definition: Failed pressure equalization via the eustachian tube, typically at its valve-like opening in the nasopharynx
Drum often pushed in, tense, dysfunctional
Causes – anything that irritates mucus lining
URTI
Allergic rhinitis
Enlarged adenoids
Environmental irritants (e.g. Tobacco smoke)
Gastroesophageal Reflux
Pregnancy (esp. third trimester)
Conditions affecting ciliary function (e.g. primary ciliary Dyskinesia)
Mass lesions
Adenoid hypertrophy
Nasopharyngeal carcinoma
Symptoms
Sense of ear fullness or plugging of the affected ear
Muffled Hearing
Valsalva does not clear ear discomfort (and may cause pain)
Tinnitus or crackling Sensation in the affected ear
Vertigo or sense of Dysequilibrium
occasionally pain
popping noises
Treatment
Usually nothing
Watchful waiting for spontaneous resolution over time is consistently effective
Clear snuffling nose – steam inhalations
Auto insufflation with Valsalva
Patient may gently clear eustachian tubes as done by scuba divers
Hold nose and blow against a closed mouth
Systemic decongestants
pseudoephedrine or phenylephrine may be helpful for congestive symptoms
Systemic or topical decongestants are not effective in cases of otitis media with effusion
Topical nasal decongestant sprays or drops may be used on a limited basis (generally three days or less) for symptomatic relief of nasal congestion or rhinitis, with or without ear blockage symptoms
Topical decongestants
may also be helpful for difficulty clearing the ears during flights and scuba diving. Patients should be counselled not to exceed three days of nasal decongestant treatment, in order to avoid nasal mucosal dependency and rhinitis medicamentosa.