The channel called “Eustachian tube” provides communication between the middle ear—located behind the tympanic membrane and is filled with air under normal conditions—and the nasopharynx region located in the farthest area behind the nose.
The Eustachian tube has a mean length of 3,5 cm, 1/3 of which has a bony structure whereas the remaining 2/3 has a cartilaginous structure. The channel that remains narrowed in its natural position in a way preventing air flow is opened as a result of contraction of the muscles around it during the act of swallowing, allowing for air flow between the middle ear and nasopharynx.
The most important functions of the Eustachian tube are to balance the pressure in the middle ear cavity and the external ambient pressure, to enable discharge of the secretions accumulated in the middle ear and to protect the middle ear against infections and secretions from the nasopharynx.
What are the Causes of Eustachian Tube Dysfunction?
Eustachian tube dysfunctions in the form of obstruction may develop in association with upper respiratory tract infections involving the nasopharynx region, allergic reactions, sinus infections, surgical traumas or tumors and masses in the nasopharynx region. They can also be observed without any reason, just due to anatomical structural features.
The condition, in which the channel is open more than normal (patulous Eustachian tube), is another dysfunction of the Eustachian tube that has totally different causes, symptoms and treatment options, will not be discussed under this topic title.
What Happens In Case of a Eustachian Tube Dysfunction?
In case the middle ear pressure cannot be equalized with the external ambient pressure as a result of inability of the Eustachian tube to function adequately, the air in the middle ear is absorbed by soft tissues and the resultant negative pressure in the middle ear causes certain symptoms in the early period, such as feeling of fullness in the ears, tinnitus, ear congestion, and sense of decreased hearing. If the pressures cannot be equalized in a long period of time, the condition may result in fluid accumulation in the middle ear, withdrawal of the tympanic membrane towards the middle ear, its adhesion to the ear structures, retraction of the tympanic membrane and consequent severe chronic middle ear infections.
Fluid accumulation in the middle ear accompanied by withdrawals and adhesions of the tympanic membrane at various levels mostly occur in patients with severe and chronic tube obstruction, whereas significant problems are not observed in patients with relatively milder levels of dysfunctions in normal times; however, symptoms may occur in cases of infections causing edema and swelling in the Eustachian tube mucosa, allergic reactions , or certain conditions such as air travel or diving that lead to significant changes in the external ambient pressure.
How is a Eustachian Tube Blockage Treated?
Drugs and nasal sprays reducing mucosal swelling (decongestants) are useful in the treatment of Eustachian tube dysfunctions that develop in a short time due to certain causes such as infection or allergic reactions. However, medications mostly cannot succeed in the treatment of long-term Eustachian tube dysfunctions.
Although very different methods have been tried until today, for the treatment of various levels of Eustachian tube blockages seen in %1 of the society, any method with a low complication risk could not be found and the most preferred method has been the procedure that involves placing an aeration tube onto the tympanic membrane to balance the middle ear pressure in patients with significant problems.
Long-term existence of ear aeration tubes on the tympanic membrane leads to perforations, calcifications and atrophic areas in the tympanic membrane, infections in the middle ear and impairs the patient's quality of life due to the continuous need for its protection from water.
How is Eustachian Tube Balloon Dilation Performed?
The "Eustachian Tube Balloon Dilation" technique that has recently been introduced gives highly good results in patients with chronic Eustachian tube dysfunction. In this technique, the Eustachian tube is accessed with a special catheter guided by an endoscope passing through the nose, from the opening at the side of the nasopharynx and then the balloon on the catheter is inflated in the cartilaginous portion of the Eustachian tube. As a result of the expansion of the tube, a long-term improvement can be achieved in its functions.
The Eustachian tube balloon dilation procedure is safely carried out in eligible patients, mostly under general anesthesia and the complete process takes 15 to 20 minutes.
Who Are Eligible for Eustachian Tube Balloon Dilation?
Patients who are candidates for “Eustachian tube balloon dilation” procedure are those who have certain problems such as fluid accumulation in the middle ear, collapse and pocketing of the tympanic membrane and its adhesion to the ear structures due to severe chronic Eustachian tube dysfunctions and middle ear fluid accumulation, infection, bleeding or serious pain problems due to the inability to balance the middle ear pressure despite medication support, especially during air travels or underwater sports, as a result of inadequate functioning of the Eustachian tube.
Especially in patients who very recently began to suffer from a problem an investigation should definitely be made before “Eustachian tube balloon dilation” procedure, in order to ascertain if there is any pathology such as allergy and tumor originating from the ear bone, sinuses, nose and nasopharynx region, which may affect the functions of the Eustachian tube.
The Eustachian balloon dilatation procedure can only be carried out for adult patients, due to the features of today’s technical equipment.
