From the Guidelines
Eustachian tube dysfunction (ETD) should be managed with watchful waiting for 3 months, and if symptoms persist, tympanostomy tube insertion may be considered, especially in children with bilateral OME and documented hearing difficulties, as recommended by the most recent guidelines 1. To manage ETD, start with simple home remedies like:
- Yawning
- Swallowing
- Chewing gum to help open the tubes
- The Valsalva maneuver (pinching your nose closed while gently blowing out with your mouth closed) can also help equalize pressure. Over-the-counter nasal steroid sprays like fluticasone (Flonase) or mometasone (Nasonex) used once daily in each nostril for 2-4 weeks can reduce inflammation, as suggested by previous studies 1. However, the most recent guideline recommends against using intranasal steroids or systemic steroids for treating OME 1. Oral decongestants such as pseudoephedrine (Sudafed) 30-60mg every 4-6 hours for up to 3 days may provide temporary relief, but avoid prolonged use due to rebound congestion. Antihistamines like loratadine (Claritin) 10mg daily can help if allergies are contributing to your ETD. Stay hydrated and consider using a humidifier to keep nasal passages moist. Avoid smoking and limit alcohol consumption as these can worsen inflammation. If symptoms persist beyond 2 weeks or include severe pain, hearing loss, dizziness, or fever, consult a healthcare provider as prescription medications or procedures like ear tube placement might be necessary. ETD often resolves on its own but can become chronic if underlying causes like allergies or sinus problems aren't addressed, highlighting the importance of proper diagnosis and management, as emphasized in the latest clinical practice guideline 1.
From the Research
Eustachian Tube Dysfunction
- Eustachian tube dysfunction (ETD) is the inability of the Eustachian tube to adequately perform its functions, including protecting the middle ear, ventilating the middle ear, and draining secretions away from the middle ear 2.
- The incidence of Eustachian tube dysfunction in adults is about 1%, while in children it is almost 40% 3.
Diagnosis of Eustachian Tube Dysfunction
- The Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum to diagnose Eustachian tube dysfunction 3.
- Other diagnostic tools include the Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy 4.
Treatment of Eustachian Tube Dysfunction
- Treatment options for Eustachian tube dysfunction include nasal steroids, topical decongestants, and surgical interventions such as Eustachian tuboplasty and balloon dilatation 2, 3.
- The Valsalva maneuver and regular performance of the Toynbee maneuver can also help to alleviate symptoms of Eustachian tube dysfunction 3, 4.
- Surgical interventions such as myringotomy, laser eustachian tuboplasty, and balloon eustachian tuboplasty may be used to manipulate the condition 4.
Effectiveness of Treatment Options
- The evidence for the effectiveness of treatment options for Eustachian tube dysfunction is limited and of poor quality 2.
- Further research is needed to address the lack of consensus on several issues, including the definition of ETD in adults, its relation to broader middle ear ventilation problems, and clear diagnostic criteria 2.
- Topical nasal decongestants may not be effective in children with severe functional tubal dysfunction, but further studies are warranted to justify their widespread use 5.