Nasal Decongestants Improve Nasal Airflow, but Not Eustachian Tube Function

Do topical nasal decongestants really improve Eustachian tube function?

Bottom Line
Nasal decongestants as a single treatment modality certainly improve nasal airflow, but objective data supporting improved Eustachian tube function is lacking.

Background: Commonly accepted clinical practice includes using nasal decongestant spray to alleviate, or prevent, Eustachian tube dysfunction associated with airline flights. Also, spray nasal decongestants are frequently recommended for acute otitis media or serous otitis media, especially if the condition is associated with an upper respiratory tract infection.

Study design: Prospective, non-randomized study.

Setting: Tertiary referral center in Germany.

Synopsis: Xylometazoline (very similar to oxymetazoline in the U.S.) was used as a nasal spray in patients with an intact tympanic membrane, with pre- and post-treatment (15 minutes) rhinomanometry and tube manometry measures. Patients with a perforated tympanic membrane were also assessed, with nasal spray delivery as well as direct application of the decongestant through the tympanic membrane perforation into the middle ear. None of the patients showed any significant improvement in opening of the Eustachian tube. The authors recognize that the 15-minute interval between applying the decongestant and measuring Eustachian tube function may not assess longer interval potential effectiveness.

Reference: Ovari A, Buhr A, Warkentin M, Kundt G, Ehrt K, Pau HW. Can nasal decongestants improve Eustachian tube function? Otol Neurotol. 2015;36:65–69.