From the Guidelines
Eustachian tube dysfunction should be managed with a 3-month period of watchful waiting in children who are not at particular risk for speech, language, or learning problems, as recommended by current 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 create pressure differences between the middle ear and environment. To treat mild cases, simple home remedies like yawning, swallowing, chewing gum, or performing the Valsalva maneuver can be tried. Over-the-counter nasal steroid sprays like fluticasone (Flonase) or mometasone (Nasonex) used once daily can reduce inflammation, as supported by the study 1. For congestion, pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or phenylephrine may help, though avoid these if you have high blood pressure. Some key points to consider in management include:
- The use of tympanostomy tubes, which may be recommended for children with bilateral OME for 3 months or longer and documented hearing difficulties, as stated in the guideline 1.
- The consideration of adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids, as recommended in the study 1.
- The importance of treating the underlying cause, especially nasal inflammation, to resolve the condition and prevent recurrence, as highlighted in the study 1.
- The need for regular follow-up and surveillance to monitor the resolution of OME and improved hearing or quality of life, as emphasized in the guideline 1. In severe cases or when symptoms persist, consulting a healthcare provider for further evaluation and treatment, including possible procedures like myringotomy (ear tube placement), is essential to prevent long-term complications and improve quality of life 1.
From the Research
Symptoms of Eustachian Tube Dysfunction
- Aural fullness, tinnitus or discomfort, hearing loss and other symptoms are commonly reported by patients with Eustachian tube dysfunction 2, 3, 4
- Symptoms can be unspecific, making diagnosis challenging 4
- The Eustachian tube score (ETS-5) and ETS-7 score can be used to diagnose Eustachian tube dysfunction in patients with perforated or intact ear drums, respectively 4
Treatment Options for Eustachian Tube Dysfunction
- Nasal steroids, decongestants, antihistamines, or a combination of these treatments may be used to reduce tubal edema and alleviate symptoms 2, 5
- Surgical interventions, such as Eustachian tuboplasty, balloon dilatation, myringotomy, and laser point coagulation, may be effective in improving outcomes for patients with Eustachian tube dysfunction 2, 6
- The Valsalva maneuver and Toynbee maneuver can be used to help equalize pressure in the middle ear and alleviate symptoms 4, 6
- Novel techniques, such as microwave ablation and balloon eustachian tuboplasty, may also be used to treat Eustachian tube dysfunction 6
- Treatment of obstructive dysfunction may include steroid nasal sprays, regular performance of the Valsalva maneuver, and tube dilation with the Bielefelder balloon catheter 4
- Treatment of patulous Eustachian tube may include saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy 4
Diagnostic Tools
- The ETS-7 questionnaire can be used to evaluate Eustachian tube dysfunction before and after treatment 3
- Tympanometry, pressure chamber test, and video nasopharyngoscopy can be used to diagnose and alleviate Eustachian tube dysfunction 6
- Ear endoscopy, pure tone audiometry, and acoustic impedance test can be used to evaluate the effectiveness of treatment for Eustachian tube dysfunction 3