What is the initial treatment for Eustachian tube dysfunction?

From the Guidelines

The initial treatment for Eustachian tube dysfunction typically involves watchful waiting for 3 months, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1. This approach is based on the understanding that many cases of Eustachian tube dysfunction resolve on their own with time.

• The American Academy of Otolaryngology-Head and Neck Surgery suggests that clinicians should manage the child with Eustachian tube dysfunction who is not at risk with watchful waiting for 3 months from the date of onset (if known) or from the date of diagnosis (if onset is unknown) 1.
• During this period, patients can try self-care measures such as the Valsalva maneuver, yawning, or chewing gum to help equalize pressure in the ears.
• If symptoms persist beyond 3 months or are severe, medical evaluation is recommended as prescription medications or procedural interventions, such as tympanostomy tubes, may be necessary 1.
• It's essential to note that the use of nasal decongestants, oral antihistamines, or nasal steroid sprays may not be recommended as initial treatment, as stated in the guidelines 1.
• The goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life, while also considering the potential risks and benefits of each treatment option 1.

From the Research

Initial Treatment for Eustachian Tube Dysfunction

The initial treatment for Eustachian tube dysfunction typically involves non-surgical methods.

• Medical management, including the use of nasal decongestants and intranasal corticosteroids, may be recommended 2.
• However, studies have shown that intranasal corticosteroids are not efficacious in improving chronic symptoms, with only 11% to 18% of cases showing improvement 2.
• Other therapies, such as Politzer devices and Valsalva therapy, have also been found to have minimally beneficial results 2.
• The Valsalva maneuver and Toynbee maneuver are also commonly used to help alleviate symptoms of Eustachian tube dysfunction 3.

Efficacy of Medical Management

• A systematic review and meta-analysis found that 50.3% of patients experienced symptomatic improvement with medical management, although the improvement in ETDQ-7 scores was clinically nonsignificant 2.
• Medical management was found to be beneficial in 30% to 64% of cases with subacute symptoms and 11% to 50% of cases with chronic symptoms 2.

Alternative Treatment Options

• For patients who do not respond to medical management, alternative treatment options such as balloon eustachian tuboplasty may be considered 4.
• This procedure has been found to be safe and efficacious in the short and long term, with an adverse event rate of 3% 4.