Topic: ENT, specificish question?
June 20, 2019 / By Dacey Question:
I'm 16 and when I was 12 I had an ossiculoplasty for my collapsed ear drum and received artificial bones. I've had ear problems and surgeries my whole life, but the other day my ENT doctor was doing a checkup and randomly said "well since your eustachian tube doesn't work..." (its just now being revealed to me that i have that and it was the cause for my ear problems) and never really explained that to me. What does that mean, that my eustachian tube doesn't work? Was I born like that?
Billie | 6 days ago
The eardrum is supposed to be airtight and watertight, so that when you go for a swim, water doesn't get inside your head.
On the other hand, for your eardrum to vibrate properly, in time with the sound-waves (coming down the outer ear passage), it needs to have air on both sides of it. We know there is plenty of air in your outer ear-passage : but there needs to be air on the inside of your eardrum as well.
So, if the airdrum is supposed to be airtight, - how does air get in to the little chamber on the inner side of your eardrum??
The answer is that on each side, right and left, there is a small air-tube which carries air directly from the back of your nose-passage inside, up into your ear chamber behind the eardrum (called the "middle ear chamber").
This tube is called the Eustachian tube, in the jargon. It is responsible for keeping the middle ear chamber air-ated, and it also allows the air-pressure on either side of your eardrum to be equalised (for going up in an aeroplane, or down deep-sea diving).
There is a problem when the Eustachian tube gets blocked, as it can do fairly easily in small children by "catarrh." Catarrh is usually the problem, - being born without Eustachian tubes at all, is rare.
Then any air left in your middle-ear chamber gets re-absorbed, and it cannot be replaced. The air-pressure inside, behind your eardrum falls, - and as a consequence the eardrum is pushed inwards by the normal outside air-pressure (or you could say that the eardrum is sucked-in by the negative pressure).
For a start, this causes discomfort and it also means that the eardrum cannot vibrate in time with the outside sound-waves (so you get deaf).
But after a little while, - if the Eustachian catarrh persists, - the middle ear chamber fills up with fluid, instead of air, - specifically a sticky fluid called "glue." This is the condition called "Glue Ear."
Then as a further problem, Glue Ears tend to become infected. Germs find their way into the middle ear chamber, and cause a middle-ear infection. Like a boil or abscess, this infection produces pus.
The pus formation causes an increase in the pressure in the middle ear chamber, and the eardrum now starts to bulge outwards into the outer ear passage. Then suddenly, POPP!! - a little hole bursts in the eardrum, and through this hole the nasty pus flows out. It is just like a boil in the skin bursting and draining.
When the pus has found this new way out, the infection inside settles down. The patient feels a lot better.
But now the patient has a little hole in his or her eardrum... and the eardrum is no longer airtight or watertight!!
For a while, this hole in the eardrum serves to let air into the middle ear chamber again, - and so the hole replaces the non-functioning Eustachian tube. All is well for a while.
Then after a few weeks, the hole in the eardrum heals up. This seals the eardrum air-tight again. The whole unpleasant cycle can now repeat itself, -
Blocked Eustachian tube-> negative pressure-> gluey fluid collects-> ear gets infected-> pus forms-> perforates a hole in the eardrum-> pus drains out-> infection settles-> air can now get in through the eardrum hole-> all is well for a while.
This is the repeating history of " Glue Ear," and I imagine these repeated infections have helped to destroy your tiny natural ear-bones? The 3 tiny ear-bones are also sat there in the middle ear chamber. Pus can eat away at them.
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The treatment of recurrent Glue Ear has always been, to cut a tiny slit in the eardrum on the affected side. This "artificial hole" allows air to get in directly, and by-passes the blocked Eustachian tube.
The big problem of this surgical slit-hole healing up in a few weeks, has been solved by inserting a tiny plastic "grommet" into the surgical hole. This physically prevents the hole from healing, and the grommet itself has a central hole in it to let the air through.
As a variant of that, some Ear Surgeons insert a "tube grommet," which is more like a tiny drinking straw, - but in my experience a tube grommet allows more ear-infections than a tiny Diabolo grommet does.
Nowadays there is an expensive new piece of kit with a laser beam. Instead of cutting a slit in the eardrum with a tiny knife, the Surgeon now burns a tiny hole in the eardrum with the quick flash of a laser-beam.
This tiny "burn hole" works the same and lets the air in, but the burn takes many months to heal up naturally and so NO grommet is needed!! A big advance, but not every centre has one.
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If you still have Eustachian catarrh, and your Eustachian tubes are blocked, then I think you should investigate getting a quick-flash laser-burn hole in your eardrum twice a year. That could help a lot, in my humble opinion.
The best treatment would obviously be to clear and re-open your Eustachian tubes, - but in practice that doesn't seem to work so well. Attempts to do that are usually disappointing, in my humble opinion.
I hope this is of some help. Please ask if it is not clear. I have avoided medical jargon words as far as I can. If you need them, I can provide them.
retired uk GP
This is a question you need to be asking your doctor. This is not the place to get information.
How on earth would WE know whether you were born with a non-functional eustachian tube?
If you are ever confused by something a doctor says to you, ask for clarification right away. It's also possible that your parents can provide some information, if the issue involves something dating back to your infancy or early childhood.