From the Guidelines
Treatment options for Eustachian tube dysfunction should prioritize watchful waiting for 3 months, and if symptoms persist, tympanostomy tube insertion is recommended, especially for children with chronic otitis media with effusion (OME) and symptoms, as stated in the 2022 clinical practice guideline on tympanostomy tubes in children 1. The treatment approach for Eustachian tube dysfunction involves both self-care measures and medical interventions. For mild cases, simple techniques like yawning, swallowing, chewing gum, or performing the Valsalva maneuver can help open the tubes. Over-the-counter nasal steroid sprays such as fluticasone (Flonase) or mometasone (Nasonex) can reduce inflammation. However, according to the 2016 clinical practice guideline on otitis media with effusion, clinicians should recommend against using intranasal steroids or systemic steroids for treating OME 1. Some key points to consider in the management of Eustachian tube dysfunction include:
- The use of oral decongestants like pseudoephedrine (Sudafed) may provide temporary relief, though they should be avoided by those with high blood pressure.
- For allergic causes, antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec) can help.
- If these measures fail, a doctor may prescribe stronger nasal steroids or antibiotics if infection is present.
- For persistent cases, a physician might perform balloon dilation of the Eustachian tube or insert pressure equalization tubes through the eardrum, as supported by the 2022 executive summary of clinical practice guideline on tympanostomy tubes in children 1. It's essential to note that the treatment approach should be individualized, taking into account the child's age, symptoms, and risk factors, as well as the potential benefits and harms of each treatment option, as outlined in the 2016 clinical practice guideline on otitis media with effusion executive summary (update) 1. Additionally, the 2022 clinical practice guideline on tympanostomy tubes in children emphasizes the importance of shared decision-making between clinicians, parents, and caregivers, considering the child's unique needs and circumstances 1. In terms of surgical options, tympanostomy tube insertion is recommended for initial surgery, as it has been shown to be effective in reducing the prevalence of effusion and improving hearing levels, as stated in the 2004 clinical practice guideline on otitis media with effusion 1. Overall, the management of Eustachian tube dysfunction requires a comprehensive approach, considering both medical and surgical interventions, as well as the individual child's needs and circumstances, with the goal of improving morbidity, mortality, and quality of life outcomes.
From the Research
Treatment Options for Eustachian Tube Dysfunction
The treatment options for Eustachian tube dysfunction can be categorized into medical, surgical, and other interventions.
- Medical treatment: According to 2, some drugs can improve otitis media with effusion, such as glycocorticosteroids. However, antihistamines and decongestants are of little use in the treatment of acute otitis media and otitis media with effusion.
- Surgical treatment: As outlined in 3, various surgical interventions can be used to manipulate Eustachian tube dysfunction, including conventional tympanostomy and myringotomy, as well as more novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty.
- Other interventions:
- Balloon dilatation of the Eustachian tube: Studies such as 4 and 5 have shown promising results for balloon dilatation of the Eustachian tube in treating obstructive dysfunction, with significant improvements in audiometry, tympanometry, and patient-reported symptoms.
- Intranasal Azelastine-Fluticasone spray treatment: Research like 6 has found that this treatment can be effective in reducing adenoid tissue hypertrophy and improving Eustachian tube function in children with adenoid hypertrophy and Eustachian tube dysfunction.
Diagnostic Tools
Diagnostic tools for Eustachian tube dysfunction include:
- Valsalva maneuver
- Toynbee maneuver
- Tympanometry
- Pressure chamber test
- Video nasopharyngoscopy
- The ETS-7 questionnaire These tools can help diagnose and alleviate the condition, as discussed in 3.