Can you see your eustachian tubes

Sometimes the doctor will put a small tube in the eardrum. The tube will fall out over time. If you have allergies, talk to your doctor about how to treat them so your sinuses stay clear and your eustachian tubes stay open. When you are in an airplane, you can chew gum, yawn, or drink liquids during takeoff and landing. Try the exercise where you gently blow while holding your nose shut.

Kim MD - Pediatrics E. Author: Healthwise Staff. Medical Review: Susan C. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Updated visitor guidelines. You are here Home » Blocked Eustachian Tubes. How is Eustachian tube dysfunction diagnosed? Can Eustachian tube dysfunction be prevented or avoided? Eustachian tube dysfunction treatment. These can include: Using a decongestant to reduce the swelling of the lining of the tubes. Taking an antihistamine or using a steroid nasal spray to reduce any allergic response.

Making a tiny incision in the eardrum and suctioning out the fluid in the middle ear. This gives the Eustachian tube lining time to shrink while the eardrum is healing usually 1 to 3 days.

Implanting small tubes in the eardrums. These let built-up fluid drain out of the middle ear. Children who get a lot of ear infections sometimes get tubes in their ears. They stay in up to 18 months and fall out on their own. Using a balloon dilation system. A doctor will use a catheter long, flexible tube to insert a small balloon through your nose and into the Eustachian tube. When it is inflated, the balloon opens a pathway for mucus and air to flow through the tube.

This can help it function properly. FDA warning The U. Living with Eustachian tube dysfunction. Questions to ask your doctor. Could I have Eustachian tube dysfunction? What can I do to make my child more comfortable?

My child has Eustachian tube dysfunction. Is there anything I can do when I travel to make myself more comfortable? Could my allergies make Eustachian tube dysfunction worse?

What is the best way to treat my Eustachian tube dysfunction? The healthy ET lumen is collapsed at rest, and consequently cannot be imaged in this state. Many have likened the ET lumen to two cones, meeting at their tips to form a narrowing of around 1. The location of this isthmus has been debated, but it appears to occur two thirds of the way along the ET from the nasopharyngeal end, in the cartilaginous part, just before the junctional region [ 2 , 10 ].

Using the same technique, they also found that the isthmus was absent in infants [ 19 ]. The lumen is lined with ciliated pseudostratified columnar epithelium to assist with the clearance of material into the nasopharynx [ 2 ].

The mucosal lining contains folds and glands inferiorly, and can become thickened, contributing to obstructive ETD. Measuring mucosal thickness radiologically is problematic, and Naito et al. Helweg et al. The mucosa cannot be clearly defined on CT [ 17 ]. Four muscles are associated with the ET: the tensor veli palatini, the levator veli palatini, the tensor tympani and the salpingopharyngeus.

The ET is passively closed at rest, and it is thought that the tensor veli palatini plays the main role in opening the lumen [ 1 ].

This muscle arises in two parts from the greater wing of the sphenoid bone and from the fibrocartilaginous ET, before passing downwards to hook around the pterygoid hamulus and insert into the soft palate aponeurosis. The levator veli palatini arises from the inferior aspect of the petrous temporal bone, running below and parallel to the ET floor.

It is thought only to be related to the ET by loose connective tissue, opening the ET during contraction by rotating the medial part of the cartilage with its increased bulk [ 10 ].

The relationship between the ET and these muscles is shown in Fig. A schematic of a transverse section through the ET in the mid-cartilaginous section, as seen in the closed state, with the collapsed lumen shown in black. The mucosal folds in the inferior part of the lumen can be seen. Orientation: AL antero-lateral, PM postero-medial. The salpingopharyngeus arises from the medial and inferior part of the cartilaginous ET.

This small muscle, which is often poorly formed, courses inferiorly embedded within connective tissue, to insert into the pharyngeal wall [ 22 , 23 ]. The tensor tympani arises from the cartilaginous ET and sphenoid bone, and receives fibres from the tensor veli palatini, before ending in a tendon that inserts into the manubrium of the malleus. Despite their proximity, neither the salpingopharyngeus or tensor tympani are thought to influence ET opening [ 2 , 23 ].

The tensor and the levator veli palatini muscles are usually well visualised using MRI [ 17 , 24 , 25 ], where they can be seen to be separated by a layer of fat [ 26 ] and their dimensions can be assessed [ 27 ] Fig.

Electromyographic and other studies have been inconclusive as to the role of the paratubal muscles in obstructive ETD [ 28 , 29 ]. In humans, cranial nerve dysfunction has not been linked to ETD, though abnormal muscle function is thought to be the reason that ETD is prevalent in those with a cleft palate.

Coronal oblique proton density MRI of the right ET and paratubal structures in a year-old healthy male volunteer. The tubal cartilage is indicated by the arrow , the levator palatini muscle by the arrowhead.

LPM lateral pterygoid muscle. MPM medial pterygoid muscle. AL and PM denote antero-lateral and posteromedial orientation of the imaging plane. The fibro-cartilage of the ET extends from the nasopharyngeal opening to firmly attach to the osseous orifice with fibrous bands. T1- and T2-weighted MRI in the oblique parasagittal plane is consistently superior to other modalities for imaging the ET cartilage [ 16 ], with short TI inversion recovery STIR images being of the highest quality [ 25 ].

Visualisation of the ET cartilage with MRI is poor in some individuals, particularly with advanced age [ 25 ], and on CT it often cannot be identified, appearing isodense with surrounding soft tissues [ 16 ]. Ostmann fat pad is an area of fatty tissue running the length of the cartilaginous ET, infero-lateral to the lumen, that is thought to play a role in tube closure [ 2 ]. Amoodi et al. Axial T1 spin echo MRI of the nasopharynx in a year-old healthy male volunteer.

Ostmann fatty tissue is indicated on the left by the arrow. The lateral third of the ET is osseous, lying within the petrous temporal bone. It joins the cartilaginous ET in a junctional region where the two overlap by 3—4 mm. The osseous part of the ET has been studied less than the cartilaginous part. Temporal bone CT scanning is routinely performed to assess middle and inner ear structures; and in many ears, air can be seen in the lumen of the osseous part of the ET [ 32 ].

Jen et al. This correlates well with histological assessments, helping to validate the accuracy of the images [ 34 ]. Jadhav et al. Peritubal cells linked to the ET lumen are potential points for CSF leakage after ear and skull base surgery such as the translabyrinthine approach for vestibular schwannoma resection.

The horizontal segment of the internal carotid artery courses antero-medially along the long axis of the petrous part of temporal bone, and is crossed by the ET as it descends medially from the middle ear [ 36 ]. The relationship between the internal carotid artery and the ET has received significant interest in recent years with the development of new treatments for ETD, and in particular, balloon Eustachian tuboplasty BET. BET is an ET dilatation technique using a high-pressure balloon catheter, similar to those employed in angioplasty.

CT provides the best structural resolution [ 37 — 39 ], and CT angiography can provide further detail if required [ 36 ].

Some institutions routinely request CT imaging prior to performing BET to look for arterial dehiscence adjacent to the ET, as this may put the artery at risk. However, many surgeons consider this unnecessary, as commercially available ET balloon catheters introduced via the nasopharynx do not reach this far.

Abdel Aziz et al. In contrast, Tisch et al. The imaging findings associated with ETD have not been extensively described, with only six published papers identified as describing features detectable on imaging that are suggestive of ETD [ 12 , 24 , 32 , 40 — 42 ]. Two groups found that the bony channel for the Eustachian tube within the temporal bone was of reduced cross sectional size in individuals with obstructive ETD [ 12 , 40 ], and one group found that the tube ran at a shallower angle in diseased ears [ 42 ].

Kanzaki et al. After grommet insertion, they could localise what appeared to be mucosal thickening in some patients with ETD, a finding shared with Liang et al. In the only study to use MRI, Lukens et al. Although all patients had ETD, in unilateral cases, unaffected ears all appeared to open normally, whereas those affected did not. Taken from Lukens et al. The defining feature of a patulous Eustachian tube is patency of the lumen at rest, when it should be closed.

This condition has been successfully imaged using CT. The first published use of CT imaging was in by Tolley et al. By reconstructing images in an oblique plane, several authors have been able to image the patent lumen over its entire length [ 44 , 45 , 47 ]. The most comprehensive study was published by Yoshida et al. Of 31 patulous ETs examined, 13 appeared patent throughout their length, and the other 18 were seen to be mostly open. None of the 50 control healthy ETs examined were found to have visibly open lumens [ 31 ].

However, no mention is made of examiner blinding and the results have yet to be replicated. An image from the study is included Fig. The group also reported good definition of soft tissues, with the exception of Ostmann fat pad.

Oblique CT image of the ET and its surrounding tissues in a patient with severe symptoms of patulous ETD reconstructed 1-mm thick, parallel and perpendicular to the long axis of the ET.

The ET can be seen to be patent along its entire length. Taken from Yoshida et al. A drawback to the use of CT for imaging patulous Eustachian tubes is that patient symptoms often resolve when lying flat [ 4 ] suggesting that the patent tube closes. Because standard CT scanning is performed supine, there is a tendency to under-diagnose patulous ET using the technique.

Although the soft tissue contrast resolution of cone beam CT is inferior to standard CT, Yoshida et al. Interestingly, by using both cone beam and standard CT scanning techniques, this group was able to visualise closure of the abnormally patent lumen on supine positioning.

Rodrigues et al. Symptomatic improvement of patulous ET symptoms was reported [ 48 ]. The ultimate goal of imaging the ET has been to develop a technique that demonstrates whether the tube is competently performing its three main functions: middle ear ventilation, drainage of middle ear secretions, and prevention of sound and fluid reflux from the nasopharynx. Seven papers were identified describing the results from eight imaging methods that directly measured an aspect of ET function [ 49 — 55 ].

One paper was identified that described an indirect measure in the form of a correlation between lumen cross sectional area and tubal function [ 56 ]. Three studies utilised spot and cine x-ray with a contrast agent injected into the middle ear via a perforation or grommet. It was demonstrated that the ET lumen could be visualised in healthy individuals, and that in patients with ETD, lumen narrowing could be seen either at localised points, or throughout the length of the tube [ 49 — 51 ].

Bluestone used the technique in patients with cleft palate and otitis media. He found that contrast failed to clear from the middle ear, or in some cases, even enter the opening of the ET within the middle ear, but that this improved significant only 2 weeks after grommet insertion [ 50 , 57 ]. The same authors also used cine x-ray to examine the reflux of contrast introduced to the nasopharynx, and found that it entered the ET and was actively ejected in healthy individuals, but obstruction at the nasopharyngeal end prevented entry from the nasopharynx in patients with cleft palate or otitis media [ 50 , 57 ].

Another imaging technique that has been successfully used to directly assess ET function is scintigraphy, with four studies published.

Isotope-labelled human albumin introduced via a perforation in the tympanic membrane to the middle ear has been used to demonstrate reduced tube patency and clearance of middle ear secretions in ETD, with slower and incomplete passage of tracer along the tube [ 52 , 55 ]. Labelled Xenon gas has been used to study middle ear ventilation by introducing it at both the nasopharyngeal and tympanic ends of the ET. It was demonstrated that less gas reached the middle ear during Valsalva in ETD patients, and that gas exchange back down the tube was also reduced [ 23 , 24 ].

The final imaging technique that has shown promise in ETD case-control trials is an indirect measure of ET function. Shim et al. They calculated the maximum cross sectional area of the aerated lumen in patients with chronic otitis media and not only found that it was significantly smaller than in healthy controls, but also that pre-operative size correlated with post operative success in the form of an aerated middle ear. They hypothesised that CT could therefore be used as a method of stratifying patients for surgical outcomes.

The inaccessible nature of the ET means that imaging techniques have often been employed in research into its function. Some novel techniques remain potential future clinical tests, whereas others have simply been of use in determining the ET opening mechanism. Early experiments in patients using nasopharyngeal or middle ear contrast, with multiple radiographs or cine x-ray, demonstrated reflux up the ET during opening when assisted by gravity, and suggested a pump-like action of the cartilaginous ET with closure from the tympanic end, clearing any contents into the nasopharynx in partnership with mucociliary clearance [ 58 , 59 ].

Two groups have also attempted insufflating the ET with a mixture of air and powdered radio-opaque material, to provide evidence of ET patency and size, under non-physiological conditions [ 60 , 61 ]. These techniques have not been developed further due to their complexity and poor images with radiographs. More recently, transtympanic injection of silver nanoparticles into the middle ear in an animal model has been shown to demonstrate middle ear and ET anatomy, and mucociliary clearance on CT images [ 62 ].

CT imaging has been utilised in the analysis of ET opening, which is still not fully understood. In healthy volunteers, Tarabichi et al.

Interestingly, the group went on to use the technique in ears undergoing surgery for chronic disease, and visualised a similar rate of patency in the nasopharyngeal third of the ET, suggesting that the obstruction may lie in the protympanic part [ 64 ].

However, if symptoms are ongoing or severe, blocked Eustachian tubes may require treatment by a healthcare professional. This is the effect of your eustachian tubes equalising the pressure. Most of the time we are unaware of this but during flights or even going up a hill, the sudden change of pressure will make this clearing more noticeable. It may even temporarily feel like your ear is blocked or clogged. If your ear feels constantly blocked and painful, you should visit your GP so that they can examine you to ascertain whether you need referring on to an ENT clinic.