Understanding how the nose and ears work together

Written by: Mr Ravinder Singh Natt
Published: | Updated: 29/04/2020
Edited by: Bronwen Griffiths

The Eustachian tube (ET) connects the middle ear with the back of the nose. It allows the equalisation of pressure on either side of the eardrum and drainage of fluid from the middle ear, which is essential for hearing. When swallowing the Eustachian tube opens allowing air to enter the middle ear space. Mr Ravinder Singh Natt is a leading otolaryngologist with huge experience in treating conditions of the Eustachian tube and here he explains them.

What problems can occur in the ET?

If the ET does not open correctly or is blocked (dilatory ET dysfunction), symptoms include:

  • Reduced hearing
  • Earache
  • Dizziness
  • A sensation of fullness within the ear
  • Tinnitus

Blockages can occur following a chest infection or with rhinitis.

If the ET cannot close correctly (palatal ET dysfunction), symptoms may include:

  • Cracking and popping in the ear
  • Hearing your own voice (autophony)
  • Disruptive nasal breathing

These can vary with different head positions. In adults, an ET dysfunction doesn’t last long, but, if it persist treatment is needed. If left untreated, damage to the eardrum and middle ear can result.

How are these treated?

All patients should be assessed by an ENT surgeon, with an audiogram (measures hearing thresholds) and a tympanogram (checks middle ear pressure) completed.

Treatments improve ventilation and include:

  • Oral / nasal steroids
  • Decongestants
  • Antihistamines

These improve the ventilation of the ET opening. If needed, a Valsalva manoeuvre is done whereby the ET is reopened by raising pressure in the nose through an auto-inflation technique of forced exhalation against a closed mouth and nose.

If needed, insertion of a ventilation grommet tube through a small incision in the eardrum is recommended to equalise the pressure on each side of the ear drum.

For palatal ET dysfunction, surgery to narrow the Et opening can be done, either by injecting filling agents or inserting implants.

What is balloon dilation?

For patients experiencing dilatory ET dysfunction, a new technique of balloon dilation is now available. This involves the cannulation of the cartilaginous portion of the ET through the posterior aspect of the nasal cavity with a balloon catheter. This catheter is inflated to multiple atmospheres of pressure for a short period and then removed, achieving dilation. It is performed with sedation or general anaesthetic. This requires a nasal endoscope for guidance. If pre-existing narrowing of access to the nasopharynx exists, then extra surgical intervention will be considered.

Side-effects of minor nose bleeds and rarely infection have been reported, but there is strong evidence that this allows significant improvements in quality of life in patients.


If you are concerned about your are concerned at al about your ENT health, make an appointment with a specialist.

By Mr Ravinder Singh Natt
Otolaryngology / ENT

Mr Ravinder Natt is a distinguished consultant ENT (ear, nose & throat) surgeon with considerable experience in treating a full range of general adult and paediatric ENT conditions through procedures and operations.

Mr Natt has a specialist interest in rhinology (the nose and sinuses), and facial aesthetic surgery, but sees both children and adults for all kinds of ear, nose and throat conditions.

After qualifying from Guy's & St Thomas' School of Medicine, he completed two prestigious fellowships in reconstructive facial aesthetic surgery and advanced rhinology and skull base surgery. Mr Natt has a strong background in education and currently serves as the Undergraduate Programme Lead for ENT/head and neck surgery at University College Medical School.

He regularly attends and delivers lectures at both conferences and courses, and often demonstrates surgical procedures to students and patients, staying up-to-date with the latest technology and treatments in his field.  

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