Eustachian Tube Pain: Causes and Treatments

The eustachian tubes are small tubes that run from the back of the upper throat to the middle ear. They are tasked with pressure regulation and fluid drainage from the ear.

They are typically closed, but open during certain activities, such as chewing, swallowing, or yawning. If the tubes become clogged when they open, it can lead to eustachian tube pain.

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Causes

The most common cause of eustachian tube pain is eustachian tube dysfunction. However, other conditions can also cause the pain, such as sinusitis, ear infections, and temporomandibular disorder (TMD).

Eustachian Tube Dysfunction

Eustachian tube dysfunction is a condition that develops because of issues with pressure regulation in the ear. Pressure changes can occur when your ears become clogged with fluid or mucus.

The condition is common in children, affecting close to 40% of them. In adults, eustachian tube dysfunction occurs in roughly 1% of the population. This is because a child's and an adult's eustachian tubes are different.

Children have smaller, less rigid, and more horizontal eustachian tubes, whereas adults have more rigid and vertical ones. The eustachian tubes in adults can drain out any fluids quickly, avoiding dysfunction, unlike the eustachian tubes in children.

Aside from pain in the eustachian tube, eustachian tube dysfunction typically presents with other symptoms, including:

A clogged or underwater feeling in the ears
Fullness and pressure in the ears
Ringing in the ears (tinnitus)
Muffled hearing
A crackling or popping sound in the ears

Eustachian tube dysfunction can develop after an upper respiratory tract infection—a viral infection that affects the nose, throat, and airways—or allergies, which can cause a buildup of fluid in the nasal cavity. An ear infection can also lead to the development of eustachian tube dysfunction.

Although rare, malignant tumors in the back of the nose or nasopharynx can obstruct the eustachian tube. For this reason, anyone with persistent eustachian tube dysfunction should see a medical professional.

Sinusitis

Sinusitis is a common infection that occurs in the sinuses. It's estimated that 31 million Americans have the condition. It causes the sinuses to become inflamed and blocked with fluid.

There are four different types of sinusitis: acute bacterial, chronic, subacute, and recurrent acute sinusitis. Although eustachian tube pain can develop in any type of sinusitis, the one that's most typically associated with eustachian ear pain is chronic sinusitis.

The causes of sinusitis include a cold, allergies, polyps, a deviated septum, and a compromised immune system.

Common symptoms of sinusitis include:

Mucus that drips down the throat
A thick nasal discharge that is yellow or green
Pressure around the nose, eyes, and forehead
Bad breath
Cough
Tiredness
Fever

Temporomandibular Disorder

The temporomandibular joint (TMJ) connects the lower jaw to the skull. There is one on both sides of the head, in front of the ears.

The TMJ allows a person to open and close their jaw. When the joints are not working as they should or there is pain in the joint and muscles around it, it is referred to as TMD. It is estimated that up to 25% of the population will have TMD at some point in their lives.

The cause of this type of condition varies from person to person, but one cause is osteoarthritis. Other common causes of TMD include:

Putting pressure on the joint consistently through teeth grinding or clenching
Stress that causes facial and jaw muscles to tighten
A dislocated disc or soft cushion between the ball and socket of the joint

Aside from pain in the eustachian tube, people with TMD will often experience other symptoms, including:

Pain and tenderness in the face, jaw joint area, neck, and shoulders
Limited mouth opening
A locked or stuck jaw when the mouth is in either an open or closed position
Grating, popping, or clicking sounds in the jaw joint when the mouth is opened or closed
Face tiredness
Trouble chewing or a sudden uncomfortable bite
Swelling on the side of the face in the affected joint
Toothaches
Headaches
Neck aches
Dizziness
Tinnitus

Eustachian tube pain has been reported in many people with TMD.

Middle Ear Infections

A middle ear infection occurs behind the eardrum. They are most commonly found in children, though they can develop at any age.

Ear infections are caused by either bacteria or viruses that travel through the eustachian tube and into the middle ear. They typically develop following a cold or respiratory infection.

The symptoms that occur in an ear infection include:

Trouble hearing
Ear pain
Yellow, brown, or white fluid draining from the ears
Fever
Poor sleep
Irritability
Loss of appetite

If an ear infection develops with an effusion (fluid that escaped into a body cavity), fluid can become trapped in the ear and cause mild hearing loss.

Blockage in the eustachian tube can also lead to an ear infection with effusion. Middle ear infections are one of the most common causes of eustachian tube pain.

Nasal Obstruction

A nasal obstruction occurs when there is a blockage or obstruction in the nasal passage. This type of condition is most commonly a symptom of other underlying health issues such as allergies, polyps, tumors, or nose malformations.

The symptoms associated with a nasal obstruction include:

A nasally voice
Drainage from the nasal passage
Mouth breathing
Recurring sinus infections

Nasal obstruction can also lead to the symptoms of eustachian tube dysfunction, which includes eustachian tube pain.

Eustachian tube pain feels like a dull, pressure-like pain that may be accompanied by muffled hearing. The pain can occur in both ears or just one. 

When to See a Healthcare Provider

When to seek treatment from a healthcare provider for eustachian tube pain depends on the cause and how frequently you feel the pain.

If you experience any pain in the ear and are unsure of the cause, call a medical professional. They can help determine the cause of the pain and develop a treatment plan.

It should be noted that if the pain is severe, you should see your healthcare provider as soon as possible. Your practitioner may refer you to an ear, nose, and throat (ENT) specialist if the issue persists.

Eustachian Tube Dysfunction

In the event that eustachian tube dysfunction is causing the pain, it's likely that the condition will clear up on its own in a few weeks. If the pain persists for two weeks or more, is getting worse, or you have other symptoms such as a fever, sore throat, or ear discharge, see your healthcare provider. You may need a more aggressive treatment plan.

Although eustachian tube dysfunction can cause temporary hearing loss, if the hearing loss becomes worse in one ear or your hearing does not return to normal once the pain and other symptoms have gotten better, see your healthcare professional. Eustachian tube dysfunction can lead to middle ear disorders if it does not go away or isn't treated effectively.  

Sinusitis

Sinusitis can be difficult to deal with, especially if it is chronic. Some home remedies can help manage the symptoms, and a medical appointment isn't always required.

However, if the symptoms do not go away or you suffer from recurrent sinus infections, it's important to see a specialist. They can help determine the underlying cause and develop a treatment plan accordingly.

Temporomandibular Disorder

In rarer cases, a mild case of TMD can heal on its own without medical intervention. If you recently had a mild jaw injury or experience symptoms of TMD for seemingly no reason, you should see your healthcare provider. They can help determine the cause and available treatment options.

Persistent eustachian tube pain is common in TMD, so this symptom along with the others should give you an idea that you may be suffering from the condition.

Middle Ear Infections

Ear infections can sometimes resolve on their own in two or three days. However, if you have a fever along with other symptoms of an ear infection, you will need to seek medical care.

Ear Infection Healthcare Provider Discussion Guide

Other signs that your ear infection needs treatment include:

Pus, discharge, or another type of fluid coming out of the ear
Symptoms that are getting worse over time or last longer than three days
Hearing loss
Severe symptoms such as excruciating pain

Nasal Obstruction

A nasal obstruction always warrants a visit to a medical professional. If you experience eustachian tube pain with other symptoms of nasal obstruction, make an appointment with your healthcare provider as soon as possible.

When Should I Worry About Eustachian Tube Pain?

If eustachian tube pain is particularly severe, doesn't resolve on its own in two weeks, or continues to worsen over time, you should see a healthcare provider.

Diagnosis

Eustachian Tube Dysfunction

Your healthcare provider will perform a physical exam. Typically, if fullness, pain, and pressure changes are present, a medical professional will likely determine that EDT is to blame for the eustachian tube pain.

They may also perform other clinical assessments, including:

Otoscopy or otomicroscopy: Your healthcare provider will place a surgical microscope in the ear to get a visual of the auditory canal.
Tympanometry: This is a type of acoustic evaluation that can help determine the condition of your middle ear and eardrum. Your healthcare provider will use various types of air pressure in the ear canal to test the function of the eustachian tube.
Rinne and Weber tuning fork test: Using a tuning fork, a healthcare provider will see if you have any degree of hearing loss.
Nasopharyngoscopy: This surgical procedure examines both the nose and throat using a scope.

Sinusitis

Your healthcare provider can diagnose sinusitis by asking about your symptoms and performing a medical exam. When talking about symptoms, it's important to share all related symptoms, when they started, and if they've occurred before.

The physical exam will be performed using an endoscope, a small optical instrument that has a light on it. This will help determine what part of the sinuses are affected. Looking inside the nose will also help your healthcare provider see if there is anything in the nose that's causing it, such as a deviated septum, nasal polyps, or a tumor.

Some people with sinusitis may need to undergo lab tests. These could include blood tests, allergy tests, and a culture of nasal drainage. They may also need a CT scan.

Temporomandibular Disorder

Since there are some conditions that can mimic TMD, it can be difficult to diagnose.

The healthcare provider will begin with a physical examination to see how your jaw opens and closes and what symptoms you have with the jaw movements. Eustachian tube pain will be a factor in the diagnosis too, because it is highly common in people with TMD.

If your practictioner is unsure about the cause of the symptoms following a physical exam, imaging tests may be performed, including:

Middle Ear Infections

Your healthcare provider will use an instrument called an otoscope to get a better look inside your ears. They will be able to determine whether the eardrum is healthy by its color. Healthy eardrums are pinkish-gray and somewhat translucent, while an infected ear will show a red, swollen, and inflamed eardrum.

To check for fluid in the ear, your healthcare provider will use two methods. The first is to blow air into your eardrum, and the second is to perform an air pressure test called tympanometry. Your healthcare provider will also look at your throat and nasal passages.

If hearing loss is suspected, your healthcare provider will refer you to an audiologist, who can conduct hearing tests.  

Nasal Obstruction

To diagnose nasal obstruction, your healthcare provider will likely go over your symptoms in a physical exam. Then they will follow up with a nasal exam that could include X-rays, CT scans, endoscopes, and other imaging tests. If the nasal obstruction is thought to be a result of allergies, they will also perform an allergy test.

Treatment

You can treat eustachian tube pain at home, but some cases may require medical treatment. It all comes down to what the underlying cause is.

For some, the pain may go away on its own in a short time, whereas others will require other forms of treatment such as medications or surgical intervention.

Home Remedies

In the case of TMD, cold packs or heating pads may help reduce the pain. Jaw exercises have also shown to be effective at relieving pain associated with the condition.

Other exercises that can help relieve eustachian tube pain include:

Goldfish exercises: To perform this exercise, you will place one finger in front of your ear and one finger on your chin. You will then place your tongue gently on the roof of your mouth. Open your mouth either halfway or all the way, and then close it back up. Do this six times per day.
Relaxed jaw: Place your tongue on the top of your mouth behind your front teeth. This can help you relax your jaw muscles for pain relief.
Resistance: Hold on to your chin and pull your mouth open, or push your mouth closed while resisting mouth movements with your jaw.

Nasal obstructions cannot be treated at home.

Medications

Medications can help alleviate the eustachian tube pain associated with sinusitis, eustachian tube dysfunction, an ear infection, or TMD.

Over-the-counter (OTC) pain relievers such as ibuprofen can help with blockages in the ear. Decongestants can also relieve some of the mucus that has built up. You will need antibiotics for an ear infection.

You can treat eustachian tube pain associated with TMD with some OTC medications such as pain relievers or muscle relaxers. In some cases, antidepressants may help manage the symptoms of TMD. If the pain is severe, a steroid shot to the affected joint will help ease swelling and pain.

Ear Candles and Eustachian Tube Pain

Ear candles are hollowed-out fabric cones wrapped in wax. Some people claim that burning them at one end while the other is inside the ear can help clear out earwax and debris. There is no proof to back up these claims, and the Food and Drug Administration has strongly cautioned against using ear candles for this purpose.

Prevention

The easiest way to prevent eustachian tube pain is by addressing the underlying health issue that causes it.

Eustachian Tube Dysfunction

Since eustachian tube dysfunction typically develops because of an infection or allergies, it is a little more difficult to prevent. This is because allergies are not entirely preventable, nor is catching a cold.

The only way to prevent eustachian tube pain caused by eustachian tube dysfunction is to avoid allergens and getting sick, or to treat them promptly when they arise.

Sinusitis

The only real way to prevent sinusitis is by avoiding allergens and keeping the nasal passages as healthy as possible.

Keep allergies at bay with daily medications or make sure your home is allergen-free, wash your hands regularly, and keep the inside of your nose moist with nasal sprays.

Temporomandibular Disorder

Some of the causes of TMD are unavoidable, such as osteoarthritis. Research suggests that preventive techniques can reduce the risk of TMD, such as practicing good oral hygiene and jaw relaxation techniques.

Research has also shown that providing people with education on how the jaw system works and what can be done to keep it healthy can lower the risk of TMD.

Middle Ear Infections

You can avoid an ear infection with a few lifestyle adjustments, including:

Getting all of your vaccines
Washing your hands regularly
Breastfeeding your baby for 18 months
Avoiding smoking and secondhand smoke exposure
Drying your ears after swimming

Nasal Obstruction

Taking allergy medication and avoiding allergy triggers can help prevent a nasal obstruction caused by allergies.

In the case of nasal polyps or tumors, there is no way to prevent them from developing. The focus is on treatment when they do arise.

Summary

Eustachian tube pain has many different causes, from eustachian tube dysfunction to ear infection to nasal obstruction. You will need to treat your specific cause to alleviate the pain. You can treat some of them at home, but others require medical treatment.

A Word From Verywell

Eustachian tube pain can be uncomfortable, but for the most part, it can be easily treated when you know what the cause is.

If you are experiencing the pain but are unsure of the cause, it's important to see your healthcare provider prior to beginning any at-home treatments. When you know what the cause is, you will have the knowledge to pursue the best course of action for relieving the pain and recovering from the ailment that led to its development.