From the Guidelines
Treatment of obstructive Eustachian tube dysfunction should begin with a 3-month period of watchful waiting, as recommended by current guidelines 1. This approach is based on the fact that many cases of otitis media with effusion (OME) settle spontaneously within several months. During this period, the patient should be monitored for any changes in symptoms or hearing loss.
- Initial treatment may include nasal saline irrigation and nasal steroid sprays such as fluticasone or mometasone for 4-6 weeks to reduce inflammation.
- Oral decongestants like pseudoephedrine may provide short-term relief but should be limited to 3-5 days to avoid rebound congestion.
- The Valsalva maneuver or the Toynbee maneuver can be performed several times daily to help equalize pressure. If medical management fails after 3 months, procedural interventions like myringotomy with tympanostomy tube placement may be necessary to provide immediate pressure equalization and symptom relief, especially in cases associated with middle ear effusion 1.
- Tympanostomy tubes are recommended for initial surgery because randomized trials show a mean 62% relative decrease in effusion prevalence and an absolute decrease of 128 effusion days per child during the next year 1.
- Adenoidectomy is not recommended for initial OME surgery unless a distinct indication exists, such as adenoiditis, postnasal obstruction, or chronic sinusitis 1. It is essential to individualize the recommendation for surgery based on consensus between the primary care physician, otolaryngologist, and parent or caregiver that a particular child would benefit from intervention 1.
From the Research
Treatment Options for Obstructive Eustachian Tube Dysfunction
- Treatment of obstructive Eustachian tube dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter 2
- Balloon Eustachian tuboplasty (BET) is a surgical, minimally invasive treatment that has shown its effectiveness and safety in obstructive Eustachian tube dysfunction in adults and children 3
- Indications for BET include barotrauma, serous otitis media, adhesive otitis, atelectatic middle ear and failure after tympanoplasty, once obstructive Eustachian tube dysfunction is confirmed 3
- BET is more effective in barotrauma and serous otitis media, with high-evidence reports showing good results that persist long-term, as compared to conservative medical treatment 3
Effectiveness of Nasal Decongestants
- Nasal decongestants have no significant effect on Eustachian tube opening in most cases, with improvement in tube opening being rather an exception 4
- Topical nasal decongestants, such as xylometazoline, do not significantly improve Eustachian tube function, although sonotubometry data suggest a significant increase in the duration of Eustachian tube opening following decongestant application 5
- There remains little or no evidence that topical nasal decongestants improve Eustachian tube function, with further investigation warranted in patients with obstructive Eustachian tube dysfunction 5
Diagnostic Tools and Questionnaires
- 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
- Other diagnostic tools include tympanometry, pressure chamber test, and video nasopharyngoscopy, as well as the Valsalva maneuver and Toynbee maneuver 6
- The ETS-7 questionnaire is also used to diagnose and alleviate Eustachian tube dysfunction 6