Intended for healthcare professionals

Practice 10-Minute Consultation

Eustachian tube dysfunction in adults

BMJ 2014; 348 doi: (Published 11 March 2014) Cite this as: BMJ 2014;348:g1647
  1. Rhona Sproat, core surgical trainee1,
  2. Christopher Burgess, specialist registrar, ENT1,
  3. Tim Lancaster, general practioner2,
  4. Pablo Martinez-Devesa, consultant ENT surgeon1
  1. 1Ear, nose, and throat department, John Radcliffe Hospital, Oxford OX3 9DU, UK
  2. 2Jericho Health Centre—Primary Care, Oxford, UK
  1. Correspondence to: R Sproat rhonasproat{at}
  • Accepted 3 December 2013

A 56 year old woman presents with a history of fullness in her ears and reduced hearing, which has persisted for three weeks. She often hears clicking when she swallows.

What is eustachian tube dysfunction?

The eustachian tube is a cartilaginous and bony tube providing a connection between the nasopharynx and the middle ear. At rest, the eustachian tube is closed, but it opens on swallowing, yawning, sneezing, and the Valsalva manoeuvre due to contraction of palatine muscles. When the eustachian tube opens it facilitates equalisation of pressures between the external environment and the middle ear by allowing a bolus of air to pass through.

Dysfunction of the eustachian tube results in development of negative pressures within the middle ear, leading to transudation of fluid and a pro-inflammatory response. Consequentially, eustachian tube dysfunction is an important component of pathology of the middle ear, particularly acute otitis media and otitis media with effusion.

What you should cover


Feeling of fullness in the ears—Eustachian tube dysfunction classically presents with a feeling of fullness in the ear, often associated with hearing loss. Eustachian tube dysfunction should be a diagnosis of exclusion as ear fullness can be the presenting feature in a wide variety of clinical entities of the external, middle, and inner ears. There is a requirement for …

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