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What Are Eustachian Tubes and Plugged Ears? The Ear and the Eustachian Tube An ear consists of far more than the part that we see on the side of our head. It contains three sections—the outer ear (pinna, ear canal and eardrum), the middle ear, and the inner ear. The pinna collects sound vibrations and directs them along the ear canal to the eardrum. When the eardrum vibrates, it causes the tiny bones in the middle ear to vibrate as well. The bones transmit the vibrations to the cochlea in the inner ear. The cochlea then sends nerve impulses to the brain, enabling us to hear. The eustachian tube links the middle ear to the back of the nose. The main function of the tube is to ensure that the air pressure in the middle ear is the same as the pressure in the outer ear and the surrounding atmosphere. It does this by transporting air from the upper throat into the ear. The tube also drains mucus and fluid from the ear. Unfortunately, a eustachian tube can sometimes become blocked and incapable of transporting substances. As a result, the pressure on the outer ear side of the eardrum may be higher than the pressure on the inner side, causing the sensation of a plugged ear. In addition, mucus and fluid may collect in the middle ear. The pinna, ear canal, and eardrum all belong to the outer ear, even though only the pinna is outside the body. Anatomy of the Ear The outer ear is made of the pinna or auricle (the part of the ear that we can see), the ear canal, which is also called the external auditory canal, and the eardrum or tympanic membrane. The middle ear is filled with air. It contains three tiny bones which are known as ossicles and are attached to each other. These bones are the malleus or hammer, the incus or anvil, and the stapes or stirrup. The stapes is the smallest bone in the human body. It's also known as the stirrup because it looks like the stirrup in which horse riders place their feet. The inner ear is filled with fluid and contains the cochlea, which is vital for hearing, and the semicircular canals, which are vital for balance. The inner ear, the middle ear, and the ear canal are located in a cavity in the skull. The vestibular nerve leaves the semicircular canals and the cochlear or auditory nerve leaves the cochlea to carry information from the ear to the brain. The two nerves join to form the vestibulocochlear nerve. Exploring an Anatomic Model How We Hear The Outer and Middle Ear In order for us to hear, sound vibrations must first travel through the ear canal and then through the tympanic membrane (or eardrum) to the malleus. The malleus transmits the vibrations to the incus and stapes. The three ossicles amplify the sound vibrations, making them about twenty times stronger than they were when they entered the ear. The footplate of the stapes is attached to the oval window, which is covered by membrane and leads to the vestible of the inner ear. The Inner Ear The vibration of the stapes against the oval window causes the window and the fluid in the vestible to vibrate as well. The vibrations are then passed to the fluid inside the cochlea, where they stimulate hair cells. The cells are known as "hair cells" because they have hair-like extensions. They perform a very important job that is essential for hearing. Hair cells convert the mechanical stimulation of vibrations into the electrochemical signals of nerve impulses. The nerve impulses travel along the auditory nerve to the brain. The brain then creates the sensation of sound. The Sense of Hearing Eutaschian is pronounced you-STAY-she-un. Most of the time our Eustachian tubes are closed. When we swallow or yawn, we often hear a clicking sound in our ears. This is produced by the tubes opening up and then closing again. Functions of the Eustachian or Auditory Tube The eustachian tube is about 3 to 4 cm long in adults (around 1.2 to 1.6 inches) and is a little shorter in children. It slopes downwards from the middle ear to the nasopharynx, which is the upper part of the throat behind the nose. The middle ear contains air. The air is constantly being absorbed by the lining of the middle ear, reducing the pressure. Air pressure needs to be the same on each side of the eardrum in order for the eardrum and ossicles to vibrate properly. When a eustachian tube is open, air passes from the back of the nose or throat through the tube to the middle ear, returning the pressure to normal and allowing the eardrum to function normally. The tube also transfers any fluids that build up away from the middle ear. Children are more likely to develop blocked eustachian tubes than adults. Their tubes are shorter and narrower than those of adults and are also more horizontal, making it harder for fluid to drain out of a eustachian tube into the throat. These factors make it more likely that bacteria and other microbes will collect and multiply inside the tubes. In addition, children have less developed immune systems than adults, making it harder for their bodies to attack bacteria, fungi, and viruses. Information From an ENT (Ear, Nose and Throat) Doctor The eustachian tubes are named after Bartolomeo Eustachio, a sixteenth century Italian anatomist who was the first person to describe the tubes correctly. Eustachian Tube Dysfunction or ETD Eustachian tube dysfunction refers to a condition in which a eustachian tube is blocked, fails to open, or fails to close. If the tube is blocked or doesn't open, the pressure on the outside of the eardrum becomes higher than the pressure on the inside, causing the eardrum to bulge into the middle ear. This process is known as ear barotrauma. Barotrauma is often minor and temporary, but if it's severe or prolonged it may damage the eardrum, reduce the ability to hear, and cause pain. Any time the pressure is different on each side of the eardrum a person may feel a fullness in their ears, as though the ears are plugged or clogged. Hearing is often muffled because the eardrum can't vibrate normally. The ears may be painful. There may also be a ringing sound in the ears (tinnitus) or a popping sound. The sense of balance may be affected as well. A patulous eustachian tube is one that stays open. The condition causes a person to hear normally inaudible sounds created by processes in his or her own body, such as breathing and the heartbeat. In addition, their own voice sounds louder than normal. These effects appear because vibrations in the body travel through the open eustachian tube and strike the eardrum directly. An ETD Slideshow What Causes Blocked Eustachian Tubes? Respiratory Infections A mucous membrane lines the insides of the eustachian tubes, the middle ear, the sinuses, the nose, and the throat. The membrane produces mucus, which is a thick, lubricating, and protective liquid. A respiratory infection such as a cold or the flu may cause mucous membranes in the area to become inflamed. Symptoms of this inflammation include swelling of the membranes and excessive mucus production. Swelling and mucus collection in the eustachian tube can block the passage of air. The mucus may form inside the tube or enter it from another area. A blocked eustachian tube may be unable to open on its own. The condition may be temporary. It often lasts for a week or more after the respiratory infection has been cured, however, since it takes time for the mucus to leave the tube and any swelling to disappear. Allergies Any allergic response which causes symptoms in the nose, such as hay fever, can also affect the eustachian tube. As in a respiratory infection, inflammation may develop inside the tube and/or in areas around it, accompanied by swelling and increased mucus production. Smoking The lining of the middle ear and eustachian tubes is covered with cilia, tiny hair-like cell extensions that move and create a current of mucus. Smoking can damage the cilia, preventing fluid from being drained from the middle ear. Prolonged and repeated exposure to secondhand smoke can have the same effect. Other Causes of Plugged Ears Elevation Changes Changing elevation rapidly can alter air pressure in the outer ear. This can cause a plugged ear sensation until the eustachian tube and the lining of the middle ear compensate for the pressure difference between the outer and middle ear. Airplane flights, scuba diving, and driving up or down mountains can all caused plugged ears. If we descend rapidly from a high elevation plane flight, for example, the air pressure in the outer ear becomes temporarily higher than the pressure in the middle ear. Enlarged Adenoids The eustachian tubes may be closed due to the presence of swollen areas nearby, such as enlarged adenoids. The adenoids are clumps of spongy tissue in the nasopharynx near the openings of the tubes. They are largest in young children and shrink with age. Their function is to help fight infection. If they become enlarged they may close the eustachian tubes. Injuries that damage the eustachian tube and malformation of the tube can also cause EDT. What Is Otitis Media? Otitis media is a middle ear infection and inflammation that is very common in young children. It's much less common in older children and adults, although it does occur in these age groups. In otitis media, fluid collects in the middle ear. The fluid pushes on the eardrum, causing an earache and preventing the eardrum from vibrating properly. The cause of otitis media is often a problem in the eustachian tube. Infected material from the tube may enter the middle ear, causing inflammation and fluid buildup. The tube normally drains mucus, fluid, and bacteria from the middle ear, but if the tube is infected, inflamed, blocked, or malfunctioning it may not be able to do its job. A collection of mucus and fluid in the ear provides a good medium for the growth of microbes. Acute otitis media (AOM) develops quickly, often when a child has a respiratory infection. Microbes can travel from the throat into the eustachian tube and from there into the middle ear. The child may experience ear pain and hearing loss. He or she may sometimes develop a fever as well. The eardrum may break due to the pressure of fluid buildup, releasing pus. Otitis Media in Young Children Glue Ear Otitis media with effusion is frequently known as glue ear or OME. It sometimes occurs after AOM but often appears with no obvious cause. In this condition, fluid escapes from blood vessels in the lining of the middle ear ("effusion") and collects in the space around the ossicles. When the eustachian tube is blocked, a partial vacuum develops in the middle ear. It's thought that this vacuum is responsible for the effusion. The fluid that collects in someone with glue ear becomes thick and sticky. It often creates an uncomfortable sensation of fullness in the ear. It can also cause hearing loss, since the eardrum and ossicles can't vibrate as well when in contact with the thick fluid. A Glue Ear Animation Otitis Media Treatment A child with otitis media should always visit a doctor. The child's body may be able to fight the infection or remove fluid by itself, but antibiotics and/or pain relievers may be needed. The body may also be able to heal a damaged eardrum on its own, but this process has to be monitored by a doctor. A tube called a grommet, a tympanostomy tube, or a pressure equalization tube is sometimes inserted into the eardrum to remove fluid and to allow air to enter or leave the middle ear as necessary. This procedure doesn't cure a problem in the eustachian tube, but it does improve hearing and relieve discomfort. The process in which the tube is inserted is called a myringotomy. Otitis media is usually treated successfully, Careful attention is needed to notice symptoms of the disorder in very young children, who may not be able to express their feelings very well. Untreated otitis media that continues for a long time can have serious consequences for a child's hearing. Occasionally, an infection in the ear may spread to other parts of the body. What Is a Myringotomy? Opening Eustachian Tubes and Removing Blockages Our body often removes the blockage from a eustachian tube and opens a closed one without any extra help, given enough time. There are things that can be done to open the tube quickly, however. Yawning, swallowing, chewing gum, or sucking on a candy can open closed tubes. Taking a deep breath and then exhaling while keeping the mouth closed and pinching the nostrils may also work. The tubes often open with a popping sound. If more help is needed to solve a eustachian tube problem, decongestants can relieve swelling and antihistamines can reduce allergic responses. Sometimes doctors prescribe corticosteroids to reduce inflammation or antibiotics to treat infections. If fluid collects in the middle ear and remains there, a myringotomy may be performed. If self-treatment for a eustachian tube problem doesn't work, it's important to visit a doctor. Seek Medical Attention When Necessary Eustachian tube problems are usually annoying and unpleasant but not dangerous. They are potentially harmful if they last a long time, occur repeatedly, or are severe, however. In these cases, or in cases where the ears are painful, a doctor's advice should be sought. A doctor should also be visited when children are showing signs that their ears are uncomfortable or if there is any indication that they have a hearing problem. In very young children who can't indicate exactly where their pain is coming from, any symptoms of general discomfort or unusual behavior require a doctor's visit. References Eustachian tube dysfunction from Stanford University Middle ear infections in children from the NIH (National Institutes of Health) Otitis media from the Merck Manual Glue ear information from the National Health Service © 2012 Linda Crampton Comments This presentation of your about the Eustachian Tubes was as much or more than I learned when studying anatomy and physiology for my nursing. Great job Alicia! You always put so much time and effort into your hubs. Happy to share. Also pinning to my Health board. Hi AliciaC... this is a hub and a half and such interesting reading... thank you for sharing this with us... voted up and sharing... just awesome. Hugs and Blessings Great hub...well researched and covered. I have had ear issues all of my life. When I was twelve I had a mastoid ectomy. When I was 30 I had a new eardrum made which opened a whole new world of hearing to me. This article is filled with lots of helpful info. Sending Angels your way :) ps I recently had some ear issues, and I would have found this very helpful if I had found it sooner. This is a very educated view on the anatomy of the ear and its problems. Great job! Wonderful explanations Alicia, my friends granddaughter has suffered with her ears since she was tiny, and had to have several surgeries done on it, so it was familiar but I didn't know all the facts, voted up! nell You are on your way to writing a set of encyclopedias here! Well done and so interesting to read. I had trouble with earaches as a child, and now I'm wondering if was some type of allergy. I Hate when my Ears get Clogged... What a Wonderful Hub Alicia, a step by step Educational read into the inner working of the Ear. So Understandable..." I HEAR YOU"! Alicia, what a profound and comprehensive hub about Eustachian tubes and plugged ears. This is the best I've read so far on the topic. Voted up and absolutely awesome! Each new detailed and informative hub you publish, Alicia, is even more detailed and informative than the last. Trust me. You are surpassing yourself each time you write. This outstanding aural dissertation is no exception. Brava and Up! Very informative hub. I found it interesting because I almost always have the feeling of blockage in one ear because of allergies. Voted up and interesting. AliciaC, this is an excellent and beautifully illustrated hub! There is more info here on the ear than in all my A&P classes combined. So well written as well. Very informative, especially for people who need this information. Great and Voted+++ I once happened to read in a resource that I did not consider most reliable, however, that the human hearing, normally about 0 - 20 kHz, can 'stretch' the eardrum and make a human hear up to about 30 kHz in conditions of physiological stress. Would you confirm, deny, or have another opinion? My youngest son suffered from glue ear when he was very little. It took a long time to clear up and included grommets and an operation. Wonderfully detailed and informative hub. Voted up and more.
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Autor: Lea Homolak Kušter, spec. otorinolaringolog Otitis media je najčešća dijagnoza s kojom u ranom djetinjstvu djeca i roditelji napuštaju liječničku ordinaciju. Jedna trećina sve djece prema svjetskim statističkim podacima ima prosječno tri upale uha tijekom prve tri godine života. 60% njih ubrzo budu izliječeni, a u oko 40% oboljelih bolest prijeđe u sekretorni otitis. Učestalost otitisa se više nego udvostručila u posljednjem desetljeću. To rezultira, osim boli i nelagode našim mališanima, i mnogim posjetama liječniku, velikoj godišnjoj potrošnji antibiotika sa svim njihovim neželjenim posljedicama. Također tu su veliki gubici radi odsustva roditelja s posla zbog bolovanja. Otitis media – što je to ? Ot- znači uho, itis- upalu, a media- srednje. Dakle, otitis media je upala srednjeg uha. Upala je rezultat infekcije. Osnovni znaci upale su bol u uhu, crvenilo bubnjića, povišena tjelesna temperatura, izbočenje bubnjića i djelomičan gubitak funkcije (oslabljen sluh). Može se javiti u jednom ili u obadva uha. Ako dijagnoza glasi Otitis media acuta radi se o infekciji srednjeg uha sa simptomima upale iznenadne pojave i kratkog trajanja. Kada se takva bolest javi ponovo za manje od mjesec dana, govorimo o rekurentnom otitisu. Supurativni otitis media je kronična bolest s perforacijom – puknućem bubnjića kroz koju se cijedi sluzavo-gnojni sadržaj. OME-otitis media s efuzijim ili sekretorni otitis je u djece relativno često stanje koje traje dulje od dva mjeseca, a karakterizira ga nazočnost sekreta iza neperforiranog bubnjića. Iako su najčešće u djece, upale uha javljaju se u oko 5 % u odraslih. Pretežno se javljaju zimi i u rano proljeće, a često im predhode respiratorne infekcije. Je li upala uha ozbiljna bolest? Posljedica upale uha mogu biti ozbiljne kao što je gubitak sluha, prolazni ili trajni pa čak i takav da utječe na razvoj govora. Bol može biti jaka, naročito ako upala zahvati okolne strukture kao što je mastoid. Po život je opasno širenje infekcije na strukture mozga, moždane ovojnice, venske sinuse. I vrlo neugodne ako zahvate npr. lični živac (facijalis) ili labirint. Najčešće otitis media, ukoliko je tretiran brzo i efikasno, prođe bez posljedica i s kompletnim oporavkom sluha. Stoga je značajno prepoznati simptome upale uha na samom početku, pratiti ih i liječiti od početka. Kako je građeno uho? Srednje uho je šupljina veličine graha, ispunjena zrakom i tankom pregradom – bubnjićem odvojena od vanjskog uha. Na bubnjić se naslanja lanac slušnih koščica. Kada zvučni val udari u bubnjić, on vibrira i pokrene koščice. Vibracije se tim putem prenesu u unutarnje uho koje generira nervni impuls koji se šalje u mozak. Zdravo srednje uho sadrži zrak istog atmosferskog tlaka kao i izvan uha tako da spomenute strukture slobodno vibriraju. Zrak ulazi u srednje uho kroz tanku cijevčicu Eustahijevu tubu, koja se proteže od stražnjeg dijela nosne šupljine do uha. Kada gutate ili žvačete i začujete klik, to znači da je kroz Eustahijevu tubu upravo poslan mjehurić zraka, koji je izjednačio tlak zraka u uhu s atmosferskim. To se događa automatski dnevno i do 1000 puta. Što uzrokuje upalu uha? Akutni otitis media uzrokovan je bakterijama ili virusima koji iz nosa ili grla uzlazno kroz Eustahijevu tubu dospiju u uho. To se događa kada tuba ne funckionira uredno, najčešće radi prehlade, upale grla ili sinusa ili alergije. Najčešći bakterijski uzročnici su Streptococcus pneuminiae i Haemophilus influenzae. Nažalost sve više njih je neosjetljivih (rezistentnih) na najprepisivanije antibiotike. Anatomske anomalije u području uha, grla i nosa pogoduju nastanku upala uha. Kako prepoznati upalu uha? Infekcija srednjeg uha prezentira se s boli, crvenilom bubnjića, nakupljanjem sekreta iza bubnjića i prolazni gubitak sluha. Kod beba usljed plača pri pregledu bubnjić može biti crven. To nije nužno znak upale. Začepljenost Eustahijeve tube dovodi do negativnog tlaka u srednjem uhu što može izazvati bol. Prema tome niti sama bol u uhu nije nužno upala uha. Ponekad upala uha bude bez ikakvih simptoma i slučajno kod nalaza sekreta u srednjem uhu se kasnije anamnestički rekonstruira preboljela upala uha. Mala djeca ponekad kao jedini simptom kod upale uha razviju toksični sindrom: gubitak teka, povraćanje, proljev, malaksalost... Najčešći simptom akutne upale je bol uz osjećaj punoće i začepljenosti uha. Dijete koje ne može opisati bol, često se povlači za uho ili ga trlja. Povišena tjelesna temperatura često prati akutni otitis media. Sluh je često oslabljen. To se događa jer sekret sprječava normalne vibracije bubnjića i prijenos slušnim koščicama. Uz odgovarajuću njegu i terapiju taj gubitak sluha je privremen. Kada sekreta više nema, sluh se vrati na normalu. Bez pravilnog tretmana gubitak sluha može postati dugotrajan ili trajan. Ponekad bubnjić pukne, gnoj se izlije iz uha. Češće gnoj i sekret ostaju u uhu jer se prirodnim putem ne mogu izliti kroz Eustahijevu tubu i biti progutani. Tako nastaje kronični sekretorni otitis media koji traje tjednima, mjesecima pa i godinama nakon akutne bolne faze. Zaostali sekret često ponovno dovede do akutne upale srednjeg uha. Što se očekuje od pregleda liječnika? Nakon razgovora s roditeljem o tijeku bolesti, slijedi klinički pregled uha, nosa i grla. Tijekom pregleda liječnik će pogledati u uho djeteta najčešće instrumentom koji se zove otoskop. Na taj način vidjet će crvenilo bubnjića, tekućinu iza bubnjića i procijeniti pokretljivost bubnjića (pneumootoskopom). U poliklinici ECHO preglede uha kod djece radimo endoskopom čime pregled dobiva na kvaliteti i sigurnosti. Ta metoda nam omogućava video snimanje te sudjelovanje roditelja u odluci o terapiji i praćenju bolesti njihovog djeteta. Još dva testa moguće je učiniti da liječniku daju potpuniju informaciju o stanju u srednjem uhu i kvaliteti sluha malih pacijenata. Timpanometrija koja mjeri tlak u srednjem uhu i pomičnost bubnjića. Ona indirektno pokazuje kako Eustahijeva tuba funckionira. Kod djece starije od tri-četiri godine i audiogram koji pokazuje koliko je oštećen sluh. Nakon toga se odredi težina bolesti i odluči o načinu liječenja. Roditelji mogu pomoći djetetu da tijekom pregleda budu mirni i tihi. Praćenje djeteta i kontrole osiguravaju potpuno izliječenje. Kako liječiti upalu srednjeg uha? Liječnik je ponekad prisiljen prepisati i neke lijekove. Jedan od njih može biti antibiotik, ako se radi o bakterijskog upali. Iako antibiotik može dovesti do brzog poboljšanja simptoma, potpuno izliječenje vašeg djeteta zatijeva više vremena. Budite sigurni da je vaše dijete uzelo potrebnu punu dozu lijeka obično tijekom 10-13 dana. Uvijek pročitajte upute o lijeku i pažljivo ih se pridržavajte. Liječnik može prepisati i antihistaminik, kortikosterod i dekongestiv ili kombinaciju lijekova ako je alergija ili prehlada nazočna. Liječnik također preporuča često i lijekove koji snizuju temperaturu i uklanjaju bol –analgetike antipiretike u obliku sirupa ili čepića. Posavjetujete se s liječnikom ako vam je nešto nejasno ili simptomi nisu prošli u potpunosti. Toaleta nosa i vježbe izjednačavanja tlaka (Valsalvin pokus) daju značajan terapijski doprinos. Što može biti neophodno? U većini slučajeva kućnim liječenjem upala uha u potpunosti se izliječi. Ipak mnoge upale uha zahtijevaju dodatno liječenje. Primjerice postavljanje ventilacijskih cijevčica u bubnjić ili otvaranje (incizija) male rupice na bubnjiću kroz koji se odstrani gnoj i sluz. To dovodi do brzog prestanka boli, a rupica zacijeli za par dana praktički bez ožiljka. Kako bi se odgodilo cijeljenje i bilo više vremena da se srednje uho i Eustahijeva tuba u potpunosti oporave i sekret ponovo ne nakupi, ponekad je potrebno postaviti tanku plastičnu cjevčicu u rupicu na bubnjiću. Ta cjevčica pomaže izjednačavanju tlaka u srednjem uhu i bržem oporavku sluha. Otorinolaringolog će ocijeniti je li za to potrebno par tjedana ili par mjeseci. Kroz to vrijeme treba uho zaštititi od ulaska vode tijekom kupanja. Otitis media se može s vremena na vrijeme ponavljati i radi kronične upale adenoida i tonzila. Ako je to slučaj kod vašeg djeteta, tada tonzile i adenoide treba odstraniti u općoj anesteziji. Više od 60% djece s upalom uha ima patološke promjene i u nosu i sinusima. Polovica zaostalih sekreta iz srednjeg uha spontano nestaje tijekom tri mjeseca. Sekret u srednjem uhu je znak prošle, sadašnje ili buduće upale uha. Popratne alergije također zahtijevaju poseban tretman. Kako pokušati spriječiti upalu uha? Dojenje je najbolja prevencija upala uha kod beba. Spriječiti rizične faktore: - bočica u krevetu - pasivno pušenje - jaslice/vrtić Dijagnosticirati rano i pouzdano Liječiti brzo i efikasno Zapamtite: Otitis media općenito nije opasan ako se ispravno i brzo liječi. Uz pomoć vašeg liječnika možete pomoći svom djetetu da se osjeća bolje i bolje čuje vrlo brzo. Izvor: Bebe, mjesečnik za trudnice i roditelje, broj 131, Zagreb, ožujak 2003, str. 18-20.