Mometasone Drops for Eustachian Tube Dysfunction
Mometasone nasal spray may provide benefit for Eustachian tube dysfunction (ETD), particularly in patients with allergic rhinitis or adenoid hypertrophy, though current evidence shows mixed results and guidelines do not strongly recommend intranasal corticosteroids as primary therapy for ETD. 1
Evidence for Intranasal Corticosteroids in ETD
Limited Efficacy in General ETD Population
The American Academy of Otolaryngology-Head and Neck Surgery notes that medical treatments including intranasal corticosteroids are either ineffective or may cause adverse effects without clear benefit for ETD that has persisted beyond 17 days 1
A 2024 systematic review and meta-analysis of randomized controlled trials found no significant difference in tympanometric normalization between intranasal corticosteroids and control (odds ratio 1.21,95% CI 0.65-2.24) 2
Nasal steroids have shown no improvement in symptoms or middle ear function for patients with otitis media with effusion and/or negative middle ear pressure 1
Potential Benefit in Specific Populations
For ETD associated with allergic rhinitis:
A 2020 study demonstrated that after 1 month of treatment with mometasone furoate nasal spray and oral loratadine, AR patients showed significantly decreased ETDQ-7 scores (p < 0.0001) and improved eustachian tube function on tubomanometry (p < 0.0001) 3
The local conditions of the pharyngeal orifices of the eustachian tubes are closely related to ETD symptoms, and treatment with nasal glucocorticoids can improve function as nasal symptoms subside 3
Allergy management is beneficial for patients with ETD secondary to allergies 1
For ETD with adenoid hypertrophy in children:
A 2023 study of 100 children with adenoid hypertrophy and ETD treated with intranasal azelastine-fluticasone combination for 3 months showed significant improvement in both adenoid tissue regression (82% to 37% choana occlusion) and Eustachian tube function scores (ETS-7 increased from 6.36 to 9.72, p < 0.05) 4
Treatment with steroid nasal sprays is recommended for obstructive tube dysfunction 5
Recommended Management Algorithm
Initial Assessment (First 3 Months)
Watchful waiting is recommended for uncomplicated ETD, as many cases resolve spontaneously within 3 months 1
Identify if ETD is secondary to allergic rhinitis or adenoid hypertrophy, as these patients may benefit more from intranasal corticosteroids 4, 3
Medical Management
If allergic rhinitis is present:
Initiate mometasone furoate nasal spray (or similar intranasal corticosteroid) combined with oral antihistamine for 1 month 3
Monitor ETDQ-7 scores and nasal symptoms, particularly nasal obstruction which correlates with ETD severity (r = 0.5124) 3
If adenoid hypertrophy is present in children:
- Consider intranasal azelastine-fluticasone combination as initial therapy for 3 months before surgical intervention 4
Adjunctive measures:
Regular performance of Valsalva maneuver 5
Nasal balloon auto-inflation is effective in clearing middle ear effusion in school-aged children (NNT = 9) 1
Surgical Intervention
Consider surgical options only if symptoms persist for 3 months or longer (chronic ETD) 1
Tympanostomy tube insertion is the preferred initial surgical procedure for persistent ETD with effusion 1
Adenoidectomy may be beneficial in children ≥4 years for OME 1
Important Caveats
Decongestants and antihistamines may provide very short-term improvements but are not recommended for long-term management due to limited efficacy 1
A Cochrane meta-analysis found no significant benefit for antihistamines, decongestants, or combinations (RR 0.99,95% CI 0.92-1.05) 1
Oral corticosteroids (prednisolone) are not recommended for ETD as they have been shown to be ineffective or may cause adverse effects without clear benefit 1
The evidence for intranasal corticosteroids is strongest when ETD is clearly associated with allergic rhinitis or adenoid hypertrophy, rather than isolated ETD 4, 3
Children with chronic OME should be reevaluated every 3-6 months until effusion resolves 1