What medications can be used to treat ear pressure?

Medications for Ear Pressure Management

Decongestants are the most effective first-line medication for treating ear pressure, particularly pseudoephedrine 60mg which provides optimal nasal decongestion without significant cardiovascular side effects. 1

First-Line Treatments

Oral Decongestants

• Pseudoephedrine (30-60mg): FDA-approved nasal decongestant that effectively reduces ear pressure by decreasing congestion and improving Eustachian tube function 2
  • Optimal single adult dose is 60mg, which achieves maximal nasal decongestion without significant cardiovascular effects 1
  • Particularly effective for ear pressure during air travel, reducing incidence of barotrauma by nearly 50% 3
  • Should be used for shortest duration possible, especially in patients with severe or uncontrolled hypertension 4

Auto-inflation Techniques

• Devices designed to help open the Eustachian tube show small but positive effects 5
• Low cost and absence of adverse effects make this a reasonable complementary approach

Second-Line Treatments

Topical Nasal Decongestants

• Phenylephrine nasal drops: May provide temporary relief but have limited efficacy in improving middle ear pressure in infants with common colds 6
• Should be used for no more than 3-5 days to avoid rebound congestion

Ineffective Treatments (Do Not Recommend)

Antihistamines and Antihistamine/Decongestant Combinations

• Not recommended for ear pressure related to otitis media with effusion (OME) 4, 5, 7
• Cochrane review found no benefit and potential harm with these medications 7
• Treated subjects experienced 11% more side effects than untreated subjects 7

Antibiotics

• Not recommended for routine management of ear pressure due to OME 5
• No long-term efficacy for treating ear pressure without active infection 5

Corticosteroids

• Not recommended for routine management of ear pressure due to OME 5
• Intranasal or systemic corticosteroids lack evidence for long-term efficacy 5

Special Considerations

Underlying Conditions

• For ear pressure due to otitis media with effusion:
  • Watchful waiting for 3 months is recommended as first-line approach 5
  • 75-90% of cases resolve spontaneously within 3 months 5
  • Regular monitoring every 4-6 weeks during watchful waiting period 5

Surgical Options

• For persistent ear pressure due to OME beyond 3 months:
  • Tympanostomy tubes (ventilation tubes) are the first-line surgical option 5
  • Reduces effusion prevalence by about 62% and improves hearing by 6-12 dB 5

Cautions and Contraindications

• Decongestants should be avoided or used with caution in:

  • Patients with severe or uncontrolled hypertension 4
  • Patients taking MAO inhibitors 4
  • Children under 4 years of age
  • Patients with cardiovascular disease, hyperthyroidism, or glaucoma

• Monitor for side effects of decongestants:

  • Increased blood pressure
  • Tachycardia
  • Nervousness
  • Insomnia

Algorithm for Management

1. Acute ear pressure (< 3 months):

   • Oral decongestant (pseudoephedrine 60mg) for short-term relief
   • Auto-inflation techniques as complementary approach
   • Avoid antihistamines, antibiotics, and corticosteroids

2. Persistent ear pressure (> 3 months):

   • Hearing evaluation
   • Consider referral to ENT specialist for possible tympanostomy tube placement