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For further information, see CMDT Part 8-04: Diseases of the Eustachian Tube

Key Features

Essentials of Diagnosis

  • Blocked eustachian tube remains for a prolonged period

  • Resultant negative pressure will cause transudation of fluid

General Considerations

  • Especially common in children because their eustachian tubes are narrower and more horizontal in orientation than in adults

  • Less common in adults, in whom it usually occurs

    • After an upper respiratory tract infection

    • With barotrauma

    • With chronic allergic rhinitis

  • In an adult with persistent unilateral serous otitis media, nasopharyngeal carcinoma must be excluded

Clinical Findings

  • Tympanic membrane is dull and hypomobile

  • Occasionally accompanied by air bubbles in the middle ear and conductive hearing loss

Diagnosis

  • Clinical

Treatment

Medications

  • Short course oral corticosteroids (eg, prednisone, 40 mg daily orally for 7 days)

  • Oral antibiotics (eg, amoxicillin, 250 mg three times daily for 7 days)

  • Combination of oral corticosteroids and antibiotics

  • The role of these regimens remains controversial; they are probably of little lasting benefit

Surgery

  • When medication fails to bring relief after several months, a ventilating tube placed through the tympanic membrane may restore hearing and alleviate the sense of aural fullness

Therapeutic Procedures

  • Endoscopically guided laser expansion of the nasopharyngeal orifice of the eustachian tube or balloon dilation may improve function in recalcitrant cases

Outcome

When to Refer

  • For persistent or recurrent symptoms

References

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Huisman  JML  et al. Treatment of eustachian tube dysfunction with balloon dilation: a systematic review. Laryngoscope. 2018 Jan;128(1):237–47.
[PubMed: 28799657]
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Roditi  RE  et al. Otitis media with effusion: our national practice. Otolaryngol Head Neck Surg. 2017 Aug;157(2):171–2.
[PubMed: 28535139]
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Vanneste  P  et al. Otitis media with effusion in children: pathophysiology, diagnosis, and treatment. A review. J Otol. 2019 Jun;14(2):33–9.
[PubMed: 31223299]

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