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

From the Guidelines

Eustachian tube dysfunction should be managed with simple remedies like yawning, swallowing, or chewing gum to help equalize pressure, and over-the-counter nasal steroid sprays like fluticasone (Flonase) or mometasone (Nasonex) used once or twice daily for 1-2 weeks to reduce inflammation, as recommended by recent guidelines 1. To treat Eustachian tube dysfunction, it is essential to address the underlying cause of the dysfunction, which is often inflammation blocking the normal opening and closing of the tube. The tube connects the middle ear to the back of the throat and normally equalizes pressure and drains fluid from the middle ear.

Key Treatment Strategies

• Simple remedies like yawning, swallowing, or chewing gum to help equalize pressure
• The Valsalva maneuver (pinching your nose closed while gently blowing out with your mouth closed) to help open the tubes
• Over-the-counter nasal steroid sprays like fluticasone (Flonase) or mometasone (Nasonex) used once or twice daily for 1-2 weeks to reduce inflammation
• Antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec) taken daily to help with allergies contributing to the dysfunction
• Nasal decongestants like oxymetazoline (Afrin) for short-term relief, but not for more than 3 days to avoid rebound congestion If symptoms persist beyond 2 weeks or are severe, it is crucial to see a doctor as prescription medications or procedures may be needed, such as tympanostomy tube insertion, which can help to equalize pressure and drain fluid from the middle ear, as discussed in recent guidelines 1.

When to Consider Tympanostomy Tube Insertion

• Chronic bilateral OME with hearing difficulty, as recommended by guidelines 1
• Chronic OME with symptoms that are likely attributable to OME, such as balance problems, poor school performance, or reduced quality of life, as suggested by guidelines 1 It is essential to follow the guidelines and recommendations for the management of Eustachian tube dysfunction to ensure the best possible outcomes for patients, in terms of reducing morbidity, mortality, and improving quality of life 1.

From the Research

Eustachian Tube Dysfunction Overview

• The Eustachian tube plays a crucial role in protecting against secretion, germs, and sound pressure from the nasopharynx, and serves as a drain and pressure equalizer for the ear drum and sound-conducting apparatus 2.
• The incidence of Eustachian tube dysfunction in adults is approximately 1%, while in children it is almost 40% 2.

Diagnosis of Eustachian Tube Dysfunction

• The Eustachian tube score (ETS-5) can be used for diagnosis in patients with a perforated ear drum, and the ETS-7 score in patients with an intact ear drum 2.
• Other diagnostic tools include the Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy 3.
• The ETS-7 questionnaire is also a useful tool for diagnosing 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.
• Balloon tuboplasty has been found to be effective in alleviating symptoms in adult and pediatric patients immediately postoperatively and long term, up to 5 years 4.
• Medical management for Eustachian tube dysfunction in adults has been found to have a pooled cohort of 50.3% of patients experiencing symptomatic improvement, although the efficacy of nonsurgical options for subacute ETD has yet to be determined 5.

Causes of Eustachian Tube Dysfunction

• Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children 2.
• Other pathologies affecting the Eustachian tube and its associated structures can also lead to dysfunction 3.

Surgical Interventions

• Conventional tympanostomy and myringotomy, along with more novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty, may be used to manipulate Eustachian tube dysfunction 3.
• The safety and efficacy of Eustachian balloon tuboplasty in patients with chronic Eustachian tube dysfunction have been found to be effective in alleviating symptoms, with an adverse event rate of 3% 4.