From the Guidelines
If you're using Flonase (fluticasone) and Xyzal (levocetirizine) but still have fluid behind your ears, the most effective approach is to wait and observe for 3 months, as fluid often goes away on its own, especially if it has been there for less than 3 months 1.
Key Considerations
- The presence of fluid behind the ears, also known as otitis media with effusion (OME), is often a self-limiting condition that may resolve without intervention 1.
- Medical treatment, including antibiotics, antihistamines, decongestants, steroids, and acid reflux medications, has not been shown to be effective in resolving OME 1.
- The use of a decongestant like pseudoephedrine for 3-5 days may help drain the fluid, but its effectiveness is not well-established 1.
Recommendations
- Ensure proper use of Flonase, with 2 sprays in each nostril once daily, consistently for at least 2-3 weeks.
- Consider nasal irrigation with a saline solution using a neti pot or squeeze bottle to help clear congestion.
- If symptoms persist beyond 2-3 weeks, consult a healthcare provider to rule out infection or other complications, and to discuss possible referral to an ENT specialist.
Important Notes
- Fluid behind the ears can cause mild discomfort, fullness in the ear, and mild hearing problems, but the effect is usually small and goes away when the fluid clears up 1.
- Young children with OME may not express themselves well, even when struggling with hearing problems or other issues related to the fluid, highlighting the importance of regular follow-up with a healthcare provider 1.
From the FDA Drug Label
The following incidence of common adverse reactions (>3%, where incidence in fluticasone propionate-treated subjects exceeded placebo) is based upon 7 controlled clinical trials Other adverse events that occurred in ≤3% but ≥1% of patients and that were more common with fluticasone propionate (with uncertain relationship to treatment) included: Observed During Clinical Practice: In addition to adverse events reported from clinical trials, the following events have been identified during postapproval use of intranasal fluticasone propionate in clinical practice. Ear, Nose, and Throat Alteration or loss of sense of taste and/or smell and, rarely, nasal septal perforation, nasal ulcer, sore throat, throat irritation and dryness, cough, hoarseness, and voice changes.
The FDA drug label does not answer the question.
From the Research
Eustachian Tube Dysfunction and Treatment
- Eustachian tube dysfunction (ETD) is a condition where the Eustachian tube, which connects the middle ear to the back of the throat, does not function properly, leading to fluid buildup in the middle ear 2.
- Treatment options for ETD include intranasal steroids, such as fluticasone, which can help reduce inflammation and improve Eustachian tube function 3, 4.
Effectiveness of Flonase and Xyzal
- Flonase (fluticasone) is a nasal steroid spray that can help reduce inflammation in the nasal passages and improve Eustachian tube function 4.
- Xyzal (levocetirizine) is an antihistamine that can help relieve allergy symptoms, but its effectiveness in treating ETD is not well established.
- A study found that intranasal fluticasone (Flonase) was effective in reducing the need for tympanostomy tube placement in children with ETD 4.
Fluid Behind the Ears
- Fluid buildup in the middle ear can be a symptom of ETD, and treatment with intranasal steroids such as fluticasone may help reduce this fluid buildup 3, 4.
- However, if fluid persists behind the ears despite treatment with Flonase and Xyzal, further evaluation and treatment may be necessary to address underlying ETD or other conditions 2.