GENERAL MEASURES:
β’ Perform Valsalva method of eustachian tube auto inflation(patient occludes nose with thumb and index finger pressure on nasal alae, then carefully exhales with mouth closed until ears pop). This will equalize pressures, relieve pain, and restore hearing. This usually needs to be repeated several times during descent or ascent.
β’ Nasal decongestant spray with repeated applications may help
β’ Recent studies demonstrate that oral decongestants in adults taken 30-60 minutes prior to exposure is superior to decongestant sprays
β’ Antihistamines
β’ If the suggested maneuvers are unsuccessful return to baseline altitude if possible, repeat Valsalva and gradually resume ascent/descent
β’ If ear block occurs, then outpatient politzerization must be performed followed by systemic and oral decongestants
β’ If associated infection, treat with appropriate antibiotics
SURGICAL MEASURES:
β’ Myringotomy, if necessary
ACTIVITY:
β’ No flying or diving until complete resolution of all signs and symptoms and Valsalva maneuver can be
performed
β’ In severe cases, bedrest
DRUG(S) OF CHOICE:
. Decongestants (topical decongestants have minimal beneficial effects whereas oral decongestants are
effective in adults)
. Pseudoephedrine (Sudafed 12-hour, Afrinol) 120 mg q12h po. Start 30-60 minutes prior to exposure.
. 0.05% oxymetazoline (Afrin, Afrin 12-Hour) two initial sprays 5 minutes apart then q12h
. 0.05% phenylephrine (Neo-Synephrine) two initial sprays 5 minutes apart then q12h
. Antihistamines for allergic component
. Diphenhydramine (Benadryl) 25-50 mg q6h
. Loratadine (Claritin) 10 mg qday
. Fexofenadine (Allegra) 60 mg bid (60 mg qday in patients with decreased renal function)
PATIENT MONITORING:
β’ Otoscopic until symptoms clear
β’ In severe cases, audiograms
PREVENTION/AVOIDANCE:
β’ Avoid altitude changes with any risk factors for eustachian tube dysfunction
β’ Chewing gum while fl ying especially for children
β’ Use of recommended medications before the activity
POSSIBLE COMPLICATIONS:
β’ Permanent hearing loss
β’ Ruptured tympanic membranes
β’ Serous otitis media
β’ Chronic tinnitus, vertigo
EXPECTED COURSE/PROGNOSIS:
β’ Ear block - hours to days with complete resolution and return to fl ight or diving within days to weeks
β’ Tympanic rupture - recovery within weeks to months