Oral Steroid Regimen for Eustachian Tube Dysfunction (ETD)
Oral steroids are not recommended as a routine treatment for Eustachian Tube Dysfunction due to limited evidence of long-term efficacy and potential for significant adverse effects. 1
Evidence on Steroid Use for ETD
The clinical practice guidelines for otitis media with effusion (OME), which is often associated with ETD, specifically state that corticosteroids do not have long-term efficacy and are not recommended for routine management 1. This recommendation is based on systematic reviews of randomized controlled trials and a preponderance of harm over benefit.
Potential Risks of Oral Steroids
Oral steroids can cause significant adverse effects including:
- Behavioral changes
- Increased appetite and weight gain
- Adrenal suppression
- Increased risk of serious infections (e.g., fatal varicella)
- Avascular necrosis of the femoral head 1
Alternative Treatment Approaches
Intranasal Steroids
- Recent systematic review and meta-analysis (2024) found no significant difference in tympanometric normalization between intranasal corticosteroids and control (odds ratio 1.21,95% CI 0.65-2.24) 2
- May be considered in specific cases where ETD is associated with allergic rhinitis or adenoid hypertrophy 3, 4
Observation
- Observation for 3 months is recommended for uncomplicated cases 1
- During observation, clinicians should inform parents/caregivers about potential reduced hearing
- Strategies to optimize listening environment can be discussed 1
Other Treatments
- Antihistamines and decongestants are ineffective for ETD and not recommended 1, 5
- Auto-inflation techniques may provide some benefit during watchful waiting 1
Limited Circumstances for Oral Steroid Use
If oral steroids are considered in exceptional circumstances (severe, refractory cases):
- Should be limited to a single short course (10-14 days)
- Should not be used for prolonged or repetitive courses 1
- Must be used with caution given the significant potential for adverse effects
- Patient should be informed that likelihood of long-term resolution is small
Conclusion
Current clinical guidelines and evidence do not support the routine use of oral steroids for ETD. The potential harms outweigh the limited evidence of benefit. Observation, addressing underlying causes, and considering less invasive approaches like auto-inflation are preferred initial management strategies.