Approach
Often Eustachian tube dysfunction (ETD) symptoms are mild and do not persist beyond a few days. In patients whose symptoms continue without an obvious underlying cause (e.g., allergic rhinitis), further investigations into Eustachian tube obstruction, trauma, and chronic otological complications can be done. There is insufficient evidence to recommend a trial of any particular intervention, and continued research is necessary.[29]
Initial treatment
Intranasal corticosteroids are given to minimise oedema and inflammation at the Eustachian tube orifice. The treatment may be given at any time after clinical presentation. This approach has been examined by various authors. It has been indirectly inferred that ETD is ameliorated by demonstrating that intranasal corticosteroids improve chronic middle ear effusion.[30] However, some authors have not found intranasal corticosteroids to have a significant effect on ETD.[31][32] The risks or significant complications associated with intranasal corticosteroid use are epistaxis and septal perforation. Corticosteroids have not been experimentally proven to improve ETD in the absence of co-existing inflammatory disease states. However, given the favourable safety profile of these medications, an empiric trial may be considered.
Numerous studies have shown both decongestants and antihistamines to be ineffective in treatment of ETD.[33]
Surgery
If intranasal corticosteroids do not prove successful, then a variety of surgical options may be considered, some dictated by the patient's particular pathology. Surgical treatment is given to relieve obstruction of the Eustachian tube orifice or to repair trauma. Treatment is given when pathology is identified.
Adenoidectomy is given for patients with adenoid hypertrophy and serous effusion.
Surgery for an obstructing nasopharyngeal neoplasm will depend on concurrent radiotherapy and chemotherapy, and on the patient's response to those treatments.
Risks of surgery in the area include: bleeding, scarring of the nasopharynx, and persistent ETD.
Pressure equalisation tubes
For a patient with evidence of retraction of the tympanic membrane, insertion of a pressure equalisation tube in the membrane may be beneficial.
This treatment is most often utilised in patients with chronic otological complications of ETD, including chronic otitis media, serous otitis media, and retraction of the tympanic membrane. The tubes are designed to alleviate the negative pressure differential between the middle ear space and the atmosphere. There is no set time course for placement of pressure equalisation tubes, although usually a trial of medical therapy - such as antibiotics, and perhaps intranasal corticosteroids - will have occurred first.
The risks associated with tube placement include infection, persistent tympanic membrane perforation, and hearing loss. Tubes typically extrude after 3 to 6 months. There are tubes designed to be utilised for longer durations, but these are associated with their own set of potential problems, including granulation tissue and clogging.
Approach for patulous Eustachian tubes
This condition is often associated with patients who have recently lost significant amounts of weight. Hearing impairment may only improve with supine position or leaning the head forwards. There is no medical treatment. Several surgical therapies have been proposed for the management of patulous Eustachian tube, but none has been shown to be reliably effective.[34][35]
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