Medical Specialties

At the Center for Neurosciences, we work together across specialties to provide the best, most comprehensive approach to treatment.

Eustachian Tube Dysfunction

The Eustachian tube (ET), an anatomic connection between the middle ear (space under the ear drum) and the nasopharynx (back of the nose) helps to ventilate the middle ear space, equalizes pressure between the atmosphere at the middle ear, drains fluid from the middle ear, and helps maintain healthy gas exchange in the middle ear space. Eustachian tube dysfunction (ETD) results in a vacuum under the eardrum, an unhealthy condition that causes several ear pathologies including otitis media, middle ear atelectasis (eardrum retraction), and cholesteatoma. The ET is closed most of the time but should open when a person yawns or swallows.

ETD is normal in children, whose Eustachian tubes are immature and relatively horizontal in orientation compared to adults. This makes them particularly prone to ear infections, which most children outgrow sometime between the ages of 5-7 years. Daycare, exposure to tobacco smoke, family history of ear disease, pacifier use, and formula feeding rather than breastfeeding have been associated with increased ETD and otitis media. A history of seasonal or perennial allergies can also cause or worsen ETD.

Most ear disease related to ETD is managed symptomatically or with intermittent use of oral antibiotics. Nasal decongestants, nasal steroid sprays, and oral antihistamines are sometimes trialed. Recurrent ear infections (> 3-4 episodes in 6 months), persistent middle ear effusions with hearing impairment, middle ear atelectasis (eardrum retraction), ossicular dysfunction (impaired vibration of hearing bones), and cholesteatoma are often managed with surgery.

Why Choose Us

  • Dr. Abraham Jacob, Medical Director for Ear & Hearing (E&H) at the Center for Neurosciences (CNS), is fellowship trained in Otology, Neurotology, and Cranial Base Surgery. He is the first and most experienced Neurotologist in Tucson.
  • Dr. Jacob was a founding member of the University of Arizona (UA) Department of Otolaryngology prior to his departure and transition to CNS. At UA, he was Vice Chair of ENT and held the rank of full Professor with Tenure. He has an international reputation as an expert for treating ear diseases.
  • Dr. Jacob transitioned his practice to the Center for Neurosciences in early 2017 as he felt that the new environment helped him to optimize delivery of personalized ear and lateral skull base care.
  • The medical management of Eustachian tube dysfunction with auto-insufflation, nasal sprays, and the identification/treatment of allergies is typically coordinated by pediatricians, family medicine doctors, or internists. For those who fail such conservative treatments, however, Dr. Jacob’s specific expertise as the only comprehensive ear/lateral skull base surgeon in Tucson is particularly helpful. The UA Ear Institute offers state-of-the-art diagnostic modalities such as microscope examination of the ears, comprehensive audiometry, and advanced CT and MR imaging techniques. When surgery becomes necessary, the initial treatment of chronic ETD often involves placement of collar button tympanostomy tubes that last anywhere from 6-18 months in most patients. Longer lasting tubes such as T-tubes placed through the eardrum or sub annular tubes placed between the eardrum and ear canal wall may become necessary. Complications like middle ear atelectasis with tympanic membrane retraction onto the ossicular chain can require cartilage tympanoplasty techniques and when cholesteatomas form, mastoidectomy procedures may be indicated. As the regional expert, Dr. Jacob has performed thousands of complex ear procedures.
  • Eustachian tube balloon dilation is a relatively new, FDA approved surgical treatment for “dilatory dysfunction” of the ET. Dr. Jacob was the first person trained to perform this operation in Southern Arizona.