Eustachian tube dysfunction (ETD)

Eustachian tube dysfunction (ETD) is where the Eustachian tube becomes blocked or doesn’t open properly. It can remain open when it should be closed. This affects pressure within your ear, often causing pain, a loss of hearing and impaired balance.

The Eustachian tube connects the middle ear, located behind the eardrum, with the back of the nose. The tube is narrow and, in adults, it is about 3-4 cm long. To function normally, the middle ear needs a constant supply of air via the Eustachian tube.

Eustachian tube dysfunction (ETD) occurs when a blocked or partially blocked Eustachian tube prevents air getting into the middle ear or remains open. This reduces the air pressure in the middle ear allowing the pressure outside the eardrum to push the eardrum inwards. This causes the eardrum to become tense and means it does not vibrate effectively when hit by sound waves resulting in dulled hearing. If it remains open you may hear your own voice and breathing very loudly.

The most common causes of Eustachian tube dysfunction are excessive mucus and inflammation of the tube. These may be caused by a cold, flu or a sinus, ear or throat infection. In these cases, ETD symptoms may persist for a couple of weeks (or sometimes longer) after other symptoms have disappeared because the swelling and trapped mucus may take longer to clear.

Glue ear may cause the Eustachian tube to become congested and prevent the free flow of air into the middle ear. Glue ear is a more common condition in children where the middle ear fills with glue-like fluid.

Allergies that affect the nose, chronic rhinitis and hay fever can cause mucus and inflammation that leads to ETD.

Anything that causes the Eustachian tube to become blocked can lead to ETD; enlarged adenoids for example. Rarely, ETD can be caused by tumours developing at the back of the nose. Weight loss and vigorous exercise may make the tube stay open.

A range of symptoms may be present depending on the exact condition and its cause. One or both ears may be affected. The main symptom is dulled or muffled hearing. There may also be some ear pain caused by the stretching and tensing of the eardrum.

Other symptoms include a feeling of pressure or fullness in the ear. Some patients also report a ringing or buzzing sound in the ear (tinnitus) and some people experience dizziness and loss of balance.

These symptoms can last from just a few hours to several weeks or more depending on the exact cause. Following an obvious and common cause such as a cold, symptoms should disappear completely within a week or so.

We recommend that you contact your doctor as soon as possible if you are experiencing any of these symptoms.

  • muffled or dull hearing
  • ears feeling plugged or full
  • a popping or clicking sensation
  • pain in one or both ears
  • a ringing or buzzing in your ears (tinnitus)
  • trouble keeping your balance
  • worsening symptoms because of altitude or air pressure changes (such as when you are flying, driving through mountains or diving

Your doctor will be able to diagnose Eustachian tube dysfunction by examining inside your ear, your nose and your throat. You may need to be referred to a specialist for additional tests, diagnosis and treatment.

MRI scan

MRI (magnetic resonance imaging) is a special technique that uses powerful magnets, radio waves and computers to produce detailed images (or scans) of the inside of your body.

CT scan

CT stands for ‘computerised tomography’. A CT scan is a detailed X-ray used to create detailed images of the inside of your body.   


An X-ray is used to diagnose and explore a wide variety of conditions mostly in the bones and joints, but can sometimes look at problems affecting soft tissues. They can also be used to monitor on-going conditions.

What next?

If you are suffering with a suspected condition, you should seek the advice of your doctor who will be able to refer you to Benenden Hospital for diagnosis and treatment.

There are four ways to access treatment at Benenden Hospital which include self-funding, using private medical insurance or your Benenden membership, or through the NHS e-Referral scheme.