Acute Eustacian Tube Dysfunction Treatment Regimen
Typically, acute Eustachian tube dysfunction arises after an upper respiratory tract infection or atmospheric pressure changes, such as flying or driving through mountains.
An adult with unilateral serous otitis media (otitis media with effusion) that persists beyond about six weeks is generally recommended to undergo nasopharyngoscopy to rule out nasopharyngeal carcinoma or other anatomic cause. Long-term bilateral eustachian tube dysfunction may require surgical intervention, such as tympanostomy tube placement or more involved surgery.
The following measures are additive and may be undertaken simultaneously, barring patient-specific contraindications:
Oxymetazoline (Afrin) Over-the-counter, no prescription needed.
Apply two sprays to each nostril twice a day for three days. Then stop!
Fluticasone (Flonase), or equivalent. Available with or without a prescription. Use whichever option is cheaper.
Apply two sprays to each nostril once a day for one month. The direction of the spray should be slightly outwards and slightly upwards so that the spray aims toward the right ear from the right nostril and toward the left ear from the left nostril.
Steroid taper. Methylprednisolone (Medrol) Dosepak.
I recommend my patients take each day's full dose in the morning with food for six days. Each day, the dose will be smaller than the previous day.
Omeprazole (Prilosec) 20 mg daily. Available with or without a prescription. Use whichever option is cheaper.
The best time to take this is on an empty stomach and an hour before a meal. Take this one time per day for 30 days.
Autoinsufflation of the ears (“popping” the ears)
Manage sinusitis or pharyngitis (including tonsillitis and adenoiditis), if present.
In the case of middle ear infection (otitis media), which is usually associated with pain and an erythematous tympanic membrane, an antimicrobial is typically warranted. Treating for Eustachian tube dysfunction, as above, will help address the predisposing pathophysiology.
Note: Be sure to differentiate an acute hearing loss from the outer and middle ear (conductive hearing loss) from an acute inner ear hearing loss (sudden sensorineural hearing loss). Weber and Rinne tuning fork tests can be useful in making this differentiation. Sudden sensorineural hearing loss is managed very differently, and in a time-sensitive manner.