How to relieve ear congestion?

How to Relieve Ear Congestion

For ear congestion related to Eustachian tube dysfunction from allergies or upper respiratory infections, oral decongestants like pseudoephedrine are the most effective first-line treatment, while topical nasal decongestants should only be used for short-term relief (maximum 3-5 days) to avoid rebound congestion. 1

Initial Management Approach

Oral Decongestants (Preferred for Eustachian Tube Congestion)

• Pseudoephedrine is the most effective oral decongestant for relieving ear congestion caused by Eustachian tube dysfunction, as it provides sustained relief without the risk of rebound congestion seen with topical agents 1, 2
• Dosing: Adults typically use 30-60 mg every 4-6 hours or extended-release formulations for longer duration 3
• Oral decongestants work by reducing mucosal swelling in the Eustachian tube, allowing pressure equalization between the middle ear and atmosphere 1
• Phenylephrine is NOT recommended as an oral decongestant because it undergoes extensive first-pass metabolism and is not bioavailable at currently recommended doses 3, 2

Topical Nasal Decongestants (Short-Term Only)

• Topical decongestants (like oxymetazoline or phenylephrine nasal spray) provide the fastest and most intense relief but should never be used for more than 3-5 days due to risk of rhinitis medicamentosa (rebound congestion) 1, 3
• These are best reserved for acute situations like air travel or severe acute congestion 1

Important Contraindications and Precautions

Who Should Avoid Oral Decongestants

• Patients with uncontrolled hypertension, cardiovascular disease, cerebrovascular disease, hyperthyroidism, closed-angle glaucoma, or bladder neck obstruction should use oral decongestants with extreme caution 3
• Children under 6 years old: oral decongestants have been associated with serious adverse events including agitated psychosis, ataxia, hallucinations, and death at recommended doses 3
• Avoid combining with caffeine or stimulant medications (like ADHD medications) as this increases risk of tachyarrhythmias and hyperactivity 3

When Ear Congestion Requires Medical Evaluation

Red Flags Requiring Immediate Assessment

• Any ear pain, drainage, or bleeding requires direct medical evaluation and is NOT simply congestion 4
• Persistent congestion lasting more than 3 months, especially in children, may indicate otitis media with effusion requiring specialist evaluation 3
• Hearing loss accompanying ear congestion warrants formal hearing testing 3

Ineffective Treatments to Avoid

What Does NOT Work

• Antihistamines alone do NOT relieve nasal or ear congestion and should not be used as monotherapy for this symptom 2
• Antihistamines and decongestants have been shown to be of little use in treating otitis media with effusion or preventing ear infections 5
• Decongestants, antihistamines, and intranasal corticosteroids are either ineffective or may cause adverse effects in children with middle ear fluid 3

Alternative and Adjunctive Measures

Non-Pharmacologic Options

• Nasal balloon auto-inflation has shown modest effectiveness in clearing middle ear effusion in school-aged children, though benefits are limited (number needed to treat = 9) 3
• Valsalva maneuver or yawning can temporarily help equalize pressure 1
• For chronic Eustachian tube dysfunction lasting months to years, balloon dilatation of the Eustachian tube is an emerging option, though long-term evidence is still limited 3, 6

Clinical Pearls

• The underlying cause matters: allergic rhinitis may benefit from intranasal corticosteroids for long-term management, while acute viral upper respiratory infections respond best to short-term oral decongestants 1, 7
• If congestion persists despite appropriate decongestant use, consider referral to otolaryngology for evaluation of chronic Eustachian tube dysfunction or other structural issues 6
• Monitor blood pressure in patients taking oral decongestants, especially those with controlled hypertension, as elevation can occur 3