From the Guidelines
The approach to eustachian tube dysfunction (ETD) should prioritize watchful waiting for 3 months, as recommended by current guidelines 1, before considering more invasive options. This approach is based on the understanding that many cases of ETD, particularly those associated with otitis media with effusion (OME), resolve spontaneously within several months. The primary goal of management is to alleviate or restore hearing, and watchful waiting allows for the potential spontaneous resolution of the condition while minimizing unnecessary medical interventions.
Key considerations in the management of ETD include:
- Identifying and treating underlying causes such as allergies, sinusitis, or upper respiratory infections.
- Using nasal saline irrigation and considering intranasal corticosteroids for a short period, although their effectiveness is debated 1.
- Avoiding the use of decongestants, antihistamines, and systemic steroids due to their lack of efficacy or potential for adverse effects 1.
- Considering the use of autoinflation devices like Otovent, which have shown promise in clearing middle ear effusion and improving ear symptoms 1.
For children with persistent OME and documented hearing difficulties after 3 months, ventilation tubes are an option, with adenoidectomy considered in children ≥4 years of age 1. The decision to proceed with surgical interventions should be made on a case-by-case basis, taking into account the individual child's risk factors for speech, language, or learning problems, as well as the potential benefits and risks of the procedure.
In the context of real-life clinical medicine, it is crucial to prioritize a conservative approach, focusing on watchful waiting and addressing underlying causes, before progressing to more invasive treatments 1. This approach minimizes the risk of unnecessary interventions and their potential complications, aligning with the principles of minimizing morbidity, mortality, and maximizing quality of life.
From the Research
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 2.
- Index tests, including two patient reported outcome measures (PROMs) and 14 tests of ET opening, can be used to diagnose obstructive and patulous forms of ETD 3.
- The latent class model suggested tympanometry, sonotubometry, and tubomanometry have the best diagnostic performance for obstructive ETD 3.
Treatment of Eustachian Tube Dysfunction
- Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter 2.
- The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated 2.
- Eustachian balloon tuboplasty is a safe and efficacious treatment for chronic ETD, with a low adverse event rate of 3% 4.
- Conventional tympanostomy and myringotomy, along with more novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty, can be used to treat ETD 5.
Role of Allergy in Eustachian Tube Dysfunction
- There is a positive association between allergic rhinitis (AR) and ETD, but not all patients with ETD suffer from AR, and vice versa 6.
- The use of medications that can decrease intranasal inflammation, such as intranasal corticosteroids or oral antihistamines, does not result in significant symptomatic improvement in patients with ETD 6.
- Further research is necessary to understand the mechanism behind the positive association between AR and ETD, and to elucidate the cause of chronic ETD in patients without associated allergies 6.