From the Guidelines
The most effective treatment for eustachian tube dysfunction, particularly in children, is the insertion of tympanostomy tubes, as recommended by the most recent and highest quality study 1. This approach is supported by the clinical practice guideline on tympanostomy tubes in children, which highlights the benefits of improving health literacy and shared decision making. The guideline emphasizes that middle ear infections or fluid buildup are often caused by a poorly functioning eustachian tube, and that tympanostomy tubes can help to equalize pressure and drain fluid from the ear.
Some key points to consider in the management of eustachian tube dysfunction include:
- The use of nasal steroid sprays, such as fluticasone or mometasone, to reduce inflammation, although their effectiveness is still debated 1
- The recommendation against using intranasal steroids, systemic steroids, antibiotics, antihistamines, or decongestants for treating otitis media with effusion (OME) 1
- The importance of watchful waiting for 3 months in children with OME who are not at particular risk for speech, language, or learning problems 1
- The consideration of ventilation tubes or adenoidectomy in children with persistent OME and documented hearing difficulties 1
- The potential benefits of nasal balloon auto-inflation in clearing middle ear effusion and improving ear symptoms in school-aged children 1
Overall, the management of eustachian tube dysfunction requires a comprehensive approach that takes into account the individual patient's needs and circumstances, and prioritizes the most effective and evidence-based treatments. The use of tympanostomy tubes, as recommended by the most recent and highest quality study 1, is a key component of this approach, and can help to improve outcomes and quality of life for patients with eustachian tube dysfunction.
From the Research
Treatment Options for Eustachian Tube Dysfunction
The treatment for Eustachian tube dysfunction (ETD) varies depending on the cause and severity of the condition. Some treatment options include:
- Medications to decrease intranasal inflammation, such as intranasal corticosteroids or oral antihistamines 2
- Steroid nasal sprays and regular performance of the Valsalva maneuver for obstructive dysfunction 3
- Tube dilation with the Bielefelder balloon catheter for obstructive dysfunction 3
- Saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy for patulous Eustachian tube 3
- Oral steroids for otitis media with effusion, ETD, and tympanic membrane retraction, although their use is not commonly recommended 4
Efficacy of Medical Management
The efficacy of medical management for ETD in adults has been evaluated in a systematic review and meta-analysis 5. The results showed that:
- 50.3% of patients experienced symptomatic improvement with medical management
- ETDQ-7 scores improved in a clinically nonsignificant manner
- Intranasal corticosteroids were not efficacious for chronic symptoms, improving only 11% to 18% of cases
- Therapies such as Politzer devices and Valsalva therapy had minimally beneficial results
Surgical Interventions
Surgical interventions, such as conventional tympanostomy and myringotomy, as well as more novel techniques like microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty, may be used to manipulate ETD 6. However, the most favorable course of treatment in cases of ETD has not been established.
Diagnosis and Treatment
Diagnosis of ETD can be made using tools such as the Eustachian tube score (ETS-5) and ETS-7 score, as well as tympanometry, pressure chamber test, and video nasopharyngoscopy 3, 6. Treatment should be tailored to the individual patient's needs and may involve a combination of medical and surgical interventions.