Eustachian Tube Dysfunction (ETD)

Eustachian Tube Dysfunction (ETD) is a common problem in babies and children.  However, it is not always diagnosed as the symptoms often correct themselves in the first 2 years of life.

The Eustachian tube connects the back of the throat behind the nose to the middle ear; it allows air to enter to the middle ear in order for the ear to function normally. Most people will have experienced discomfort in the Eustachian tube when in a plane, a lift or when you drive up a hill and the pressure builds in your ears.  That is the tube temporarily not allowing the air in the middle ear to equalise.  However, when you swallow, your ears “pop” and the discomfort is relieved.

In babies and children, the Eustachian tube does not always work as efficiently as in adults.  When this occurs over a period of time, the air in the middle ear is absorbed by the body and replaced by a fluid.  The fluid itself does not cause any damage to the ear but it does cause discomfort.  During the day time when a child eats and drinks, they swallow and so regulate the pressure within the ear.  At night time however, they do not swallow and so the fluid in the middle ear builds up, and causes pain.  This can cause the baby or child to wake in pain and generally be distressed.

I had not heard of this condition until I happened to see a different GP at our surgery about Ella having an ear infection.  As we chatted about her symptoms, he asked how she slept at night, to which I replied – she doesn’t!  Ella has never, to this day, slept through.  Before diagnosis, she would wake screaming hysterically and be inconsolable every few hours.  We had tried controlled crying but she would get herself into a lather and vomit.  Whenever we went to her, she would be pulling on her ear.  After an examination and discussion, the doctor diagnosed Ella as having ETD.

The symptoms of ETD are easily treated – give the child a drink!  They then have to swallow which regulates the pressure in the ear.  In Ella’s case, hers is managed with a combination of drinking and a painkiller/mild sedative.

Most children grow out of this by the age of 2.  If they haven’t, ear tubes or grommets can be fitted.  The fluid is drained under anaesthetic and the grommet inserted.  This allows the fluid to drain away and gives the tube a chance to function properly.  In most cases, the condition is resolved with 1 set of grommets, but if not, a further set can be given.

Ella was diagnosed at 7 months.  I was beginning to think that I was going mad as it seemed that everyone else’s child slept through, but not mine!  Her ears do still bother her, but she’s only 13 months so there is still time for her Eustachian tube to develop itself.  If it doesn’t, she will be referred for grommets.  The following symptoms are an indication of ETD:

• The child will fall asleep fine in his or her cot, on their own.
• Sleeps well for the 1st hour or so.
• Doesn't sleep for more than 6 hours in a row without waking.
• Is inconsolable when awake in the night and possibly pulling madly on ear/s but doesn't necessarily show signs of fever or high temp.
• No problems in the day time, but possibly similar problems to night time in day time sleeps
• Severe pulling on ears, not just flicking or playing - but real tugging

Teething will aggravate ETD, as will an ear infection.
Had I not seen a doctor whose children had suffered from ETD, I would probably still be tearing my hair out with a child that won’t sleep!  She still wakes, but on a good night only once or twice and not for long.  This is such an improvement to how she used to be.
I hope that this is of use to someone.  I was not aware of this condition, but since Ella’s diagnosis, we have found that one of my nephews had ETD too, but his was untreated until the age of 3.  It’s a lot more common than people realise, and yet not every child who has it is diagnosed.  If you suspect your child may have a similar problem, keep a diary of their nights, including whether this is resolved by offering a drink.  If it is, it’s worth seeing your GP.

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