Ask the Doctors

Dear Doctor: My hearing loss is related to my Eustachian tubes: They stay closed. I can open them and improve my hearing by holding my nose and blowing, but the effect lasts only a short time. Hearing aids don't help. What can I do?

Dear Reader: First, let's consider the size and location of the Eustachian tubes, one on each side of your head. Only half a centimeter wide, each one starts behind the nose and travels through cartilage and bone toward the middle ear, an air-filled chamber bordered on one side by the eardrum. The pressure within the middle ear should be equal to the air pressure outside, and the Eustachian tube is the only way for the body to equalize these pressures. This gas pressure homeostasis is necessary for optimal hearing.

The most common reason that the Eustachian tube closes is from inflammation within the tube and secretions that can block it from opening. With the tube closed, the middle ear has no way for the air to go in or out. When that happens, the air in the middle ear gets absorbed by the surrounding structures, creating a negative pressure in the middle ear. The sensation is similar to how your ears feel at the bottom of a pool. This negative pressure makes it even more difficult for the Eustachian tube to open, increasing to the point where fluid starts to fill the middle ear. In severe cases, blockage of the Eustachian tube can lead to vertigo and balance problems.

Now let's look at the possible causes for a closed Eustachian tube. In my experience, the most common cause is chronic nasal congestion, either from allergies or environmental irritants. Infection of the adenoids, sinus or nose also are likely causes; to determine this, an ear, nose and throat doctor would visualize the adenoids to assess their condition.

Chronic nasal swelling is another potential culprit. If that's the case, medications such as nasal steroids, leukotriene inhibitors and antihistamines could decrease the swelling, opening your Eustachian tubes and thus improving your hearing.

Note that one study, however, did not show significant change in Eustachian tube dysfunction with the use of a common steroid delivered via nasal spray, Nasacort. In addition, an over-the-counter expectorant, guaifenesin, could thin secretions sufficiently in the Eustachian tube to help clear it.

Essentially, the treatment depends on the cause. For inflammation and closure of the Eustachian tube caused by infection, antibiotics can help. For inflammation caused by acid reflux, which can lead to inflammation in the nasopharynx, look for ways to decrease acid reflux. If adenoids are blocking the Eustachian tube, the adenoids can be surgically removed.

As for medications, if those are ineffective, either balloon dilation of the Eustachian tube or laser therapy can be used to clear the opening in the nasopharynx.

Talk to your doctor about your symptoms. Eustachian tube dysfunction can be treated and, because symptoms can worsen, it should not be ignored.

Also, a note to my readers: A recent column on the potential link between proton pump inhibitors and heart disease referred to a study involving both clopidogrel and Plavix. In fact, they're the same drug. The reference should have said that researchers found an increase in the rate of heart events among those taking a proton pump inhibitor and clopidogrel/Plavix after angioplasty, but no difference in death rates. Thanks to those readers who pointed this out.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

More like Ask the Doctors