Can a steroid nasal spray, such as fluticasone propionate (fluticasone), help with a fluctuating blocked ear?

From the Guidelines

A steroid nasal spray, such as fluticasone propionate, can help alleviate a fluctuating blocked ear by reducing inflammation in the nasal passages and around the Eustachian tubes, as supported by the most recent and highest quality study 1. The mechanism of action of steroid nasal sprays involves reducing inflammation, which can help to relieve symptoms of allergic rhinitis, including nasal congestion, and subsequently improve Eustachian tube function, as noted in the study 1. Key points to consider when using a steroid nasal spray for a blocked ear include:

• Using the spray consistently for at least 1-2 weeks to allow for the full benefits to develop
• Following the recommended dosage, typically 1-2 sprays in each nostril once or twice daily
• Properly administering the spray by gently blowing the nose, shaking the bottle, and tilting the head forward
• Directing the spray away from the nasal septum to minimize potential side effects The study 1 demonstrated significant improvements in nasal blockage and overall rhinitis symptoms with the use of fluticasone propionate nasal spray, which can indirectly benefit Eustachian tube function and alleviate ear blockage. If symptoms persist or worsen after 2-3 weeks of consistent use, or if severe ear pain, hearing loss, or discharge occurs, it is essential to consult a healthcare provider to rule out more serious conditions requiring alternative treatment, as the study 1 highlighted the importance of monitoring for potential side effects, such as epistaxis.

From the Research

Efficacy of Steroid Nasal Spray for Blocked Ear

• The use of steroid nasal sprays, such as fluticasone propionate, for treating blocked ear due to Eustachian tube dysfunction has been investigated in several studies 2, 3, 4.
• A study published in 2023 found that a combination of azelastine and fluticasone propionate nasal spray was effective in reducing adenoid tissue hypertrophy and improving Eustachian tube function in children with Eustachian tube dysfunction and adenoid hypertrophy 2.
• However, a systematic review and meta-analysis published in 2024 found no significant difference in tympanometric normalisation between intranasal corticosteroids and control, suggesting that the evidence does not strongly support the use of intranasal corticosteroids for Eustachian tube dysfunction 3.
• Another study published in 2024 found that an exhalation delivery system was more effective than a conventional nasal spray in delivering topical medication to the nasopharynx and Eustachian tube orifice, and that targeted endoscopic sinus surgery may facilitate greater penetration of the medication 5.
• A randomized, placebo-controlled trial published in 2011 found no statistically significant difference in the normalization of abnormal tympanometric signs or symptom scores between patients treated with intranasal aqueous triamcinolone acetonide and those treated with placebo 4.

Comparison of Different Steroid Nasal Sprays

• A review published in 2016 compared the effects of different types of intranasal steroids, including fluticasone propionate, and found that there was insufficient evidence to suggest that one type of intranasal steroid is more effective than another in patients with chronic rhinosinusitis 6.
• The review also found that higher doses of intranasal corticosteroids may be associated with an increased risk of epistaxis, but that lower doses may have similar effectiveness with fewer side effects 6.

Clinical Implications

• The evidence suggests that steroid nasal sprays may not be effective in treating blocked ear due to Eustachian tube dysfunction, and that other treatment options may be necessary 3, 4.
• However, the use of an exhalation delivery system and targeted endoscopic sinus surgery may improve the delivery and effectiveness of topical medication for Eustachian tube dysfunction 5.