What are the symptoms and treatment options for Eustachian (auditory) tube dysfunction?

From the Guidelines

Eustachian tube dysfunction typically presents with symptoms such as ear fullness, muffled hearing, ear pain, tinnitus, and sometimes dizziness or balance problems, and the most effective treatment approach is to address the underlying cause and use simple self-care measures like yawning, swallowing, or performing the Valsalva maneuver, as recommended by recent guidelines 1.

Symptoms of Eustachian Tube Dysfunction

The symptoms of Eustachian tube dysfunction (ETD) can vary, but common presentations include:

• Ear fullness
• Muffled hearing
• Ear pain
• Tinnitus
• Dizziness or balance problems These symptoms occur when the tube connecting the middle ear to the throat fails to open properly, preventing air pressure equalization.

Treatment Options

Treatment begins with simple self-care measures, including:

• Yawning
• Swallowing
• Performing the Valsalva maneuver (pinching the nose and gently blowing while keeping the mouth closed) Over-the-counter options may also be considered, such as:
• Decongestants like pseudoephedrine (30-60mg every 4-6 hours for up to 3 days)
• Nasal steroid sprays like fluticasone (1-2 sprays per nostril daily) For allergic causes, antihistamines like loratadine (10mg daily) may help, as noted in general medical practice, although specific guidelines for ETD may not recommend these medications for otitis media with effusion 1.

Medical Evaluation and Intervention

If symptoms persist beyond 2 weeks, it is essential to see a doctor who may prescribe stronger medications or consider procedures like:

• Myringotomy (eardrum incision)
• Tube placement for chronic cases
• Balloon dilation of the Eustachian tube, a newer option for persistent cases Addressing underlying conditions like allergies, sinusitis, or acid reflux is crucial for long-term management, as emphasized in the guidelines for managing otitis media with effusion 1. Most cases of Eustachian tube dysfunction resolve with conservative treatment, but persistent symptoms warrant medical evaluation to prevent complications like chronic hearing loss or middle ear infections.

From the Research

Symptoms of Eustachian Tube Dysfunction

• Symptoms are often unspecific 2
• Middle ear atelectasis with retraction of the tympanic membrane (TM) can be a symptom of chronic obstructive Eustachian tube dysfunction 3
• Conductive hearing loss can be associated with Eustachian tube dysfunction 4

Treatment Options for Eustachian Tube Dysfunction

• Treatment of obstructive dysfunction includes:
  • Steroid nasal sprays 2
  • Regular performance of the Valsalva maneuver 2, 5, 3, 4
  • Tube dilation with the Bielefelder balloon catheter 2
  • Conventional tympanostomy and myringotomy 5
  • Novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty 5
• Treatment of patulous Eustachian tube includes:
  • Saline nasal irrigation 2
  • Estrogen-nasal ointment 2
  • Craniocervical manual therapy 2

Diagnostic Tools for Eustachian Tube Dysfunction

• Eustachian tube score (ETS-5) for patients with a perforated ear drum 2
• Eustachian tube score (ETS-7) for patients with intact ear drum 2, 5, 3
• Computed tomography (CT) combined with Valsalva maneuver 3, 4
• Tympanometry 5
• Pressure chamber test 5
• Video nasopharyngoscopy 5