Middle Ear

Eustachian Tube Dysfunction (ETD)

Eustachian Tube:

The Eustachian Tube (ET) connects the back of the nose to the middle ear, it remains shut most of the time, only opening when swallowing, chewing and yawning happen.  Its function is to allow air to pass freely between the nose and middle ear cavities to maintain equal pressure.  Air is ‘used up’ continually by the middle ear (behind your eardrum) so the tube needs to open regularly to get a fresh supply of air.

Equal air pressure on each side of the eardrum is required for the best hearing and healthiest ears possible.

During infancy the ET is short and almost horizontal contributing to a high rate of childhood middle ear (ME) problems.  This is why babies should not drink bottles while lying down.  Through childhood it becomes elongated with a slight downward angle inhibiting the upward movement of pathogens and milk!

Three factors that cause ET dysfunction

  • structural abnormalities
    • are related to genetics and immaturity and often improve with age
  • mucosal swelling
    • may be caused by infection, allergy, and/or irritants, which in turn may be aggravated by other underlying problems with nose, sinus or mouth anatomy
  • physical blocking
    • occlusion of the tube opening is possible from enlarged adenoids or possibly a tumour

Avoid Painful Flights or Diving!

Before your holiday/trip:

  • Blow your nose and then “POP” your ears many times each day during the week before you leave
    To do this hold your nose firmly shut with your fingers and then gently blow against the shut nostrils – the air will then go up the eustachian tube and ‘pop’ into your middle ear. Swallow afterwards to equalize the pressure.
  • Take a packet of Air Waves chewing gum with you – if a stuffy nose develops the Menthol & Eucalyptus will help keep the Eustachian tubes open and working well – a Vick’s Inhaler will achieve the same

If you have waxy ears get them cleared prior to your trip – come for a FREE Ear Canal Check to make sure your ear canals are empty – you will prevent problems from happening

During a flight:

  • During ascent, the cabin pressure is decreased and the middle ear pressure becomes increased. If the ET opens normally, air will leave the middle ear space until the pressure is equalized. If the ET does not open normally, the excess pressure stretches the eardrum causing pain.
  • To help a sticky ET to open during ascent hold your nose shut and swallow – this moves air down the tube which lowers the middle ear pressure (Toynbee’s Manouvre).
  • During descent the cabin air pressure increases rapidly, if the ET does not open to equalize, the middle ear pressure becomes a vacuum, sucking the eardrum inwards, this stretching causes pain.
  • To open ET’s to get more air into the middle ear during descent, hold your nose shut and blow out gently against the blockage (Valsalva Manouvre).

In severe cases the tiny blood vessels become damaged, bleeding can occur within the layers of the eardrum or in the middle ear. The body can react to the negative pressure by filling the middle ear space with fluid. This injury is called Barotrauma.


For successful equalization when diving, ‘practise makes perfect’. Dive instructors teach a variety of methods to keep the middle ear safely inflated and about the reasons why it is so important to avoid ‘middle ear squeeze’ or ‘reverse block’, which lead to barotrauma or burst eardrums.

Other safety points:

  • make sure a diving hood does not make an airtight seal over the ears
  • do not wear ear plugs when diving
  • if you have a cold, sinusitis or cannot ‘pop’ your ears for any reason DO NOT DIVE
  • call into TOLBECS for a FREE Ear Canal Check to make sure your ear canals are empty prior to diving