What is the diagnosis and treatment for Eustachian (auditory) tube dysfunction?

From the Guidelines

Eustachian tube dysfunction should be managed with watchful waiting for 3 months, and tympanostomy tubes should be considered for children with persistent otitis media with effusion (OME) and hearing loss or other symptoms, as recommended by the most recent guidelines 1. The management of Eustachian tube dysfunction typically begins with self-care measures, including:

• Nasal saline sprays to reduce congestion
• Staying hydrated to thin out mucus
• Performing the Valsalva maneuver to help equalize pressure in the ears Over-the-counter medications like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or intranasal steroid sprays such as fluticasone (Flonase) 1-2 sprays per nostril daily can also be used to reduce inflammation and congestion 1. For persistent cases, the doctor may prescribe antibiotics if infection is present or consider balloon dilation of the Eustachian tube for chronic dysfunction 1. The condition often results from upper respiratory infections, allergies, or anatomical abnormalities that block normal airflow and pressure equalization between the middle ear and throat 1. Avoiding rapid altitude changes, treating underlying allergies, and quitting smoking can help prevent recurrence. Key points to consider in the management of Eustachian tube dysfunction include:
• The natural history of the condition, with most cases resolving spontaneously within 3 months 1
• The importance of hearing evaluation and surveillance for children with persistent OME 1
• The potential benefits and harms of surgical interventions, such as tympanostomy tube insertion and adenoidectomy 1 Overall, the management of Eustachian tube dysfunction should prioritize watchful waiting and self-care measures, with surgical interventions considered for persistent cases with significant symptoms or hearing loss.

From the Research

Eustachian Tube Dysfunction

• The Eustachian tube plays a crucial role in protecting against secretion, germs, and sound pressure from the nasopharynx, acting as a drain, and serving pressure equalization in both directions so that the ear drum and sound-conducting apparatus can vibrate optimally 2.
• The incidence of Eustachian tube dysfunction in adults is about 1%, in children almost 40%, with symptoms often being unspecific 2.

Diagnosis of Eustachian Tube Dysfunction

• The Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum for diagnosis 2.
• Other diagnostic tools include the Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy 3.
• The ETS-7 questionnaire is also used to diagnose Eustachian tube dysfunction 3.

Treatment of Eustachian Tube Dysfunction

• Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter 2.
• The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated 2.
• Nasal decongestants have no significant effect on Eustachian tube opening in most cases, with improvement in tube opening being rather an exception 4.
• Oral steroids are infrequently used to treat otitis media with effusion, Eustachian tube dysfunction, and tympanic membrane retraction, with adults being more likely to receive steroids than children 5.
• Medical management for Eustachian tube dysfunction in adults has limited guidance, with a systematic review and meta-analysis finding that 50.3% of patients experienced symptomatic improvement with medical management, but intranasal corticosteroids were not efficacious for chronic symptoms 6.

Causes of Eustachian Tube Dysfunction

• Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children 2.
• Other causes of Eustachian tube dysfunction include craniofacial anomalies, but these are excluded from some studies 6.

Surgical Interventions

• Surgical interventions that may be used to manipulate Eustachian tube dysfunction include conventional tympanostomy and myringotomy, as well as more novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty 3.