From the Guidelines
Hydroxyzine can potentially contribute to Eustachian Tube Dysfunction (ETD) due to its anticholinergic properties. As an antihistamine, hydroxyzine can cause drying of mucous membranes throughout the body, including those lining the Eustachian tubes, as noted in the study on the diagnosis and management of rhinitis 1. This drying effect may thicken secretions and reduce their normal flow, potentially impairing the proper opening and closing of the Eustachian tubes that normally equalizes pressure between the middle ear and the environment.
Some key points to consider about hydroxyzine and ETD include:
- Anticholinergic effects of first-generation antihistamines like hydroxyzine can lead to dryness of mouth and eyes, constipation, and inhibition of micturition, as well as increased risk for provocation of narrow angle glaucoma 1.
- The use of first-generation antihistamines should be approached with caution, especially in older adults who are more sensitive to psychomotor impairment and adverse anticholinergic effects 1.
- Patients taking hydroxyzine who experience ear fullness, muffled hearing, ear pain, or popping/clicking sensations in the ears should consider this medication as a possible contributing factor to their symptoms.
- Staying well-hydrated while taking hydroxyzine may help minimize these effects, and if ETD symptoms develop, patients should consult their healthcare provider about possible alternatives with fewer anticholinergic effects, such as non-sedating antihistamines like loratadine or cetirizine 1.
From the Research
Eustachian Tube Dysfunction (ETD) and Hydroxyzine
There is no direct evidence in the provided studies that hydroxyzine causes Eustachian Tube Dysfunction (ETD).
- The studies focus on various aspects of ETD, including its treatment and association with other conditions, but none mention hydroxyzine as a potential cause.
- Studies 2, 3, 4, 5, and 6 discuss different treatments and conditions related to ETD, such as nasal decongestants, dupilumab, balloon dilatation, intranasal azelastine-fluticasone spray, and the relationship between ETD and allergic rhinitis, but do not reference hydroxyzine.
Related Conditions and Treatments
While the provided studies do not directly link hydroxyzine to ETD, they do offer insights into the condition and its management:
- Nasal decongestants may not significantly improve Eustachian tube function, as suggested by 2.
- Dupilumab has been shown to improve ETD and otologic symptoms in patients with aspirin-exacerbated respiratory disease, according to 3.
- Balloon dilatation of the Eustachian tube may lead to a clinically meaningful improvement in ETD symptoms compared to non-surgical treatment, as indicated by 4.
- Intranasal azelastine-fluticasone spray treatment can be effective in regressing adenoid tissue and improving Eustachian tube dysfunction in children, as found by 5.
- Treatment with mometasone furoate nasal spray and oral loratadine can improve eustachian tube function in patients with house dust mite-allergic rhinitis, as reported by 6.