Intranasal Corticosteroids Treatment Shown Ineffective for Chronic Eustachian Tube Dysfunction

by Linda Kossoff •

How do current available medical treatments for Eustachian tube dysfunction (ETD) compare in efficacy according to existing literature?

BOTTOM LINE

Most patients with chronic ETD fail intranasal corticosteroid (INCS) treatment, and benefits of medical therapy for subacute ETD are indeterminate. 

BACKGROUND: Eustachian tube dysfunction is a common otolaryngological complaint, and obstructive ETD is the most common of these ailments. Treatment for ETD begins with medical management (MM), typically INCS and nasal decongestants, but no single nonsurgical treatment has proven significantly more efficacious than others in treating adult patients with ETD. 

STUDY DESIGN: Systematic review. 

SETTING: Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C. 

SYNOPSIS: Researchers conducted a literature review for studies on adults >16 years old treated medically for ETD. Twelve articles published between 1993 and 2020 were selected for review. A total of 625 patients (mean age 46.5 years) were examined, involving 802 ears. Therapies evaluated included INCS, oral decongestants, antihistamines, Valsalva therapy, Politzer device, Buteyko breathing techniques, nitric oxide gas, and a combination of multiple therapies. MM led to improvement of symptoms in 30% to 64% of subacute cases and 11% to 50% of chronic cases. Intranasal corticosteroids were effective for symptomatic improvement in only 11% to 18% of patients with chronic ETD symptoms, though in one small study, combination therapy of INCS and Buteyko breathing was more efficacious than INCS alone. Alternative therapies such as Politzer devices and Valsalva therapy yielded minimally beneficial results. Among patients with subacute ETD, INCS showed improvement in 42% to 56% of cases, but patients received antihistamines and oral decongestants, obscuring the role of INCS. Researchers concluded that the benefits of MM for subacute ETD are indeterminate. Study limitations included reliance on data collected secondhand from published articles. 

CITATION: Mehta NK, Ma C, Nguyen SA, et al. Medical management for Eustachian tube dysfunction in adults: a systematic review and meta-analysis. Laryngoscope. 2022;132:849-856.