What are the treatment options for Eustachian tube dysfunction?

From the Guidelines

Treatment for Eustachian tube dysfunction should prioritize watchful waiting for 3 months, and if symptoms persist, tympanostomy tube insertion may be considered, especially in children with chronic otitis media with effusion (OME) and symptoms, as recommended by the most recent guidelines 1. The treatment options for Eustachian tube dysfunction include 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. Some key points to consider in the management of Eustachian tube dysfunction include:

• Over-the-counter nasal steroid sprays, such as fluticasone or mometasone, may reduce inflammation, but their use should be limited to 2-4 weeks due to potential side effects.
• Oral decongestants like pseudoephedrine can temporarily relieve symptoms, but they should be avoided by those with high blood pressure.
• For persistent cases, a doctor may prescribe antibiotics if infection is present or recommend prescription-strength nasal steroids.
• In more severe cases, procedures such as myringotomy, tympanostomy tube placement, or balloon dilation of the Eustachian tube may be necessary, as supported by recent guidelines 1. It is essential to note that the use of intranasal steroids, systemic steroids, antibiotics, antihistamines, or decongestants is not recommended for treating OME, as stated in the guidelines 1. The decision to proceed with surgical interventions, such as tympanostomy tube insertion, should be based on the presence of symptoms, the duration of OME, and the individual patient's risk factors, as outlined in the most recent guidelines 1.

From the Research

Treatment Options for Eustachian Tube Dysfunction

The treatment options for Eustachian tube dysfunction (ETD) can be categorized into several approaches, including:

• Pharmacological interventions:
  • Nasal steroids, which showed no improvement in symptoms or middle ear function for patients with otitis media with effusion and/or negative middle ear pressure 2
  • Topical decongestants, which may provide very short-term improvements in middle ear function 2
  • Antihistamines and decongestants, which have been shown to be of little use in the treatment of acute otitis media and otitis media with effusion 3
• Mechanical devices for middle ear pressure equalization:
  • Pressure equalisation devices, which have been associated with significant short-term improvements in symptoms, middle ear function, and/or hearing 2
• Surgical interventions:
  • Eustachian tuboplasty, which has been associated with improved outcomes 2
  • Balloon dilatation, which has also been associated with improved outcomes 2
  • Myringotomy, directly applied topical steroids, and laser point coagulation, which have reported positive results 2
• Other treatments:
  • Adenoid hypertrophy treatment, which includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter 4
  • Treatment for patulous Eustachian tube, which includes saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy 4

Effectiveness of Nasal Decongestants

The effectiveness of nasal decongestants in improving Eustachian tube function is still unclear, with some studies showing:

• No significant improvement in tube opening quality or parameters 5
• A minor effect on ET opening frequency during passive equalization condition 6
• No significant difference in ET opening pressure, ET opening duration, and ET closing pressure parameters before and after application of decongestants 6