The middle ear is the space between the ear drum and the inner ear. It is filled with air and connects to the back of the nose via a small tube, the eustation tube. In the middle ear are three small bones, the malleus, incus and stapes (aka "hammer, anvil and stirrup") and these transmit the vibration of the ear drum to the inner ear fluids.

The eustation tube keeps the pressure of the middle ear equalised. If this does not not work, then a number of things can happen, such as:

-patients can have symtoms of negative pressure, discomfort and some deafness.

-fluid can build up in the middle ear causing hearing loss.

-the ear drum is more likley to be "sucked in", which can lead to problems such as cholesteatoma, perforation and weakening of teh ear drum.

Many patients with these sorts of problems also have a degree of rhinitis, or nose/sinus congestion, as this process also affects the eustation tube. Treating or controlling the rhinitis as effectively as possible can help with the middle ear problems.