dysfunction can be tinnitus, which is the perception of sounds in the ear without an external sound source. This may be triggered by negative pressure or reduced air circulation in the middle ear, which irritates the sensitive auditory system. The tinnitus may be temporary or persistent.

6. Difficulty achieving pressure equalization
   People with a Eustachian tube dysfunction have trouble achieving normal pressure equalization through swallowing, chewing, or yawning. They may need to perform additional jaw movements or special maneuvers (e.g., the Valsalva maneuver) to regulate pressure. These difficulties are especially noticeable during colds or allergies when mucous membranes are additionally swollen.
   Small differences in ambient pressure are often consciously perceived by affected individuals, for example, when driving or hiking in areas with altitude changes.
   Even altitude differences of 50 or 100 meters can already be felt as pressure changes in the ear. Air travel, therefore, poses a significant problem for affected individuals.

7. Feeling of “clogged ears”
   A common symptom is the feeling of clogged ears, similar to the sensation of a damp ear. This can be persistent or intermittent and is particularly noticeable during or after colds or allergies. This condition arises because the Eustachian tube does not open properly and fails to equalize pressure.
   In particular, the condition known as tubal catarrh is perceived as a sensation of moisture and fullness in the middle ear (a feeling similar to having water in the ear). However, tubal catarrh is already a complication that can lead to middle ear infections.

8. Worsening of symptoms during colds or allergies
   People with a Eustachian tube dysfunction often experience worsening symptoms when they have a cold or allergic reactions. Inflammation and mucous membrane changes in the area of the tube and upper respiratory tract can further impair the function of the Eustachian tube, leading to stronger pressure sensations and hearing disturbances.

These symptoms can occur individually or in combination and vary in intensity. In some cases, chronic Eustachian tube dysfunction can lead to recurring middle ear infections or other long-term ear problems.

Chronic Eustachian Tube Dysfunction is not only uncomfortable but can also cause long-term damage to hearing and ear health.
Early treatment (medication, Eustachian tube exercises, or in severe cases, possibly surgery) can help prevent complications.
The following list distinguishes between common (often less severe) and rare possible complications of (chronic) Eustachian tube dysfunction.

Common:

1. Persistent pressure sensation & hearing problems

   • Feeling as if the ear is "blocked" and certain frequencies are no longer perceived well

   • Muffled hearing or altered sounds

   • Less commonly: ear noises (tinnitus)

2. Fluid accumulation in the Eustachian tube and middle ear ("Eustachian catarrh," "middle ear effusion")

   • Poor ventilation → fluid collects behind the eardrum or in the Eustachian tube

   • May lead to temporary hearing loss

   • Increased risk of middle ear infections

3. Retraction of the eardrum ("tympanic membrane retraction")

   • Negative pressure in the middle ear pulls the eardrum inward

   • Can lead to long-term damage to the eardrum or ossicles

Rare:

4. Middle ear infections

   • Impaired ventilation makes it easier for bacteria to multiply

   • Possible symptoms: pain, fever, and hearing deterioration

5. Permanent hearing loss ("hypoacusis")

   • Due to scarring or permanent perforations of the eardrum

   • Damage to the ossicles from frequent infections or trauma

   • Damage to the cochlea in the inner ear due to inflammation or chronic negative/positive pressure

6. Chronic ear infections & cholesteatoma

   • Severe, untreated cases can lead to chronic inflammation

   • A cholesteatoma (overgrowth of skin cells in the ear) may develop → dangerous as it can destroy bone

   • Cholesteatoma is by far the most severe complication, but it is significantly rarer and usually affects only extreme cases where middle ear ventilation is persistently and severely impaired. However, permanent, irreversible hearing loss is also one of the more problematic long-term consequences, as it can have a significant negative impact on both professional and private life.

The good news first: There are now several promising treatment options that can provide symptom relief.
However, as is often the case, this does not apply equally to all patients, as not every therapeutic measure or surgery achieves the same effect. In fact, it is often necessary to try different treatment alternatives one after another to find the best solution that is most compatible with one's own anatomy.
Unfortunately, the principle also applies here: there is no treatment for Eustachian tube dysfunction that offers "only" advantages and is completely free of risks or complications (although these are usually minor and generally considered low-risk by medical professionals). Therefore, it is important to carefully weigh the costs and benefits for oneself, depending on the individual severity of the condition.

I am absolutely not a fan of generalizations or the way certain surgical methods are sometimes marketed online as a "miracle cure."
One thing should be clear to everyone: some treatment options for Eustachian tube dysfunction are often private services and are not or only partially covered by health insurance.
For the treating specialists, this can be quite a lucrative business, where the patient's well-being may not always be as much of a priority as it should be.

Overview of therapy and surgical methods known to me (as of 02/2025):

Medication-based treatment:

• Nasal sprays with decongestant or anti-inflammatory substances (e.g., corticosteroid nasal sprays or decongestants) that help relieve mucous membranes and improve Eustachian tube ventilation.

• Antihistamines or corticosteroids to suppress inflammation in the mucous membranes and Eustachian tubes.

• Ibuprofen to reduce swelling in the nasal passages and Eustachian tube.

• Nasal rinses can be helpful in cases of allergic causes to reduce inflammation and swelling.
  → Important: Please consult your ENT doctor before using any of these medications!

Physical therapies:

• Eustachian tube training (e.g., Valsalva maneuver or Toynbee maneuver), where one gently blows against a closed nose to normalize ear pressure. This can be practiced in a healthy state (important!) over an extended period, e.g., 50 times per day, to train the function of the Eustachian tubes. This method is recommended by an ENT specialist personally known to me.
  However, I emphasize that one should consult an ENT doctor before starting tube training! I take no responsibility if someone regularly performs this procedure and experiences no improvement or even a worsening of their condition. Always talk to your doctor first!

• Special breathing exercises or ear acupuncture can provide supportive relief to improve Eustachian tube function.
  → Again, always consult a trusted ENT specialist first!

Surgical options (always discuss surgical options with your ENT specialist!):

• Eardrum puncture: In cases of middle ear effusion (fluid behind the eardrum) or extreme over-/underpressure, a puncture can be performed to improve ventilation and drain fluid.
  → Warning: This should only be performed by an ENT specialist when deemed necessary. Never attempt this yourself!!

• Insertion of tympanostomy tubes (metal or T-tubes): In cases of chronic ventilation problems, a small tube is inserted into the eardrum to regulate pressure and improve ventilation.

  • In recent years, so-called T-tubes (T-shaped tubes) made of silicone have been developed, which can remain in the ear significantly longer than traditional metal tubes.

  • Tympanostomy tubes are exclusively placed by ENT doctors. Unfortunately, not all specialists have experience with T-tubes or the ability to place them correctly.

• Balloon Eustachian tuboplasty:

  • Since about 10 years ago, the throa-tside of the Eustachian tube, which opens into the throat, can be dilated using a balloon catheter.

  • This procedure is usually performed under general anesthesia and can improve Eustachian tube function. However, it does not work for all patients.

  • Success rates are reported to be between 70-90%. However, personally, I consider this figure to be somewhat optimistic.

  • What can balloon Eustachian tuboplasty NOT achieve? The bony portion of the Eustachian tube, known as the isthmus, cannot be enlarged by this procedure, which may explain why it does not work for every patient.

• Microsurgical procedures:

  • In severe cases, such as eardrum retraction, microsurgical intervention may be necessary to stabilize the ear.

  • Various parts of the middle ear can now be replaced using microsurgery, e.g., the eardrum or the ossicles.

  • Cochlear implants even allow, in certain cases, the replacement of the cochlea (inner ear).

• Surgery on the paranasal sinuses:

  • If one suffers from chronic sinus infections and Eustachian tube dysfunction often occurs alongside sinus infections, surgical correction of the sinuses may be helpful.

  • However, this does not usually address the actual anatomical cause of Eustachian tube dysfunction—namely, the Eustachian tube itself.