What are the treatment options for congested ears?

Treatment Options for Congested Ears

Watchful waiting for 3 months is the recommended first-line approach for congested ears (otitis media with effusion), as most cases resolve spontaneously without intervention. 1

Understanding Ear Congestion

Ear congestion is commonly caused by otitis media with effusion (OME), which is the presence of fluid in the middle ear without signs or symptoms of acute infection. This condition often follows an upper respiratory infection or acute otitis media.

First-Line Management Approach

Watchful Waiting (3 months)

• The primary recommended approach for uncomplicated cases is observation for 3 months from the date of effusion onset or diagnosis 1
• Approximately 75-90% of OME cases resolve spontaneously within 3 months 1
• During this period, regular follow-up every 4-6 weeks is recommended to monitor the condition 1

Self-Help Techniques

1. Valsalva maneuver: Gently blow while pinching the nose and keeping the mouth closed to equalize pressure 2, 3
2. Toynbee maneuver: Swallow while pinching the nose closed 2
3. Auto-inflation: Using devices designed to help open the Eustachian tube 1
   • Small but positive effects shown in studies
   • Low cost and absence of adverse effects make this a reasonable option during watchful waiting

Medications to AVOID

Strong evidence shows the following medications are ineffective and NOT recommended:

• Antihistamines and decongestants: No benefit for OME 1
• Systemic antibiotics: No long-term efficacy for OME 1
• Intranasal or systemic corticosteroids: Not recommended for routine management 1

When to Consider Further Intervention

Hearing Testing

• Recommended when OME persists for 3 months or longer 1
• Should be performed earlier if language delay, learning problems, or significant hearing loss is suspected 1

Surgical Options (for persistent cases)

If OME persists beyond 3 months with documented hearing difficulties:

1. Tympanostomy tubes (ventilation tubes):

   • First-line surgical option for persistent OME 1
   • Reduces effusion prevalence by about 62% 1
   • Improves hearing by 6-12 dB while tubes remain patent 1

2. Adenoidectomy:

   • Not recommended as initial surgery unless specific indications exist (nasal obstruction, chronic adenoiditis) 1
   • Most beneficial as an adjunct to tube insertion in children ≥4 years of age 1
   • Reduces need for ventilation tube re-insertions by about 10% 1

Special Considerations

At-Risk Children

Children with certain conditions may need earlier intervention:

• Permanent hearing loss
• Speech/language delays
• Developmental disorders
• Cleft palate
• Visual impairments
• Unstable home environment 1

Care During Watchful Waiting

• Speak clearly and face the child when talking
• Stand or sit close to the child when speaking
• Repeat phrases when misunderstood
• Consider preferential classroom seating if applicable 1

Follow-Up Recommendations

• Regular monitoring every 4-6 weeks during watchful waiting period
• Hearing testing if symptoms persist beyond 3 months
• If tympanostomy tubes are placed, follow-up every 4-6 months to ensure tubes remain in place 1

Remember that interventions carry potential risks and costs, while most cases of ear congestion resolve spontaneously with time. The evidence strongly supports an initial watchful waiting approach for uncomplicated cases.