Allergic rhinitis (AR) leads not only to significant nasal obstruction and ocular symptoms but also, by affecting the entire respiratory epithelium, causes combined damage to the Eustachian tube and middle ear, resulting in exudative otitis media (EOM). To evaluate the clinical features of EOM of allergic origin and to compare treatment regimens targeting allergic inflammation — with the goal of restoring Eustachian tube function and middle ear drainage — 329 patients with confirmed allergic rhinitis were examined. Following otorhinolaryngological and audiological evaluations, pathology of the middle ear and Eustachian tube was identified in 51% of cases (168 individuals). Interestingly, 16% of these patients subjectively reported no hearing loss or sensation of ear fullness, despite objective confirmation of pathology. To assess the comparative effectiveness of different AR therapy regimens and their impact on middle ear and Eustachian tube pathology, the 168 affected patients were divided into four parallel groups: Main group (41 patients): treated with a fixed-dose combination of mometasone furoate and olopatadine hydrochloride (Rialtris); Control group 1 (45 patients): received intranasal monotherapy with mometasone furoate; Control group 2 (41 patients): treated with the oral antihistamine levocetirizine; Control group 3 (41 patients): received combination therapy of intranasal mometasone furoate and oral levocetirizine. To monitor the restoration of auditory tube function and middle ear pneumatization, tympanometry and micro-otoscopy were performed on days 1, 7, 14, and 30. All treatment regimens positively influenced Eustachian tube dysfunction. The combination of intranasal mometasone furoate and oral levocetirizine demonstrated superior efficacy, with a statistically significant difference (p=0.01, CO = –33.60; 95% CI –61.05 to –6.15). Due to the accelerated recovery of Eustachian tube function and restoration of its drainage capabilities, the need for invasive middle ear drainage procedures (e.g., shunting, tympanostomy) was eliminated in the group receiving the fixed intranasal combination of mometasone furoate and olopatadine hydrochloride. This fixed-dose combination appears to be the optimal treatment for allergic Eustachian tube dysfunction, owing to its direct endonasal action on the respiratory epithelium at the Eustachian tube, allowing for rapid restoration of middle ear ventilation.