From the Guidelines
For a bulging eardrum without infection, watchful waiting (surveillance) is recommended as the initial approach, as it allows the condition to potentially resolve on its own without immediate intervention, according to the clinical practice guideline by 1. This approach involves regular check-ups with a healthcare provider every 3 to 6 months to monitor the condition of the eardrum and periodic hearing tests to assess any changes in hearing.
- The benefits of watchful waiting include giving the body a chance to recover on its own, which can be beneficial in cases where the condition is not severe or persistent.
- However, it's essential to be aware of the potential risks, such as persistent fluid reducing hearing, bothering the individual, and rarely damaging the eardrum and causing it to collapse.
- If watchful waiting is not effective, or if the condition worsens, other treatment options like ear tube placement or adenoidectomy may be considered, as outlined in the shared decision grid for parents and caregivers regarding surgical options for otitis media with effusion by 1.
- It's crucial to follow the healthcare provider's recommendations and attend scheduled follow-up appointments to ensure the condition is properly monitored and addressed if necessary.
- In the meantime, managing discomfort with over-the-counter pain relievers, applying warm compresses, and using nasal decongestants or antihistamines as needed can help alleviate symptoms, as suggested in the example guidance.
- However, it's essential to prioritize the guidance from the clinical practice guideline by 1 and consult with a healthcare provider for personalized advice and care.
From the Research
Management of Bulging Eardrum without Infection
To manage a bulging eardrum without infection, several options can be considered:
- The Valsalva maneuver, which involves pinching the nose shut, closing the mouth, and exhaling gently to help equalize the air pressure in the ears 2
- The Toynbee maneuver, which involves swallowing while pinching the nose shut to help open the Eustachian tube 2
- Nasal decongestants, although their effectiveness is debated, with some studies showing no significant improvement in Eustachian tube function 3, 4
- Oral decongestants, which may have a favorable effect on Eustachian tube function, especially in cases of upper respiratory infection 4
- Combination of oral decongestant and antihistamine, which may also have a favorable effect on Eustachian tube function 4
Eustachian Tube Dysfunction Treatment
Eustachian tube dysfunction can be treated with various methods, including:
- Medical management, which has shown symptomatic improvement in 50.3% of patients, although the evidence is mostly level 2 or 3 5
- Intranasal corticosteroids, which have been found to be ineffective for chronic symptoms 5
- Politzer devices and Valsalva therapy, which have shown minimally beneficial results 5
- Surgical interventions, such as tympanostomy and myringotomy, as well as more novel techniques like microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty 2