From the Guidelines
To treat Eustachian Tube Dysfunction (ETD), the most effective approach is to start with watchful waiting for 3 months, as recommended by the latest clinical practice guideline 1. This approach is based on the understanding that many cases of ETD, particularly those associated with otitis media with effusion (OME), resolve spontaneously within this timeframe.
- The use of nasal saline sprays and steroid nasal sprays like fluticasone or mometasone may help reduce inflammation, but their effectiveness is not strongly supported by the latest evidence 1.
- Over-the-counter oral decongestants such as pseudoephedrine can provide temporary relief but should be used cautiously and for no more than 3-5 days to avoid rebound congestion.
- The Valsalva maneuver, chewing gum, or yawning may also help equalize pressure and provide relief.
- For persistent cases, particularly those with suspected infection or allergy-related ETD, antibiotics or antihistamines like cetirizine may be considered, but their use should be guided by a thorough clinical evaluation.
- Auto-inflation devices like Otovent can be effective for children, and in severe or chronic cases that don't respond to conservative treatment, surgical options such as myringotomy with tube placement may be necessary, as indicated by older guidelines 1. However, the latest guideline 1 emphasizes the importance of watchful waiting and avoiding unnecessary interventions, highlighting the need for a cautious and evidence-based approach to managing ETD.
- Key considerations include the child's age, hearing status, and presence of underlying risk factors, as well as the potential benefits and harms of different treatment strategies.
- Ultimately, the management of ETD should be individualized and guided by the latest clinical evidence, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Treatment Options for Eustachian Tube Dysfunction (ETD)
- Nasal steroids: showed no improvement in symptoms or middle ear function for patients with otitis media with effusion and/or negative middle ear pressure 2
- Topical decongestants: very short-term improvements in middle ear function were observed in patients receiving directly applied topical decongestants 2
- Antihistamine and ephedrine: very short-term improvements in middle ear function were observed in patients receiving a combination of antihistamine and ephedrine 2
- Pressure equalisation devices: significant short-term improvements in symptoms, middle ear function and/or hearing were found 2
- Eustachian tuboplasty: associated with improved outcomes 2, 3
- Balloon dilatation: associated with improved outcomes, safe and efficacious in the short and long term post operatively in select patients with chronic ETD 2, 4, 5
- Myringotomy: positive results were reported 2
- Laser point coagulation: positive results were reported 2
- Microwave ablation: a novel technique that may be used to manipulate the condition 3
- Laser eustachian tuboplasty: a novel technique that may be used to manipulate the condition 3
- Balloon Eustachian tuboplasty (BET): effective in alleviating symptoms in adult and pediatric patients immediately postoperatively and long term, up to 5 years, with a low adverse event rate 4, 5
- Valsalva maneuver: can be used as a treatment option 6
- Steroid nasal sprays: can be used as a treatment option for obstructive dysfunction 6
- Saline nasal irrigation: can be used as a treatment option for patulous Eustachian tube 6
- Estrogen-nasal ointment: can be used as a treatment option for patulous Eustachian tube 6
- Craniocervical manual therapy: can be used as a treatment option for patulous Eustachian tube 6
Surgical Interventions
- Eustachian tuboplasty: a surgical procedure that can be used to treat ETD 2, 3
- Balloon dilatation: a minimally invasive surgical procedure that can be used to treat ETD 2, 4, 5
- Myringotomy: a surgical procedure that can be used to treat ETD 2
- Tympanostomy: a surgical procedure that can be used to treat ETD 3
- Microwave ablation: a novel surgical technique that may be used to manipulate the condition 3
- Laser eustachian tuboplasty: a novel surgical technique that may be used to manipulate the condition 3
Diagnosis and Treatment Guidelines
- The Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum to diagnose ETD 6
- Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children 6
- BET is more effective in barotrauma and serous otitis media 5
- Indications for BET include barotrauma, serous otitis media, adhesive otitis, atelectatic middle ear and failure after tympanoplasty, once obstructive Eustachian tube dysfunction is confirmed 5