Correct Use of Nasal Sprays for Eustachian Tube Dysfunction

by , last modified on 8/10/21.

Assuming you thoroughly understand what eustachian tube dysfunction is, the question now becomes how does one use nasal sprays to correctly treat this disorder. Of note, fluid in the middle ears is treated the same way.

Obviously, ear drops will not work because the eardrum prevents anything administered through the ear canal from getting to the eustachian tube which is located BEHIND the eardrum.


Image is a modification of that found in Wikipedia under GNU Free Documentation License.

Therefore, the only way medication can be delivered directly to the eustachian tube is through the nose where the other end of the eustachian tube is located (eustachian tube goes from your ear to the back of your nose).

That's why when you yawn, swallow, chew, or blow your nose, you can (normally) hear a "pop" in your ears. The "pop" is the eustachian tube opening up.

To see what an actual eustachian tube looks like in the nose, here is a video (the eustachian tube can be seen 1 minute into the video). Here's another video showing an animation of how the eustachian tube works.


Image is a modification of that found in Wikipedia under GNU Free Documentation License.

SO, when one uses a nasal spray as prescribed by your physician (steroid and/or anti-histamine nasal sprays and/or Afrin), it needs to be directed towards the eustachian tube... the spray angle is perpendicular to the face (the nozzle needs to be pointed toward your neck/ear).

One sniffs as one sprays just hard enough so one can feel it in the back of the nose, but not so hard that it goes straight down into your mouth. After spray use and hourly while awake, try to pop the ear by pinching the nose and blowing gently. This milks the spray into the eustachian tube.

Because spray bottles use a straw, one needs to bend the head down so you are looking down at the floor when you use the spray.

nasal spray

spray angle

CORRECT spray angle. Image is a modification of that found in Wikipedia under GNU Free Documentation License.

DO NOT use the spray the way most people automatically assume which is with the spray nozzle directed to the top of the head. This is incorrect and the spray will help your sinuses... but not your ears.

nasal spray

spray angle

INCORRECT spray angle. Image is a modification of that found in Wikipedia under GNU Free Documentation License.

hearing test

There are other techniques to try and get the medication to where the eustachian tube is located, but are more uncomfortable even though they do seem to work better. If you want to try these other methods of administering medications, click here.

afrin nasal spray

It may take up to 4 weeks for the ears to start feeling normal. One must also try to pop the ears immediately after nasal spray use and every hour while awake throughout this period of time. When one tries to pop the ears, try to blow out your nose with your nose pinched shut with your fingers. Popping the ears in this manner, esp after nasal spray use helps to squeeze some of the medication into the eustachian tube. Do not exceed the pressure one uses as if you have mild constipation. Swallowing or yawning does not work as well in this situation.

As a reminder, though a decongestant spray like Afrin is VERY helpful to resolve eustachian tube dysfunction, do NOT use this spray daily for more than 3 days as people do get addicted to this medication (a condition known as rhinitis medicamentosa). Steroid and anti-histamine nasal sprays can be used indefinitely.

For young children (or even some adults) who just have trouble popping their ears, there are some devices that one can buy over-the-counter that try to pop the ears for you. A few such devices (like the Otovent) are shown here.

Watch a video showing a 3 years old using an Otovent device or the EarPopper here. Whereas the Otovent essentially mimics only the valsalva maneuver (trying to blow air out the nose while pinched shut), the Earpopper simultaneously mimics the valsalva AND physically increases the eustachian tube diameter with swallow (muscles pull the eustachian tube open).

If this method fails, your physician may give a trial of singulair and prednisone and if that fails, placement of tubes is often helpful.

Want to read more about eustachian tube dysfunction? Read FAQ here.

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