What alternatives can be used to treat ear pressure now that Auragla is no longer available?

Alternatives for Ear Pressure Management

For symptomatic ear pressure relief, oral analgesics (acetaminophen or ibuprofen) are the primary evidence-based treatment, while topical analgesics may provide brief additional benefit; nasal decongestants are not effective for improving eustachian tube function or middle ear pressure.

First-Line Treatment: Analgesics

Oral acetaminophen (paracetamol) and ibuprofen are effective for relieving ear pain and pressure symptoms associated with middle ear conditions. 1 These medications address the discomfort directly and should be dosed appropriately for age and weight.

• Topical analgesics may provide additional brief symptomatic relief, though current evidence on their effectiveness is limited 1
• Pain management is the mainstay of treatment for ear pressure and discomfort, particularly when associated with otitis media 1

What Does NOT Work: Decongestants

Nasal decongestants (including xylometazoline and phenylephrine) do not improve eustachian tube function or middle ear pressure despite their widespread use. The evidence against decongestants is compelling:

• A prospective study found that nasal decongestants have no effect on eustachian tube opening in most cases, and in some patients actually reduced eustachian tube function 2
• In infants with common colds and abnormal middle ear pressure, intranasal phenylephrine failed to improve middle ear pressures compared to placebo (88% remained abnormal with phenylephrine vs. 76% with placebo) 3
• A pressure chamber study showed xylometazoline only increased the frequency of eustachian tube openings but did not improve opening pressure, duration, or closing pressure 4
• Antihistamines and decongestants showed no benefit for middle ear effusion resolution (RR 0.99,95% CI 0.92-1.05) 1

Auto-Inflation Techniques

Auto-inflation devices represent an evidence-based non-pharmacologic option for improving middle ear pressure. 1

• Auto-inflation improved tympanogram findings with a relative risk of 1.74 (95% CI 1.22-2.50) at 1 month compared to no treatment 1
• A crossover study demonstrated improvement in middle ear pressure by 166 daPa with treatment versus 19 daPa with control (P < 0.0001), along with mean hearing level improvement of 6 dB 1
• This technique is non-invasive and can be taught to patients for self-administration

Cerumen Management (If Applicable)

If ear pressure is related to cerumen impaction rather than middle ear pathology:

• Carbamide peroxide otic drops (5-10 drops twice daily for up to 4 days) can soften cerumen 5
• Contraindications include ear drainage, ear pain, tympanic membrane perforation, or recent ear surgery 5
• Manual removal by a clinician using irrigation, curette, or suction remains the most effective method 1
• Never use cotton-tip swabs, as they can push cerumen deeper or cause complications 1

When Underlying Pathology Requires Specific Treatment

The approach depends on the cause of ear pressure:

For Sudden Hearing Loss with Ear Fullness:

• Corticosteroids (oral or intratympanic) may be offered as initial therapy 1
• Ear fullness is a common associated symptom with sudden sensorineural hearing loss 1

For Ménière's Disease:

• Betahistine may be considered, though evidence is mixed 1
• Intratympanic steroids can be offered for active disease not responsive to noninvasive treatment 1
• Positive pressure therapy (Meniett device) is NOT recommended, as systematic reviews found no significant benefit for vertigo control 1

For Otitis Media with Effusion:

• Watchful waiting is appropriate as many cases resolve spontaneously 1
• Tympanostomy tubes improve hearing for 6 months and reduce middle ear effusion for up to 2 years compared to watchful waiting 1

Critical Pitfalls to Avoid

• Do not prescribe nasal decongestants expecting improvement in ear pressure or eustachian tube function - the evidence clearly shows they are ineffective 2, 4, 3
• Avoid recommending ear candling, which has been proven ineffective and can cause burns, ear canal occlusion, and tympanic membrane perforation 1
• Do not use irrigation if tympanic membrane perforation is suspected or in diabetic/immunocompromised patients 6
• Recognize that approximately one-third to two-thirds of patients with sudden hearing loss and associated ear fullness may recover spontaneously within 2 weeks 1