Eustachian Tube Dysfunction

The Eustachian tube is a small tube that connects the back of the nose to the middle ear. Its purpose is to equalize air pressure across the ear drum so the middle ear can drain properly.

The Eustachian tube normally remains closed. It opens with movements of the throat muscles, such as during swallowing, chewing, or yawning. Sometimes the tube becomes blocked, swollen, or collapsed, making the tube difficult to open. Air and fluids then become trapped in the middle ear, causing a pressure change that affects ear drum movement. This affects hearing and causes sounds to be muffled or blocked, and can be uncomfortable.


Eustachian tube dysfunction commonly results from upper respiratory infections (colds) or allergies. People who were born with a narrower Eustachian tube, or who had frequent childhood ear infections, may also experience dysfunction.


  • pressure in the ear; similar to the feeling of changing altitude
  • occasional pain or discomfort
  • occasional ringing in the ears
  • mild balance disturbance; feeling dizzy or unsteady
  • headaches or facial pain without apparent cause


Because most symptoms are related to upper respiratory infections, symptoms usually subside when the virus goes away. Antibiotics are not necessary in treating Eustachian tube dysfunction.

At times, other medications, including decongestants, antihistamines, or topical nasal steroids may be beneficial. People with high blood pressure should not take pseudoephedrine, a decongestant. Analgesics such as acetaminophen or ibuprofen can be used as needed for pain relief, according to label directions.

Ear comfort while flying

When flying, try swallowing to open the Eustachian tube or create positive pressure against the closed nasal airway by squeezing the nostrils together with the fingers and then exhaling through the nose. This usually equalizes pressure in the middle ear to the outside. Do this frequently during the change in altitude to reduce large pressure differences. Chewing gum or sucking on hard candy can also help.

Use of oral decongestants, antihistamines, and nasal decongestant sprays, such as Afrin nasal spray, prior to flying may allow for easier pressure equalization. Use 30 minutes before flying and 30 minutes before landing to help open the nasal passages and Eustachian tubes when ill with a cold or experiencing congestion.

Special types of ear plugs (e.g., EarPlanes) slow down the pressure changes from flying by allowing more time to equalize the pressure and may decrease ear pain. These plugs are available in drug stores and at most airports.

When to consult a clinician

Although complications are rare, consult a clinician if any of the following occur:

  • persistent or increasing ear pain
  • fever over 101ºF despite aspirin, acetaminophen, or ibuprofen
  • bloody or pus-like drainage from the ear canal
  • severe dizziness
  • neck stiffness

[HU 475 : updated 5/07]