From the Guidelines
Eustachian tube dysfunction should be managed with watchful waiting for 3 months, and if symptoms persist, ventilation tubes may be considered, as recommended by the most recent guidelines 1. The symptoms of Eustachian tube dysfunction include ear pressure, pain, and hearing problems, which can be caused by upper respiratory infections, allergies, or changes in altitude that lead to inflammation or fluid buildup in the middle ear. To treat mild cases, simple home remedies can be tried, such as:
- Yawning
- Swallowing
- Chewing gum
- Performing the Valsalva maneuver (pinching the nose closed while gently blowing out with the mouth closed) Over-the-counter nasal steroid sprays like fluticasone (Flonase) or mometasone (Nasonex) used once daily can reduce inflammation, as suggested by 1. For congestion, pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or phenylephrine may help, though these should be avoided if the patient has high blood pressure. If symptoms persist beyond 2 weeks or are severe, it is recommended to see a doctor who may prescribe stronger medications or consider procedures like myringotomy (ear tube placement) 1. The management of Eustachian tube dysfunction is primarily aimed at alleviating or restoring hearing, and current guidelines recommend a 3-month period of watchful waiting in children with otitis media with effusion (OME) who are not at particular risk for speech, language, or learning problems 1. Adenoidectomy as a standalone operation or as an adjunct to tube insertion is most beneficial in children with OME ≥4 years of age, as shown by 1. Nasal balloon auto-inflation has been shown to be effective in clearing middle ear effusion and improving ear symptoms at 3 months in school-aged children presenting in primary care with a recent onset of OME, but its effects are modest and more research is needed to determine its effectiveness in reducing the need for ventilation tubes 1.
From the Research
Symptoms of Eustachian Tube Dysfunction
- The symptoms of Eustachian tube dysfunction (ETD) can vary, but they are often related to the inability of the Eustachian tube to adequately perform its functions, including protecting the middle ear from sources of disease, ventilating the middle ear, and helping to drain secretions away from the middle ear 2.
- Nasal symptoms of allergic rhinitis, such as nasal obstruction, are correlated with Eustachian tube dysfunction questionnaire (ETDQ-7) scores, suggesting a link between nasal inflammatory disease and ETD 3.
- ETD can also be associated with symptoms such as hearing loss, ear fullness, and ear pain.
Treatment Options for Eustachian Tube Dysfunction
- There are several treatment options for ETD, including pharmacological interventions, mechanical devices, and surgical interventions 2, 4.
- Pharmacological interventions, such as nasal steroids, decongestants, and antihistamines, may be used to reduce tubal edema and improve Eustachian tube function 2, 5.
- Mechanical devices, such as pressure equalization devices, may be used to help equalize the pressure in the middle ear 2.
- Surgical interventions, such as Eustachian tuboplasty, balloon dilatation, and myringotomy, may be used to improve Eustachian tube function and alleviate symptoms 2, 4.
- Topical nasal decongestants, such as xylometazoline, may be used to help improve Eustachian tube function, although the evidence for their effectiveness is limited 6.
Effectiveness of Treatment Options
- The evidence for the effectiveness of treatment options for ETD is limited and of poor quality, making it difficult to draw conclusions about the best course of treatment 2, 4.
- Some studies have reported improvements in symptoms and Eustachian tube function with certain treatments, such as nasal steroids and mechanical devices, but these findings are not consistent across all studies 2, 4.
- Further research is needed to fully understand the effectiveness of different treatment options for ETD and to develop evidence-based guidelines for management 2, 4.