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Last reviewed: 20 Mar 2025
Last updated: 08 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • inability to "pop" or "clear" the ear with changes in barometric pressure
  • normal head and neck exam

Other diagnostic factors

  • aural fullness
  • subjective hearing loss
  • autophony
  • history of serous otitis media or of chronic otitis media
  • edema of the Eustachian tube orifice
  • history of retracted or hypermobile tympanic membrane

Risk factors

  • cleft palate
  • adenoid hypertrophy
  • allergic rhinitis
  • chronic rhinosinusitis
  • neoplasm of nasopharynx or infratemporal fossa
  • Eustachian tube trauma
  • Eustachian tube infection
  • age <5 years
  • cigarette smoking
  • GERD
  • radiation exposure
  • history of recent weight loss

Diagnostic tests

1st tests to order

  • nasal endoscopy
  • tympanometry

Tests to consider

  • nasopharyngoscopy
  • CT scan

Treatment algorithm

Contributors

Authors

Edward D. McCoul, MD, MPH

Associate Professor

Department of Otorhinolaryngology

Ochsner Clinical School

University of Queensland School of Medicine

New Orleans

LA

Disclosures

EDM is the author of references cited in this topic and is a consultant for Stryker.

Acknowledgements

Dr Edward D. McCoul would like to gratefully acknowledge Dr Erica R. Thaler, the previous contributor to this topic.

Disclosures

ERT declared that she had no competing interests.

Peer reviewers

Alan G. Micco, MD

Associate Professor

Otolaryngology: Head and Neck Surgery

Northwestern University Feinberg School of Medicine

Chicago

IL

Disclosures

AGM declares that he has no competing interests.

Niels van Heerbeek, MD, PhD

Consultant

Department of Otorhinolaryngology, Head & Neck Surgery

University Medical Centre

Nijmegen

The Netherlands

Disclosures

NVH declares that he has no competing interests.

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