What are the treatment guidelines for Eustachian (auditory) tube dysfunction?

From the Guidelines

Treatment for Eustachian tube dysfunction (ETD) should begin with conservative approaches, including nasal saline irrigation, nasal steroid sprays, and oral decongestants, with procedural interventions like eustachian tube balloon dilation or tympanostomy tube placement considered for refractory cases. The management of ETD is primarily aimed at alleviating or restoring hearing and middle ear function. According to the most recent guidelines 1, clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months’ duration.

Initial Management

• Nasal saline irrigation to help moisturize the nasal passages and promote drainage
• Nasal steroid sprays like fluticasone (2 sprays per nostril daily) or mometasone to reduce inflammation
• Oral decongestants such as pseudoephedrine (30-60mg every 4-6 hours for no more than 3-5 days) to relieve congestion
• Antihistamines like cetirizine (10mg daily) for allergic causes
• Valsalva maneuvers or the Toynbee maneuver several times daily to help equalize pressure

Procedural Interventions

For refractory cases, procedural interventions may be considered, including:

• Eustachian tube balloon dilation to improve tube function
• Tympanostomy tube placement to restore middle ear ventilation and drainage

Surveillance and Follow-Up

Clinicians should reevaluate children with chronic OME at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected 1. The goal of treatment is to restore normal eustachian tube function, which is essential for middle ear ventilation, drainage, and protection from nasopharyngeal secretions, thereby improving hearing and quality of life. Patients should avoid altitude changes when possible and consider using specialized earplugs for flying that help regulate pressure changes gradually.

Special Considerations

Children with recurrent acute otitis media (AOM) or with OME of any duration should be assessed for increased risk of speech, language, or learning problems due to baseline sensory, physical, cognitive, or behavioral factors 1. The decision to proceed with tympanostomy tube insertion should be based on the presence of documented hearing difficulties and the duration of OME, among other factors.

From the Research

Treatment Guidelines for Eustachian Tube Dysfunction

• The treatment of Eustachian tube dysfunction (ETD) may involve the use of nasal decongestants, although studies have shown that these may not be effective in improving Eustachian tube function 2.
• Steroid nasal sprays and regular performance of the Valsalva maneuver may be used to treat obstructive dysfunction, while tube dilation with the Bielefelder balloon catheter may also be an option 3.
• For patulous Eustachian tube, treatment may include saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy 3.
• The use of medications such as intranasal corticosteroids or oral antihistamines may not result in significant symptomatic improvement in patients with ETD, although these may be beneficial in patients with concurrent allergic rhinitis (AR) and ETD 4.
• Surgical interventions such as conventional tympanostomy and myringotomy, as well as novel techniques like microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty, may be used to manipulate the condition 5.

Diagnostic Tools

• The Eustachian tube score (ETS-5) and ETS-7 score may be used to diagnose ETD in patients with perforated or intact ear drums, respectively 3.
• Other diagnostic tools include the Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy 5.

Pathophysiology and Associated Conditions

• ETD may be related to functional obstruction or nasal cavity and nasopharyngeal inflammation, with allergic rhinitis being a potential contributing factor 4.
• Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children 3.
• The incidence of ETD is approximately 1% in adults and 40% in children 3.