From the Guidelines
Treatment for eustachian tube dysfunction should prioritize watchful waiting for 3 months, as recommended by the most recent guidelines 1. This approach is based on the understanding that many cases of eustachian tube dysfunction, particularly those associated with otitis media with effusion (OME), resolve on their own without the need for immediate medical intervention. The guidelines from 2016 1 emphasize the importance of documenting the presence of middle ear effusion and assessing the need for further intervention based on the duration of symptoms and the presence of risk factors for speech, language, or learning problems.
Key considerations in managing eustachian tube dysfunction include:
- Avoiding unnecessary use of medications such as intranasal steroids, systemic steroids, antibiotics, antihistamines, or decongestants, as these are not recommended for treating OME 1.
- Considering tympanostomy tubes for children with persistent OME, especially those under 4 years old, as this can help to equalize pressure and drain fluid from the middle ear 1.
- Educating families about the natural history of OME, the need for follow-up, and the possible sequelae, as well as counseling them on the potential impact on speech and language development in cases of bilateral OME with documented hearing loss 1.
It's essential to approach each case individually, taking into account the child's age, symptoms, and risk factors, and to prioritize interventions that promote the best possible outcomes in terms of morbidity, mortality, and quality of life. The use of tympanostomy tubes, as discussed in the 2022 update on clinical practice guidelines for tympanostomy tubes in children 1, can be an effective treatment for persistent cases, helping to improve health literacy and shared decision-making between clinicians and families.
From the Research
Treatment Options for Eustachian Tube Dysfunction
- Nasal steroid sprays: A study published in 2011 2 found no significant difference in the normalization of abnormal tympanometric signs with the use of intranasal aqueous triamcinolone acetonide compared to placebo.
- Pressure equalisation devices: A systematic review published in 2014 3 found that two pressure equalisation devices were associated with significant short-term improvements in symptoms, middle ear function, and/or hearing.
- Eustachian tuboplasty: The same systematic review 3 found that eustachian tuboplasty was associated with improved outcomes in seven case series.
- Balloon dilatation: The 2014 systematic review 3 also found that balloon dilatation was associated with improved outcomes in three case series.
- Myringotomy: A case series mentioned in the 2014 systematic review 3 reported positive results for myringotomy.
- Laser point coagulation: A controlled before-and-after study mentioned in the 2014 systematic review 3 reported positive results for laser point coagulation.
- Valsalva maneuver: A study published in 2018 4 recommended regular performance of the Valsalva maneuver as a treatment for obstructive tube dysfunction.
- Bielefelder balloon catheter: The 2018 study 4 also recommended tube dilation with the Bielefelder balloon catheter for obstructive tube dysfunction.
- Saline nasal irrigation: A study published in 2018 4 recommended saline nasal irrigation as a treatment for patulous Eustachian tube.
- Estrogen-nasal ointment: The 2018 study 4 also recommended estrogen-nasal ointment as a treatment for patulous Eustachian tube.
- Craniocervical manual therapy: The 2018 study 4 recommended craniocervical manual therapy as a treatment for patulous Eustachian tube.
Diagnosis and Assessment
- Eustachian tube score (ETS-5 and ETS-7): A study published in 2018 4 recommended the use of the ETS-5 and ETS-7 scores for diagnosis.
- Tympanometry: A review published in 2022 5 mentioned tympanometry as a tool for diagnosing eustachian tube dysfunction.
- Video nasopharyngoscopy: The 2022 review 5 also mentioned video nasopharyngoscopy as a diagnostic tool.
- Pressure chamber test: The 2022 review 5 mentioned the pressure chamber test as a diagnostic tool.
- Toynbee maneuver: The 2022 review 5 mentioned the Toynbee maneuver as a diagnostic tool.
Role of Allergy in Eustachian Tube Dysfunction
- A study published in 2020 6 found an association between allergic rhinitis and eustachian tube dysfunction, but noted that not all cases of eustachian tube dysfunction are related to allergies.
- The use of medications such as intranasal corticosteroids or oral antihistamines may not result in significant symptomatic improvement in patients with eustachian tube dysfunction 6.