From the Guidelines
Treatment for eustachian tube dysfunction (eustachitis) should prioritize self-care measures and medical interventions that reduce inflammation, drain fluid, and restore normal pressure-equalizing function, with tympanostomy tube placement being a recommended option for persistent cases, as supported by the most recent clinical practice guideline 1.
Overview of Treatment Options
Treatment options for eustachian tube dysfunction include:
- Self-care measures: yawning, swallowing, chewing gum, or performing the Valsalva maneuver to equalize pressure and open the tubes
- Over-the-counter nasal steroid sprays: fluticasone (Flonase) or mometasone (Nasonex) to reduce inflammation
- Oral decongestants: pseudoephedrine (Sudafed) to provide temporary relief by reducing nasal congestion
- Antihistamines: loratadine (Claritin) or cetirizine (Zyrtec) for allergic causes
Medical Interventions
If self-care measures fail, medical interventions may include:
- Stronger nasal steroids
- Oral steroids like prednisone
- Antibiotics if infection is present
- Procedures such as myringotomy, tympanostomy tube placement, or balloon dilation of the eustachian tube for persistent cases
Rationale for Tympanostomy Tube Placement
Tympanostomy tube placement is recommended for persistent cases of eustachian tube dysfunction, as it allows air to enter the middle ear directly, draining fluid and eliminating negative pressure, as described in the clinical practice guideline 1. This procedure has been shown to reduce the incidence of future infections and improve hearing outcomes, with benefits lasting up to 12-24 months, as supported by systematic reviews and RCTs 1.
Considerations for Adenoidectomy
Adenoidectomy may be considered in conjunction with tympanostomy tube placement for children over 4 years old, as it can reduce the prevalence of middle ear effusion and achieve hearing outcomes comparable to tube insertion alone, as noted in the clinical practice guideline 1. However, the decision to perform adenoidectomy should be made on a case-by-case basis, taking into account the individual child's needs and risk factors.
From the Research
Treatment Options for Eustachian Tube Dysfunction (Eustachitis)
- The treatment options for eustachian tube dysfunction are varied, but the effectiveness of certain treatments is still being researched and debated 2, 3, 4, 5, 6.
- Some studies have shown that antihistamines and decongestants are of little use in the treatment of acute otitis media and otitis media with effusion 2.
- Nasal decongestants have been found to have no significant effect on eustachian tube opening in most cases, and may even reduce eustachian tube function in some patients 3.
- Intranasal phenylephrine-surfactant treatment has been shown to be ineffective, and possibly detrimental, in the resolution of otitis media with effusion 4.
- Treatment with nasal glucocorticoids and oral antihistamines has been found to significantly improve eustachian tube function in patients with house dust mite-allergic rhinitis 5.
- Balloon dilation of the eustachian tube is a more recent procedure that has shown initial success, but requires further evaluation to determine its effectiveness 6.
Medical Treatments
- Glycocorticosteroids have been found to improve otitis media with effusion 2.
- Surfactant treatment has been shown to reduce eustachian tube opening pressure and allow the tube to open 4.
- Mometasone furoate nasal spray and oral loratadine have been found to significantly improve eustachian tube function in patients with house dust mite-allergic rhinitis 5.
Non-Medical Treatments
- Balloon dilation of the eustachian tube is a minimally invasive procedure that has shown initial success in improving eustachian tube function 6.
- Further research is needed to determine the effectiveness of this procedure and other non-medical treatments for eustachian tube dysfunction.