What is the treatment for Eustachian (auditory) tube dysfunction?

From the Guidelines

Treatment for Eustachian tube dysfunction should start with watchful waiting for 3 months, as recommended by current guidelines 1, and may include self-care measures such as nasal saline sprays, decongestants, and nasal steroid sprays to reduce inflammation. For patients with persistent Eustachian tube dysfunction, the following options can be considered:

• Nasal balloon auto-inflation, which has been shown to be effective in clearing middle ear effusion and improving ear symptoms in school-aged children 1
• Tympanostomy tube placement, which is an option for children with otitis media with effusion (OME) who still have documented hearing difficulties after 3 months 1
• Adenoidectomy, which may be beneficial in children with OME aged 4 years or older, either as a standalone operation or as an adjunct to tube insertion 1 It is essential to note that the management of Eustachian tube dysfunction should be individualized, taking into account the patient's age, symptoms, and underlying medical conditions. Some key points to consider when managing Eustachian tube dysfunction include:
• The importance of watchful waiting for 3 months before considering further intervention 1
• The potential benefits and risks of different treatment options, such as tympanostomy tube placement and adenoidectomy 1
• The need for ongoing monitoring and follow-up to assess the effectiveness of treatment and adjust the management plan as needed 1

From the Research

Treatment Options for Eustachian Tube Dysfunction

• The treatment of Eustachian tube dysfunction can vary depending on the cause and severity of the condition, as noted in studies 2, 3, 4.
• For obstructive tube dysfunction, treatment options include:
  • Steroid nasal sprays
  • Regular performance of the Valsalva maneuver
  • Tube dilation with the Bielefelder balloon catheter, as mentioned in 2
• For patulous Eustachian tube, treatment options include:
  • Saline nasal irrigation
  • Estrogen-nasal ointment
  • Craniocervical manual therapy, as noted in 2
• Other treatment options that have been explored include:
  • Intranasal corticosteroids (INCS)
  • Politzer devices
  • Valsalva therapy, as discussed in 4
  • Microwave ablation
  • Laser eustachian tuboplasty
  • Balloon eustachian tuboplasty, as mentioned in 3

Efficacy of Treatment Options

• A systematic review and meta-analysis found that medical management for Eustachian tube dysfunction in adults resulted in symptomatic improvement in 50.3% of patients, as noted in 4.
• The same study found that ETDQ-7 scores improved in a clinically nonsignificant manner following medical treatment.
• INCS were found to be ineffective for chronic symptoms, improving only 11% to 18% of cases, as reported in 4.
• Further research is needed to determine the efficacy of single-agent medical therapies for Eustachian tube dysfunction, as noted in 4.