From the Guidelines
The most effective treatment for middle ear pressure is the insertion of tympanostomy tubes, which allows air to enter the middle ear directly and eliminates negative pressure, as supported by the latest clinical practice guideline update 1. This approach is particularly beneficial for children with chronic otitis media with effusion (OME) or recurrent acute otitis media (AOM), as it can improve their quality of life (QOL) by reducing the risk of suppurative complications, damage to the tympanic membrane, and adverse effects of antibiotics 1. Some key points to consider when treating middle ear pressure include:
- The importance of equalizing pressure through techniques that open the Eustachian tubes, such as the Valsalva maneuver, chewing gum, yawning, or swallowing.
- The use of over-the-counter decongestants like pseudoephedrine or nasal sprays containing oxymetazoline to reduce inflammation and allow the tubes to open.
- The potential benefits of antihistamines like loratadine if allergies are contributing to the problem.
- The consideration of oral steroids or procedures like myringotomy or placement of pressure equalization tubes for severe or persistent cases. It is essential to weigh the risks and benefits of each treatment option, considering the potential complications and the impact on the patient's quality of life, as outlined in the clinical practice guideline update 1. In terms of specific treatment recommendations, the guideline suggests that tympanostomy tube insertion can improve QOL for children with chronic OME, recurrent AOM, or both, and that the risks of tube insertion must be balanced against the risks of chronic OME, recurrent otitis media, or both 1.
From the Research
Treatment Options for Middle Ear Pressure
- Various treatment options are available for middle ear pressure, including pharmacological interventions, mechanical devices, and surgical interventions 2.
- Nasal steroids have shown no improvement in symptoms or middle ear function for patients with otitis media with effusion and/or negative middle ear pressure 2.
- Topical decongestants and a combination of antihistamine and ephedrine have shown short-term improvements in middle ear function 2.
- Pressure equalisation devices have been associated with significant short-term improvements in symptoms, middle ear function, and/or hearing 2.
Surgical Interventions
- Eustachian tuboplasty and balloon dilatation have been associated with improved outcomes 2, 3.
- Myringotomy, directly applied topical steroids, and laser point coagulation have also shown positive results 2.
- However, the evidence is limited in quantity and overall is of poor quality, making it difficult to draw conclusions regarding the effectiveness of these interventions 2.
Pharmacological Treatments
- Oral pseudoephedrine has been shown to decrease the rate of transmucosal nitrous oxide exchange for the middle ear 4.
- Oxymetazoline and fluticasone treatment has been investigated as a potential prevention method for middle ear barotrauma, but the results were not statistically significant 5.
Eustachian Tube Dysfunction
- Eustachian tube dysfunction (ETD) is thought to contribute to the majority of middle ear pathology, although the mechanisms and the degree to which it contributes to middle ear disease is poorly understood 6.
- The anatomy and physiology of the Eustachian tube, as well as methods for measuring ETD, are important factors in understanding and treating middle ear disease 6.