Causes of Eustachian Tube Pain and Treatment Options

There are several common reasons for pain in the eustachian tubes, the small tubes that run from the back of the upper throat to the middle ear. Conditions that cause eustachian tube pain can be accompanied by a variety of different symptoms, including neck pain or stiffness, pressure in the ears, and headaches.

Treatment for eustachian tube pain depends on the underlying cause. In most cases, eustachian tube pain is not cause for serious concern. But if the pain is persistent or particularly severe, it's best to call a healthcare provider.

This article explains the causes of eustachian tube pain and the symptoms that may come with it. It also covers how those causes may be treated.

Causes

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

Eustachian Tube Dysfunction

Eustachian tube dysfunction (ETD) 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 children at some point. 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
• Sore throat
• Bad breath
• Loss of smell
• Fatigue
• Malaise, a general feeling of being ill
• Fever
• Headache
• Pressure-like pain behind the eyes and nose
• Toothache

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 12% 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
• Neck 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, or if the pain is severe, call or see a healthcare provider. You should also contact a provider if you have eustachian tube pain in addition to:

• Fever
• Sore throat
• Ear discharge
• Hearing loss
• Recurrent sinus infections
• A recent head injury
• Nasal obstruction

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.

Ear Infection Healthcare Provider Discussion Guide

Diagnosis

When you visit a healthcare provider with eustachian tube pain, they will start by asking about your symptoms and performing a medical exam. It’s important to share all related symptoms, when they started, and if they’ve occurred before.

Eustachian Tube Dysfunction

Typically, if fullness, pain, and pressure changes are present, a medical professional will likely determine that ETD 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

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, and 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

The healthcare provider will begin by checking 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 provider 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. 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 to see how well your eardrum moves. If the eardrum doesn't move well, there may be fluid behind it. The second is 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 do 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 been 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, place one finger in front of your ear and one finger on your chin. 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.

Note that 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.

Prevention

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

Eustachian tube dysfunction: 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: 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: Research suggests that preventive techniques can reduce the risk of TMD, such as practicing jaw relaxation techniques and avoiding excessive use of chewing gum.

Middle ear infections: You can help avoid middle ear infections by getting all your vaccines, washing your hands regularly, avoiding smoking, and drying your ears after swimming.

Nasal obstruction: Taking allergy medication and avoiding allergy triggers can help prevent 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.

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 American Academy of Otolaryngology—Head and Neck Surgery has strongly cautioned against using ear candles for this purpose.

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. Some conditions can be treated at home, but others require medical treatment.

If you are experiencing the pain but are unsure of the cause, it’s important to see your healthcare provider before beginning any at-home treatments. When you know what the cause is, you will can ten pursue the best course of action for treatment.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Johns Hopkins Medicine. Eustachian tube dysfunction.
2. Schröder S, Ebmeyer J. Diagnostik und therapie von funktionsstörungen der tuba auditiva [diagnosis and treatment of eustachian tube dysfunction]. HNO. 2018;66(2):155-166. German. doi:10.1007/s00106-017-0465-2
3. Schilder AG, Bhutta MF, Butler CC, et al. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol. 2015;40(5):407-411. doi:10.1111/coa.12475
4. American College of Allergy, Asthma, and Immunology. Sinus infection.
5. Maniakas A, Desrosiers M, Asmar MH, et al. Eustachian tube symptoms are frequent in chronic rhinosinusitis and respond well to endoscopic sinus surgery. Rhinology. 2018;56(2):118-121. doi:10.4193/Rhin17.165
6. Penn Medicine. Sinus infection (sinusitis).
7. National Institute of Dental and Craniofacial Research. Prevalence of TMJD and its signs and symptoms.
8. Cardoneanu A, Macovei L, Burlui A, et al. Temporomandibular joint osteoarthritis: pathogenic mechanisms involving the cartilage and subchondral bone, and potential therapeutic strategies for joint regeneration. Int J Mol Sci. 2023;24(1):171. doi:10.3390/ijms24010171
9. Johns Hopkins Medicine. Temporomandibular disorders.
10. Newman AC, Omrani K, Higgins TS, Ting JY, Walgama ES, Wu AW. The prevalence of eustachian tube dysfunction symptoms in temporomandibular joint disorder patients. Laryngoscope. 2020;130(4):E233-E236. doi:10.1002/lary.28162
11. Penn Medicine. Ear infection (middle ear).
12. Earwood JS, Rogers TS, Rathjen NA. Ear pain: diagnosing common and uncommon causes. Am Fam Physician. 2018;97(1):20-27.
13. Johns Hopkins Medicine. Nasal obstruction.
14. Harju T, Kivekäs I, Numminen J, Rautiainen M. Eustachian tube dysfunction-related symptoms in chronic nasal obstruction caused by inferior turbinate enlargement. Ann Otol Rhinol Laryngol. 2017;126(12):798-803. doi:10.1177/0003489417735538
15. Teschner M. Evidence and evidence gaps in the treatment of eustachian tube dysfunction and otitis media. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2016;15:Doc05. doi:10.3205/cto000132
16. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91(6):378-386.
17. Shimada A, Ogawa T, Sammour S, et al. Effectiveness of exercise therapy on pain relief and jaw mobility in patients with pain-related temporomandibular disorders: A systematic review. Front Oral Health. 2023;4(1):1170966. doi:10.3389/froh.2023.1170966
18. University of Michigan Health. Blocked eustachian tubes.
19. Beth Israel Lahey Health Winchester Hospital. Medications for temporomandibular disorders (TMD).
20. American Academy of Family Physicians. Eustachian tube dysfunction.
21. Ellie S, Christina M. A method for preventive intervention regarding temporomandibular pain and dysfunction. Acta Odontol Scand. 2018;76(7):482-487. doi:10.1080/00016357.2018.1439529
22. Centers for Disease Control and Prevention. Ear infection.
23. Cedars Sinai. Nasal polyps.
24. American Academy of Otolaryngology—Head and Neck Surgery. Experts update best practices for diagnosis and treatment of earwax (cerumen impaction): important patient education on healthy ear care.

By Angelica Bottaro
Bottaro has a Bachelor of Science in Psychology and an Advanced Diploma in Journalism. She is based in Canada.

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