If symptoms persist or if the cause of the ETD is unclear, referral to an otolaryngologist may be necessary. He or she can perform tympanometry to further assess eustachian-tube function. Tympanography, which measures middle-ear pressure, tympanic membrane movement, ear-canal volume, and acoustic reflexes, may detect the presence of effusions. Other tests include an audiogram and telescopic examination of the nose. Posterior rhinoscopic examination with a mirror or fiberoptic endoscopy helps visualize any mass obstructing the pharyngeal end of the eustachian tube. CT or MRI may be obtained to assess for temporal bone tumors.
If middle ear infections happen often enough, placement of tubes are often helpful. Why would placing a tube help in these situations? Really, tube placement is a "detour" whereby the natural eustachian tube is bypassed so that ventilation occurs through the ear canal instead of the nose. Furthermore, a tube allows for ear popping automatically. Another way of thinking about a tube is a hole in a balloon. When there is a hole in a balloon, no pressure can build up as it would automatically escape out the hole. Read about the different types of tubes here .
Otitis externa means that the inflammation affects the layer of cells lining the outer or external portion of the ear canal. Otitis media and interna refer to infections of the middle and inner ear canal, and they are most often are a result of the spread of infection from the external ear. These more advanced cases can be very serious, and could lead to deafness, facial paralysis, or signs of vestibular disease, such as head tilting, circling, and lack of coordination. That's why it is important to prevent and seek early treatment for ear problems.