Eustachian tube dysfunction

Presents with fullness in the ear, sometimes reduced hearing, sometimes hearing a clicking sound on swallowing. It can be triggered by rhinosinusitis (viral or allergic), by adenoidal enlargement (much commoner in children than in adults) or, extremely rarely, by nasopharyngeal carcinoma. The latter means that persistent unilateral cases should be seen by an ENT surgeon.

Examination may show a retracted tympanic membrane, or sometimes an effusion if severe, but may also be normal. The main purpose of examination is to look for other causes for the symptoms.

A third of patients in a recent study had improved spontaneously at six-month follow-up, so watch-and-wait is a perfectly good option if patient OK with it.

There is good evidence for the use of OTC auto-inflation devices (used to apply positive pressure through the nose during swallowing) 2 – 3 times daily for at least two weeks. These include Otovent and Ear Popper.

There is no evidence one way or the other for the use of intranasal preparations.

Resistant cases can be treated with grommets, or possibly with balloon dilatation of the Eustachian tube, which is a new treatment but looks promising in terms of success/low risk.

(BMJ 2014;348:g1647)


About Dr Sarah

I'm a GP with a husband and two young children.
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