The Anatomy of the Eustachian Tube

The eustachian tubes connect your middle ears to the upper part of the throat behind the nose. Also called auditory tubes, eustachian tubes keep the middle ears healthy by equalizing pressure, draining fluids, and protecting your middle ears from pathogens that could cause infections.

This article will go over the anatomy and function of the eustachian tube. You will also learn about conditions that can affect the auditory tube.

Where Is the Eustachian Tube?

The eustachian tube is located in a part of the head and neck called the parapharyngeal space. It runs from the front wall of the middle ear to the side wall of the top part of the throat (nasopharynx).

In adults, the eustachian tube slopes down about 35 degrees. In children, the eustachian tube only slopes about 10 degrees down.

The eustachian tube is made of bone, cartilage, and fibrous tissue. It is a hollow tube that is lined with hair-like projections (cilia) that sweep mucus away from the middle ear toward the nasopharynx.

There are six muscles that help the eustachian tube open and close. The muscles are located in the ear, head, neck, soft palate, and jaw.

What Does the Eustachian Tube Do?

The eustachian tubes help make sure the middle ear stays healthy by:

• Keeping the air pressure on both sides of the eardrum equal
• Draining secretions from the middle ear
• Protecting the middle ear from pathogens like bacteria and viruses

Each eustachian tube usually stays closed to act as a barrier to protect the ear. However, they will open when the muscles contract—for example, when a person is yawning and swallowing.

When the air pressure changes outside, the eustachian tube opens to allow air to move from the ear canal to the middle ear. This ensures the pressure can equalize on both sides of the eardrum. 

To keep the middle ear working right, the space around the tubes needs to be free of fluid and other debris. The cilia and mucosal folds in the eustachian tube work together to drain the mucus that is made in the middle of the ear.

Conditions That Affect the Eustachian Tube

Eustachian tube dysfunction (ETD) is when the tubes do not open or close properly. There are a few conditions that can be caused by an auditory tube that isn't working right.

Eustachian Tube Blockage

If a eustachian tube is blocked, it makes the pressure in the ear canal and middle ear unequal. This can cause symptoms such as fullness in the ears, reduced hearing, and ear pain. The pressure can also cause a ringing or buzzing in the ears (tinnitus).

The eustachian tubes commonly get blocked by nasal secretions from upper respiratory tract infections, allergies, or sinusitis. The secretions can have bacteria or viruses in them, which can cause a middle ear infection (otitis media).

Patulous Eustachian Tube

In most people, the eustachian tubes open without a problem whenever the air pressure changes, such as when flying in an airplane or diving underwater. However, in some people, the tubes have a harder time equalizing the pressure. As a result, people may have temporary ear pain when they are in these situations.

Patulous eustachian tube is when a eustachian tube stays open longer than usual. It can cause a feeling of pressure in the ears. People can also experience a distortion in the sound of their own voice or breathing.

Often, the cause of patulous eustachian tube is not known. However, there are some known risk factors for patulous eustachian tubes including weight loss, pregnancy, neurologic disorders like multiple sclerosis, anxiety, and exhaustion.

How Eustachian Tube Dysfunction Is Treated

Most symptoms of eustachian tube dysfunction are mild and get better on their own within a few days. If your eustachian tubes are blocked, swallowing, chewing gum, or yawning can help clear them.

If your symptoms persist or if you’re having pain, make an appointment with your healthcare provider. They can figure out why your ears are blocked and recommend the best treatment.

They might suggest you try a few treatments to reduce nasal congestion and clear the middle ear of drainage, such as:

• Nasal saline spray
• Decongestants
• Antihistamines
• Corticosteroids
• Antibiotics (if the blockage is being caused by a bacterial infection)

Alternative medicine practitioners often recommend using eustachian tube massage as a natural way to help ear congestion drain. You press your fingers behind and below your ear lobe and gently massage the area by pulling your fingers down.

Some people might find eustachian tube massage helpful for symptoms, but there has not been a lot of research to prove that it works to clear up a blockage or treat eustachian tube dysfunction.

Surgery Eustachian Tube Dysfunction

For severe eustachian tube dysfunction symptoms that don't go away, you might need to have surgery. There are a few ways that providers can clear the eustachian tubes if they are blocked:

• Ear tubes (tympanostomy tubes) can be put in to help with drainage and blockage in the middle ear.
• Balloon dilation is when a small balloon device that's filled with saline is put into the eustachian tube through the nose, emptied, then taken out.

Most people with patulous eustachian tubes can manage their symptoms without surgery because they only happen once in a while (e.g., while they're in an airplane). For example, putting your head down between your knees can quickly relieve symptoms.

If these strategies do not work, patulous eustachian tubes can be treated with surgery similar to eustachian tube dysfunction.

Summary

The eustachian tubes run from the top of your throat to your middle ear. Their job is to help protect your ear and keep it healthy. Sometimes, there are problems with the eustachian tube and they don't open or close correctly.

Eustachian tube dysfunction can often be treated without surgery, but sometimes people need to have special tubes put in their ears to help prevent them from getting blocked up or infected.