From the Guidelines
Tinnitus and Eustachian Tube Dysfunction (ETD) are closely related, and treating the underlying ETD may help alleviate tinnitus symptoms, as suggested by the most recent guidelines 1. When managing both conditions, it's essential to address ETD first, as it can contribute to tinnitus. For ETD, start with:
- Nasal saline sprays 2-3 times daily
- Nasal steroid sprays like fluticasone (Flonase) once daily for 2-4 weeks
- The Valsalva maneuver (pinching your nose closed while gently blowing out with closed mouth) to equalize pressure several times daily For immediate relief, over-the-counter decongestants like pseudoephedrine may help temporarily, but they shouldn't be used for more than 3-5 days to avoid rebound congestion.
For tinnitus management, consider sound therapy using white noise machines or smartphone apps, especially at night, as recommended by recent clinical practice guidelines 1. If symptoms persist beyond 2-3 weeks or are severe, consult an ENT specialist who might recommend:
- Prescription medications
- Hearing aids if hearing loss is present
- Tympanostomy tubes for persistent ETD These conditions are connected because ETD creates pressure changes in the middle ear that can affect inner ear function, potentially triggering or worsening tinnitus. Addressing ETD often improves both conditions simultaneously, highlighting the importance of a comprehensive approach to managing these related conditions 1.
From the Research
Tinnitus and Eustachian Tube Dysfunction (ETD)
- Tinnitus is a common problem encountered in primary care, and most cases are benign and idiopathic, strongly associated with sensorineural hearing loss 2.
- Eustachian tube dysfunction can cause symptoms such as hearing loss, ear fullness, and tinnitus, and its incidence in adults is about 1% 3.
- The Eustachian tube plays a crucial role in protecting against secretion, germs, and sound pressure from the nasopharynx, and its dysfunction can lead to various symptoms 3.
Diagnosis and Treatment of ETD
- The Eustachian tube score (ETS-5) can be used to diagnose ETD in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum 3.
- Treatment of obstructive ETD includes steroid nasal sprays, regular performance of the Valsalva maneuver, and tube dilation with the Bielefelder balloon catheter 3.
- Patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy 3.
Relationship between Tinnitus and ETD
- There is no direct evidence to suggest a causal relationship between tinnitus and ETD, but some studies suggest that ETD can contribute to the development of tinnitus 2, 3.
- Nasal decongestants have been shown to have no significant effect on Eustachian tube opening, and their use may not improve tinnitus symptoms 4.
Management of ETD and Tinnitus
- Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 2.
- Sound therapy and tinnitus retraining therapy are treatment options for tinnitus, but evidence is inconclusive 2.
- Management of ETD includes various therapeutic and surgical options, such as the Valsalva maneuver, Toynbee maneuver, tympanometry, and video nasopharyngoscopy 5.