Conditions and Diseases

When the Eustachian tube remains inappropriately closed or open, it causes a host of problems.

What it is

The Eustachian tube connects the back of your nose (nasopharynx) to your middle ear (air-filled space that helps to conduct and transmit sound from the eardrum to the inner ear). It equalizes the pressure in your middle ear with the outside world. The valve, located at the back of the nose, is usually closed to prevent bacteria and other substances from getting into the middle ear.

The valve opens to equalize the pressure when you swallow, yawn, or blow your nose. It also serves to drain secretions from the middle ear and allows for ventilation. When the Eustachian tube remains inappropriately closed or open, it causes a host of problems.


When the Eustachian tube is inappropriately closed, whether from a variation in anatomy (such as cleft palate) or inflammation in the nasopharynx (such as from allergy or infection), it may prevent the Eustachian tube from functioning properly. A number of symptoms can occur as a result:

  • Muffled or distorted hearing
  • Ear infection (otitis media)
  • Feeling of fullness
  • Ear pain

Longstanding dysfunction can lead to more than discomfort; it may lead to more serious issues, such as perforation of the eardrum or development of cholesteatoma.

Patulous Eustachian Tube

What it is

When the tube remains open when it should be closed, the condition is referred to as “Patulous Eustachian Tube.” Symptoms of this condition include:

  • Autophony (when your voice sounds louder and lower-pitched to yourself)
  • Audible body noises (when you hear yourself breathing or chewing)
  • Feeling of fullness in the ear
  • Fluctuating sensation of the eardrum with breathing

Despite the sensation of fullness, your hearing remains normal and you won’t feel pain. This condition is generally temporary and doesn’t cause any damage. Although this condition can be caused by weight loss, hormonal changes from pregnancy, menopause, pre-menopause, or hormone medication, most of the time no specific cause can be identified.

How to treat it

An abnormally open Eustachian tube can be difficult to treat. There are management options that help alleviate symptoms, but you may need to experiment until you find an option that works for you. Management options include:

  • Inducing acid reflux. Drink a glass of either orange or tomato juice an hour before bed (and do not take reflux medicine) to induce reflux.
  • Sleep on your affected ear. By getting some reflux into the back of the nose on the affected side, you cause some swelling, which then closes the tube.
  • Using Premarin (intramuscular formula) 25 mg in 30 cc of saline nasal drops
  • Using double strength or hypertonic saline (1.8%) nasal drops
  • Using PatulEND® vitamin supplement nasal drops (available at

It’s important to use nasal drops correctly. You should either lie down or tilt your head far back and then turn it 15 degrees toward the affected ear. Place the drops in the nostril and sniff the solution into the back of the nose.

If your symptoms are unresponsive to medical management, there are surgical options your physician can discuss with you. Those options include:

  • Placement of a myringotomy (pressure equalization) tube
  • Injection of filler substance around the opening of the Eustachian tube
  • Placement of cartilage graft at the opening of the tube

As a last resort, the Eustachian tube can be closed surgically and a perforation created in the eardrum.