What is it?
The Eustachian tube is a short channel that links the middle ear to the back of your nose. It opens briefly when you swallow and when you yawn, balancing the pressure in the middle ear with the air outside. When it does not open enough, the pressure behind the eardrum drops, and the ear feels full, blocked and under pressure.
Typically the symptoms are fullness, crackling, hearing your own voice in your ear, and sounds seeming to come from far away. They become obvious on a plane, in a lift and while diving, and they increase during colds, allergies and periods of a blocked nose. Swallowing or yawning may bring short-lived relief.
The reason this picture is discussed in a dental clinic is that the same symptoms can also come from the jaw joint. When the fullness comes from the joint, the discomfort increases with chewing, pressing in front of the ear and over the temple is tender, and opening and closing the mouth changes the feeling. In a picture coming from the Eustachian tube, the link with the nose and with pressure is at the front.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Upper respiratory infections and allergy
In a cold and in hay fever the lining at the back of the nose swells and the mouth of the tube narrows. This is the most common background, and the symptoms most often carry on for a while after the infection has passed.
- 02
Blockage in the nose and behind it
Enlarged adenoids, a constantly blocked nose and breathing through the mouth make it harder for the tube to open. In children this is often what lies behind a full feeling in the ear.
- 03
Changes in pressure
Flying, diving and rapid changes in altitude put the tube under strain. Flying with a cold can leave clear pain and fullness in the ear; the symptoms are felt more on the descent.
- 04
Things that constantly irritate the lining
Cigarette smoke, dusts at work and acid reflux can cause lasting swelling of the lining at the back of the nose. In an adult, symptoms that stay on one side and do not go call for the area behind the nose to be examined separately.
How does it progress?
- Blocked type
The tube not opening enough
This is the most common form. Fullness, pressure and a slight drop in hearing are at the front, and it usually goes along with a blocked nose.
- Pressure type
A picture that appears with flying and diving
The symptoms only appear with rapid changes in pressure. There is pain and blockage in the ear on the descent, and it most often settles within hours.
- Open type
The tube not closing
This is rarer. Your own voice and your breathing echo in your ear; bending forward or lying down eases the symptoms. It can be seen after rapid weight loss.
- Long-lasting
Symptoms going on for more than three months
If the symptoms are not settling, or they persist on one side, an endoscopic examination of the area behind the nose is needed. That assessment is an ENT specialist's job.
How is it treated?
The doctor to see for this picture is an ENT specialist. There the eardrum is examined with an otoscope; tympanometry, which measures the pressure in the middle ear, and a hearing test may be carried out, and if it is thought necessary the nose and the space behind it are assessed with an endoscope. The diagnosis is made at that examination, and a dentist does not diagnose this picture.
The ENT specialist's plan most often addresses the underlying cause, taking in a blocked nose, allergy, adenoids and acid reflux. In patients whose symptoms go on for a long time, procedures aimed at the eardrum or at widening the tube may be considered. The order and the timing of these options are that doctor's decision.
The dentist's role is limited to noticing and telling apart. At the examination the chewing muscles, the jaw joint and the bite are looked at; if the findings point to the joint, the matter is dealt with within dentistry, and if ear and nose findings are at the front, you are referred on. It cannot be said that treatment aimed at the jaw joint will clear a full feeling in the ear.
- Hearing loss that comes on suddenly; this needs assessment the same day
- Pain in the ear, a temperature and discharge from the ear
- A full feeling in one ear in an adult that does not go for weeks
- Weakness in the face or double vision alongside the ear symptoms
How is it prevented?
- Do not let a blocked nose and allergy symptoms drag on; the pressure in your ears is largely managed through the nose.
- If you have to fly with a cold, swallow often during the descent; for children, ask your doctor beforehand.
- Stay away from cigarette smoke; smoke can cause lasting swelling of the lining at the back of the nose.
- If your child breathes through the mouth all the time and snores, ask for an assessment before ear symptoms start.
Frequently asked questions
- Is the fullness in my ear coming from my jaw joint?
- The examination tells them apart. Symptoms that increase with chewing, that become tender when the area in front of the ear and the temple is pressed, and that change as you open and close your mouth suggest the joint. Those linked to a blocked nose, flying and colds point to the Eustachian tube. The two can also be present together in the same person.
- The ENT specialist could not find a problem. What can a dentist do?
- The dentist examines the jaw joint and the chewing muscles. If the findings suggest a picture coming from the joint, it is dealt with within their own field. If the examination shows nothing of the kind, the assessment is handed back to the ENT specialist; an ear symptom is not explained away with dental treatment.
- Is the ringing in my ear coming from the Eustachian tube?
- Ringing can go along with Eustachian tube dysfunction, but on its own it does not give that diagnosis. Ringing is also linked to hearing loss, to middle ear problems and to other causes. For that reason an ENT assessment and a hearing test are expected first.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.