From the Guidelines
Medications such as antihistamines, decongestants, and certain antihypertensive medications can cause or worsen Eustachian Tube Dysfunction (ETD). Several medications can cause or worsen Eustachian Tube Dysfunction (ETD).
- Antihistamines like diphenhydramine (Benadryl), loratadine (Claritin), and cetirizine (Zyrtec) can dry out the mucous membranes lining the Eustachian tubes, making them less effective at equalizing pressure 1.
- Decongestants such as pseudoephedrine (Sudafed) and phenylephrine can cause similar drying effects when used long-term 1.
- Certain antihypertensive medications, particularly beta-blockers like metoprolol and atenolol, may contribute to ETD in some patients.
- Birth control pills and hormone replacement therapies containing estrogen can sometimes cause fluid retention that affects the Eustachian tubes.
- Some anticholinergic medications used for overactive bladder, such as oxybutynin (Ditropan) and tolterodine (Detrol), can reduce secretions throughout the body, including in the Eustachian tubes. If you suspect a medication is causing ETD symptoms like ear fullness, popping, or hearing changes, don't stop taking prescribed medications without consulting your healthcare provider, as they may be able to adjust your dosage or switch you to an alternative medication that doesn't affect your Eustachian tube function, as supported by recent studies on otitis media and ETD management 1.
From the Research
Medications that can Cause Eustachian Tube Dysfunction (ETD)
- Antihistamines: These medications can impair the opening function of the Eustachian tube 2
- Decongestants: While decongestants can improve Eustachian tube function in some cases, they can also have negative effects on the tube's function, especially when used in combination with antihistamines 3
- Atropine: This medication can impair the opening function of the Eustachian tube 2
- Glycocorticosteroids: These medications can improve otitis media with effusion, but their effect on Eustachian tube function is not fully understood 2
- Ephedrine: Nasal spray of 1% ephedrine appeared to have no apparent effect on Eustachian tube function in children 3
- Pseudoephedrine hydrochloride: This decongestant tended to alter parameters of Eustachian tube function in the direction of baseline values, but the favorable changes were only partial 3
- Chlorpheniramine maleate: This antihistamine, when combined with a decongestant, had a favorable effect on Eustachian tube function in children without a URI 3
- Xylometazoline chloride: A topical decongestant that improved Eustachian tube function, but only at unphysiologically high pressures 4
Important Considerations
- The evidence on the effectiveness of medications for Eustachian tube dysfunction is limited and of poor quality 5
- Further research is needed to determine the effectiveness of medications for ETD and to establish clear diagnostic criteria 5, 6
- The use of medications for ETD should be approached with caution, as some medications can have negative effects on the Eustachian tube's function 2, 3