Managing Eustachian Tube Dysfunction: Steroid Use and Side Effects

Eustachian tube dysfunction treated with corticosteroids?

Dear Director Zheng,
I experienced symptoms of Eustachian tube dysfunction in my left ear suddenly in January of this year.
Although my hearing is normal, every time I drink water or swallow, I hear a "pop, pop" sound in my right ear during the swallowing motion.
I have consulted many doctors and even took two types of antibiotics, but they were ineffective, and the "pop, pop" sound has actually become louder.
In March, I started to have clear nasal discharge from my left nostril, and after examination, the doctor diagnosed me with allergic rhinitis.
After taking antihistamines and steroids for two weeks, my nasal allergy and Eustachian tube issues improved significantly, but I have not fully recovered.
While I was on steroids, I also took gastrointestinal medication, but I still experienced gastroesophageal reflux leading to throat inflammation, causing frequent coughing that made it difficult to sleep.
Currently, I have stopped taking steroids for about a week, and the "pop, pop" sound in my ear initially decreased after treatment but has now started to become louder again (I am very worried that the previous treatment may have been in vain).
I understand that long-term use of steroids can have significant side effects on the body.
However, I really want to continue taking steroids to completely resolve my Eustachian tube dysfunction, but I am concerned about my stomach's tolerance.
Therefore, I would like to ask you the following questions:
1.
I have already taken steroids for two weeks.
Given my current condition of gastroesophageal reflux, can I continue taking steroids?
2.
After taking steroids, I have experienced knee pain.
I have previously been tested for bone density and have osteoporosis.
Given my current stomach condition, can I take calcium citrate? If so, when is the best time to take it?
3.
If my Eustachian tube dysfunction heals after taking steroids, will it relapse after stopping the medication?
4.
If my nasal allergies have been treated but the Eustachian tube dysfunction persists, could it be due to inflammation of the ear nerves?
Thank you very much for taking the time to respond to my questions despite your busy schedule.
I wish you peace and good health!
Sincerely,
Doctor Q&A Teams

Xue Xiaojie, 40~49 year old female. Ask Date: 2018/04/30

Dr. Zheng Jueyi reply Otolaryngology

Hello, if eustachian tube dysfunction is caused by nasal allergies, long-term oral steroids are not recommended.
It is advisable to switch to intranasal steroid sprays for management, as nasal sprays can be used long-term and help avoid gastrointestinal discomfort, osteoporosis, and other issues.
There are many causes of eustachian tube dysfunction, and if there are other concerns, further medical evaluation is necessary.
Generally, it is not significantly related to ear nerve inflammation.
Wishing you peace and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/04/30

More Info

Managing Eustachian Tube Dysfunction (ETD) can be quite challenging, especially when considering the use of steroids and their potential side effects. Your experience with the "pop" sound in your ear during swallowing, alongside the development of allergic rhinitis, indicates a complex interplay between your Eustachian tube function and nasal health. Let's address your questions one by one.

1. Continuation of Steroid Use with GERD: Given your history of gastroesophageal reflux disease (GERD), it is crucial to approach the use of steroids cautiously. Corticosteroids can exacerbate GERD symptoms, leading to increased acid reflux and potential esophageal irritation. If your ENT specialist prescribed steroids to manage your ETD, it may be beneficial to discuss alternative treatments or adjunct therapies that could mitigate the reflux while still addressing the Eustachian tube dysfunction. Options may include using a lower dose of steroids, switching to a different class of medications, or implementing lifestyle changes to manage GERD symptoms more effectively.

2. Calcium Citrate Supplementation: Since you have a history of osteoporosis and are experiencing knee pain, calcium citrate can be a suitable option for supplementation. Calcium citrate is generally well-tolerated and can be taken with or without food, making it a good choice for individuals with gastrointestinal issues. It is advisable to take calcium supplements in divided doses throughout the day to enhance absorption. However, it is essential to consult your healthcare provider before starting any new supplement, especially considering your current medications and health conditions.

3. Recurrence of ETD After Steroid Discontinuation: The recurrence of Eustachian tube dysfunction after stopping steroids can vary from person to person. While steroids can reduce inflammation and improve Eustachian tube function, the underlying causes of ETD—such as allergies, infections, or anatomical issues—may still persist. If your symptoms improve with steroid use, it is possible that they could return after discontinuation. Long-term management strategies, including allergy treatments, nasal saline irrigation, or even surgical options in severe cases, may be necessary to prevent recurrence.

4. Persistent ETD and Possible Nerve Inflammation: If your nasal allergies have improved but ETD persists, it may not necessarily be due to nerve inflammation. Eustachian tube dysfunction can result from various factors, including residual inflammation, mucosal edema, or even mechanical obstruction. It is important to have a thorough evaluation by an ENT specialist to determine the exact cause of your ongoing symptoms. In some cases, further imaging studies or audiometric tests may be warranted to assess the function of the Eustachian tube and the overall health of the ear.

In conclusion, managing Eustachian tube dysfunction, especially in the context of allergies and GERD, requires a comprehensive approach. It is essential to maintain open communication with your healthcare providers, including your ENT specialist and primary care physician, to tailor a treatment plan that addresses your specific symptoms while minimizing potential side effects. Lifestyle modifications, careful medication management, and possibly additional therapies may be necessary to achieve optimal results. Always prioritize your health and well-being, and do not hesitate to seek further medical advice if your symptoms persist or worsen.

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