By Marcello Cherchi, MD PhD
For patients
Some patients who feel “stuffiness” in the ears may use nasal sprays that have fluticasone or azelastine in them.
For clinicians
Overview
Fluticasone and azelastine nasal sprays can diminish inflammation in the nasopharynx, and sometimes promote Eustachian tube patency.
Pharmacology
Fluticasone and azelastine have anti-inflammatory effects, but through different mechanisms of action: fluticasone is a corticosteroid, and azelastine is an anti-histamine.
Adverse effects
Since fluticasone is a corticosteroid, frequent or long-term use increases the risk of infection (often oral thrush). Since fluticasone has anti-histaminic effects, frequent or long-term use increases the risk of drying out the nasal mucosa and lead to nosebleeds.
Cautions and contraindications
Fluticasone and azelastine nasal sprays are intended to be delivered to the nasopharynx. They are not intended to be inhaled into the lungs.
Relevance in otoneurology
When delivered by an intranasal spray, these medications sometimes diminish swelling in the nasopharynx, and can promote patency of the Eustachian tube. The studies of fluticasone alone (Crowson et al. 2017) or in combination with azelastine (Bilgili et al. 2023) were done in pediatric patients, but many practitioners extrapolate the conclusions of these studies to adults in the treatment of Eustachian tube dysfunction.
Other notes
Fluticasone nasal spray is available in the United States over-the-counter. Azelastine nasal spray, and the combination of azelastine and fluticasone, require prescriptions.
References
Bilgili AM, Durmaz HO, Dilber M (2023) Eustachian Tube Dysfunction in Children with Adenoid Hypertrophy: The Effect of Intranasal Azelastine-Fluticasone Spray Treatment on Middle Ear Ventilation and Adenoid Tissue. Ear Nose Throat J 102: 198-203. doi: 10.1177/01455613221140281
Crowson MG, Ryan MA, Ramprasad VH, Choi KJ, Raynor E (2017) Intranasal fluticasone associated with delayed tympanostomy tube placement in children with eustachian tube dysfunction. Int J Pediatr Otorhinolaryngol 94: 121-126. doi: 10.1016/j.ijporl.2017.01.023
