Orange County Ear, Allergy, Nose & Neck (OCEANN) ENT
ABOUT EUSTACHIAN TUBE DYSFUNCTION
What is Eustachian Tube Dysfunction?
The Eustachian Tubes are small mucosa-lined passages extending from your middle ear space (the space in the ear internal to the eardrum) to either side of the nasopharynx (the space in the upper throat area in the very back of the posterior nasal cavity above where the tonsils usually are). These passages usually remain closed, and open briefly when you chew, swallow, sneeze, or yawn to prevent excess fluid accumulation in the middle ear space by allowing for normal drainage of mucous through the Eustachian Tube into the nasopharynx (the space in the very back of the posterior nasal cavity). In addition, the Eustachian Tube (when it intermittently opens) also prevents excessive pressure from building up in the middle ear space by allowing for equalization of pressure in the ears. Click here to see an ear diagram. Eustachian Tube Dysfunction occurs when one or both of these tube(s) becomes narrowed by mucosal congestion or becomes obstructed. Blocked Eustachian Tubes may make you feel like you have ear plugs in your ears or the sensation of fluid in your ears at times. You may also experience ear pressure, ear pain, episodic tinnitus, sensation of fullness or fluid in the ears, and/or episodic vertigo/disequilibrium. Eustachian Tube Dysfunction symptoms may worsen with any cold, allergy flare-up, or sinus infection (either acute or chronic). Sinus disease and/or allergies can lead to inflammation that usually exacerbates Eustachian Tube obstruction from mucosal congestion within the tube or at the Eustachian Tube orifice draining into the nasopharynx at the back of the posterior nasal cavity, and is one of the most common underlying cause(s) of Eustachian Tube Dysfunction. Adjacent inflammation from the sinus and nasal cavities can cause edema (swelling) surrounding the Eustachian Tube orifice in the nasopharynx, when then compromises the ability of the Eustachian Tube to drain fluid from the ear in addition to impairing a person's ability to equalize pressure in their ears (when changing altitude on a plane flight, for example). Patients who experience the symptoms listed below at either normal elevation or with baro-challenge (air travel or scuba diving) are usually good candidates for this novel, FDA-approved, minimally-invasive ear procedure that can be performed as an outpatient same-day In-Office Procedure without any incisions or the need for general anesthesia (which makes the procedure less risky due to elimination of general anesthesia risks, especially for elderly patients); and also makes the procedure more affordable without added Facility fees or Anesthesia fees versus when done in the hospital.
What are the symptoms of Eustachian Tube Dysfuction?
● Fullness in the ears.● Feeling like your ears are plugged.● Clicking, popping, or crackling sounds in the ears.● Ear pressure or pain.● Tinnitus (usually episodic in occurrence if from Eustachian Tube Dysfunction and can be either high-pitched ringing or sound like white noise or static from the TV/radio).● Sensation of fluid in the ears.● Sensation of irritation or itching deep in the ears. Changes in altitude, such as flying in a plane, driving through the mountains, or scuba diving; may worsen symptoms.
How is Eustachian Tube Dysfunction Diagnosed and Treated?
First, the team at OCEANN ENT will initially review your Symptoms and Medical History and perform a Physical Exam including a Tympanometry measurement (which is an objective measure of your Eustachian Tube function and ability to equalize pressure in the ears). We then examine the inside of your ears as well as the nasal passages, in addition to the back of your nose (where the Eustachian Tubes drain), with a small 3-mm endoscope; and in some cases a CT scan of the sinuses and/or ears may need to be performed to confirm the diagnosis. After we at OCEANN ENT diagnose your condition, our highly-trained and experienced Sinus Specialty Surgeon, Dr. Kathy Yu-Syken, who was one of the first surgeons who had pioneered this innovative and minimally-invasive procedure to treat Eustachian Tube Dysfunction, and who had also been performing these procedures off-label even prior to FDA approval in 2018, creates a personalized treatment plan for the patient suffering from this condition that can drastically limit his or her quality-of-life. Medical treatment for Eustachian Tube Dysfunction may initially involve taking medications such as allergy medications or antibiotics, in addition to sinus rinses and intranasal steroid sprays to treat inflammation of the mucosal lining the Eustachian Tube(s) itself and/or at the Eustachian Tube orifice(s) opening into the nasopharynx, mostly secondary to infections or allergies. If your Eustachian Tube Dysfunction is severe and does not respond to medical management, a quick minimally-invasive procedure called Eustachian Tube Dilation, or also known as Balloon Dilation of the Eustachian Tube(s); can be efficiently, expertly, and comfortably performed in our state-of-the art OCEANN ENT Procedure Suite safely with oral sedation, as well as Topical and Local anesthesia (without the need for general anesthesia). This procedure is intended to improve functionality of your Eustachian Tube(s) in a minimally-invasive fashion without incisions or bleeding, and patients can return back to normal activity within 24 hours, without needing prescription pain medications afterwards. Dr. Kathy Yu-Syken has successfully and safely completed over 2,000 of these procedures and is highly regarded in her field as an expert in this procedure. Some Surgeons who are not as experienced or proficient at performing this novel and effective procedure may choose to perform this under general anesthesia, however this does increase the cost of the overall procedure due to facility and anesthesia fees, and adds the risk of General Anesthesia, which may not necessary. Recovery is usually expeditious, with most patients being able to return to work or exercise the following day as no incisions are made so excessive bleeding is highly unlikely. This has been a revolutionary procedure that is an effective and less risky alternative to traditional Myringotomy with Tympanostomy Tube insertion (where an incision is made in the eardrum and a small ventilation tube placed through this incision to equalize pressure by bypassing the dysfunctional or obstructed Eustachian Tube). The benefit of choosing Eustachian Tube Dilation in lieu of Myringotomy with Tympanostomy Tube insertion is that it is a less invasive option that preserves the integrity of the eardrum so that the patient does not have to take precautions to keep ears dry at all times (so that swimming, showering, and water sports can proceed as normal without the need for waterproof ear plugs).
Am I a good candidate for Eustachian Tube Dilation?
Patients who experience the Eustachian Tube Dysfunction symptoms listed below at normal elevation or with baro-challenge (air travel or scuba diving) are usually good candidates for this novel, FDA-approved, minimally-invasive procedure that is accomplished through gentle balloon dilation technique and can be done without any incisions:● Fullness in the ears.● Feeling like your ears are plugged.● Clicking, popping, or crackling sounds in the ears.● Ear pressure or pain.● Tinnitus (usually episodic in occurence if from Eustachian Tube Dysfunction and can be either high-pitched ringing or sound like white noise or static from the TV/radio).● Sensation of fluid in the ears.● Sensation of irritation or itching deep in the ears. Changes in altitude; such as flying in a plane, driving through the mountains, or scuba diving; may worsen symptoms.
What is Eustachian Tube Dilation Treatment?
The Eustachian Tube Dilation procedure is an advanced minimally-invasive procedure for more extended treatment and relief of symptoms from chronic Eustachian Tube Dysfunction. During this procedure, Dr. Kathy Yu-Syken inserts a small balloon catheter through your nasal passage and into the proximal cartilaginous portion of the Eustachian Tube(s). She then carefully aligns the balloon catheter device with your Eustachian Tube(s) and inflates the balloon (previously filled with saline or water to prep the balloon prior to starting the procedure) to dilate the Eustachian Tube(s) for approximately 2 minutes (recommended amount of time in clinical studies studying the efficacy of Eustachian Tube Dilation in treating Eustachian Tube Dysfunction), which subsequently results in the restored ability of both air and mucous to pass through the Eustachian Tube to provide symptomatic relief after a period of 1 to 6 months. Balloon Dilation of the Eustachian Tube(s), or Eustachian Tube Dilation, has recently been introduced as a novel and minimally-invasive method in the last 5 years for treating chronic obstructive Eustachian Tube Dysfunction when medical management (such as decongestants, antihistamines, nasal steroid sprays, and in some cases antibiotics) fail to resolve symptoms, and has become more popular due to decreased risk of complications and success rates comparable to the traditional alternative of performing a myringotomy incision in the eardrum followed by insertion of a tympanostomy tube (foreign body) to keep myringotomy incision open (which is most often only a temporary fix for the duration of time the tympanostomy tube remains in place). Symptoms can return after myringtomy with tympanostomy tube insertion inevitably when the tympanostomy tube extrudes and falls out (into the ear canal) in approximately 12-18 months after placement of tympanostomy tube. This innovative procedure has been approved by the FDA in the recent years and involves passing a high-pressured balloon attached to a catheter through the nasal passage past the sinus cavities and into the cartilaginous portion of the Eustachian Tube(s). The balloon is carefully aligned with the patient’s own Eustachian Tube under endoscopic view and balloon is inflated to 12 atm pressure. This leads to controlled transient ischemia of the thickened mucosal lining of the Eustachian Tube, which then subsequently leads to replacement of the previous inflamed and swollen mucosal lining by a thinner layer of fibrous tissue in the subsequent months after the dilation, thus resulting in a more open and patent Eustachian Tube. This procedure takes approximately a half hour to complete (including the numbing process) and can be performed in a comfortable office setting without the need for general anesthesia or hospitalization, with minimal recovery time needed off from work. This has proven to be an effective alternative in the recent years to the traditional practice of myringotomy (incision in the eardrum), as well as myringotomy with tube insertion (incision in the eardrum with insertion of a tympanostomy tube). Dr. Yu-Syken has been one of the pioneers of this procedure and has been helping patients with Eustachian Tube Dysfunction achieve a better quality of life through Eustachian Tube Dilation since 2015, performing the procedure off-label in combination with Balloon Sinuplasty until it was FDA approved by most insurances in 2018.