From the Guidelines
Management of eustachian tube dysfunction primarily involves watchful waiting for 3 months, as most cases resolve spontaneously, and avoiding unnecessary medical treatments such as steroids, antihistamines, and decongestants, which are ineffective or may cause adverse effects 1.
Initial Management
Initial treatment includes:
- Nasal saline irrigation
- Nasal steroid sprays like fluticasone (2 sprays per nostril daily) or mometasone
- Patients should perform Valsalva maneuvers (pinching the nose and blowing gently with closed mouth) or use the Toynbee maneuver (swallowing while pinching the nose) several times daily to help equalize pressure
- For allergic causes, antihistamines like cetirizine (10mg daily) or loratadine may help
Referral to ENT Specialist
If symptoms persist beyond 4-6 weeks or recur frequently, referral to an ENT specialist is warranted. They may recommend:
- Eustachian tube balloon dilation
- Tympanostomy tube placement
- Other interventions
Lifestyle Modifications
Patients should:
- Avoid smoking
- Manage allergies
- Treat underlying conditions like sinusitis or GERD that can contribute to dysfunction
Goal of Treatment
The goal of treatment is to restore normal eustachian tube function, which equalizes middle ear pressure and allows proper drainage, thereby preventing complications like hearing loss, tinnitus, or chronic otitis media. Surgical options, such as tympanostomy tube insertion, may be considered in children with persistent otitis media with effusion (OME) and hearing difficulties, or in those who are at risk for speech, language, or learning problems 1.
From the Research
Management of Eustachian Tube Dysfunction
The management of Eustachian tube dysfunction involves various therapeutic and surgical options.
- 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 the condition 2.
- 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.
Diagnostic Tools
Several diagnostic tools are available to assess Eustachian tube function, including:
- The Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy 3.
- The ETS-7 questionnaire 3.
- Sonotubometry, nine-step test inflation/deflation, continuous impedance, patient-reported opening, observed tympanic membrane movement, and Tubo-tympano-aerodynamic-graphy 4.
Treatment Options
Various treatment options are available for Eustachian tube dysfunction, including:
- Conventional tympanostomy and myringotomy 3.
- Novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty 3.
- Middle ear inflation devices, such as the Ear Popper 5.
Eustachian Tube Function Tests
Studies have evaluated the effectiveness of different tests for assessing Eustachian tube function, including:
- The Valsalva maneuver, sniff test, and Toynbee maneuver 6.
- The nine-step inflation deflation test 5.
- Sonotubometry and the nine-step test 4.
Middle Ear Pressure Equalization Techniques
Research has compared the efficiency of middle ear pressure equalization techniques, including: