Eustachian Tube Lumen Research Articles

Relationship Between Clinical Test Results and Morphologic Severity Demonstrated by Sitting 3-D CT in Patients With Patulous Eustachian Tube

To investigate the correlation of sitting 3-D computed tomography (CT) scans of the Eustachian tube (ET) with subjective and objective findings in patients with patulous Eustachian tube (PET). Retrospective. Tertiary referral center. A retrospective survey of medical records in Sen-En Hospital identified 40 patients and 62 ears with PET between September 2014 and June 2015. Diagnosis of PET was based on the presence of three characteristic aural symptoms (autophony of voice or breathing sounds, and aural fullness), as well as verification of synchronous movement of the tympanic membrane in response to forced breathing under an endoscope. Any pressure changes in the external auditory canal (EAC) elicited by deep breathing and sniffing were detected by tubotympanoaerodynamography (TTAG). In addition, sonotubometry was performed where two parameters were used determined to evaluate ET function. Patients were examined by 3-D CT (Accuitomo; Morita, Kyoto, Japan) in the sitting position. The length of the closed ET lumen section was measured. Ears were divided into three groups as follows: completely open, closed-short (3 mm or less), and closed-long (longer than 3 mm). The median length of the closed section of the ET lumen was 1.85 ± 2.69 mm in positive findings of PET. The three groups were significantly different in both aural fullness (p = 0.023) and, similarly, the difference in tympanic membrane movement (p = 0.032) among these three groups was also significantly different (p = 0.032). However, for autophony of breathing sounds, there was no significant difference with regard to autophony of breathing sounds among these three groups (p = 0.324). Although TTAG findings were did not reveal any significantly difference among these three groups (p = 0.589), the difference was significant (p = 0.001) in degree of EAC pressure change in TTAG. The difference among the three groups was significant (p = 0.001) based on sonotubometry findings. Under resting conditions, the lengths of the closed area of the ETs in PET groups are clearly shorter than in groups without PET based on sitting position CT scans in resting condition. Among the symptoms and clinical test findings including the ET function test results, the presence of tympanic membrane movement induced by respiration, the high degree of EAC pressure change in TTAG, as well as the positive results of sonotubometry are significantly correlated with the positive findings of sitting CT revealing the open ET.

Critical distance between the cartilaginous Eustachian tube and the internal carotid artery.

During the last decade, endoscopic surgery of the Eustachian tube (ET) has been advocated for ET dilatory dysfunction and for patulous ET. The internal carotid artery (ICA) and the ET are closely related, and knowledge of their surgical anatomy has become essential. This study was designed to establish the anatomical relationships between the endoscopically critical area along the full length of the cartilaginous ET and its closest association with the ICA. The perpendicular distance between the ET lumen and the ICA was measured from head magnetic resonance images (MRI) at three levels: (A) cartilaginous and bony ET junctional point, (B) mid cartilaginous ET point, and (C) the nasopharyngeal orifice of the cartilaginous ET. Totally, 200 sides were reviewed in MRI scans of 229 patients. The mean distances for each level were: A=4.3mm (range 1.6-10.4mm), B=25mm (range 9.0-61.6mm), and C=62mm (range 34.3-84.4mm). The perpendicular distance between ET and ICA at the nasopharyngeal orifice is large, but the distance shortens quickly while moving from the nasopharyngeal orifice of the ET to the junctional point of the ET. The potential for complications to the ICA rises as the surgical field moves closer to the isthmus of the ET because of the decreasing distance between the ET and the ICA.

Cross-platform data integration of paratubal electromyography and sonotubometry for eustachian tube: a pilot study

Conclusion: The sensitive sonotubometry and MATLAB provide a new tool to study the eustachian tube (ET) function and contribute more to reliable data and precise analysis. The levator veli palatini muscle (mLVP) and the salpingopharyngeus muscle (mSP) may, respectively, be the most important and least important muscle for ET function.Objectives: The ET lumen dilation is a result of the contraction of the paratubal muscles, the tensor veli palatini muscle (mTVP), mLVP and mSP. To trace the dynamic ET muscle/lumen activities, the present study aimed to optimize sonotubometry and achieve cross-platform data integration of electromyography (EMG) and sonotubometry using MATLAB (matrix laboratory).Method: Seventeen healthy volunteers (34 ears) were chosen for the concurrent recordings of the paratubal EMG and sonotubogram under dry and water swallowing.Results: The optimized sonotubometry based on computer sound card showed satisfied sensitivity. For both EMGs and sonotubogram, dry swallowing generated significantly greater amplitude and longer duration compared to water swallowing. Moreover, statistically significant differences (p < 0.05) were detected in the comparison of the amplitude, duration, and latency for the mTVP, mLVP, and mSP. The mSP activity was the weakest and even inactive in some cases, the mLVP presented the most powerful and long lasting activity during ET-opening.

Multi-scale finite element modeling of Eustachian tube function: influence of mucosal adhesion.

The inability to open the collapsible Eustachian tube (ET) leads to the development of chronic Otitis Media (OM). Although mucosal inflammation during OM leads to increased mucin gene expression and elevated adhesion forces within the ET lumen, it is not known how changes in mucosal adhesion alter the biomechanical mechanisms of ET function. In this study, we developed a novel multi-scale finite element model of ET function in adults that utilizes adhesion spring elements to simulate changes in mucosal adhesion. Models were created for six adult subjects, and dynamic patterns in muscle contraction were used to simulate the wave-like opening of the ET that occurs during swallowing. Results indicate that ET opening is highly sensitive to the level of mucosal adhesion and that exceeding a critical value of adhesion leads to rapid ET dysfunction. Parameter variation studies and sensitivity analysis indicate that increased mucosal adhesion alters the relative importance of several tissue biomechanical properties. For example, increases in mucosal adhesion reduced the sensitivity of ET function to tensor veli palatini muscle forces but did not alter the insensitivity of ET function to levator veli palatini muscle forces. Interestingly, although changes in cartilage stiffness did not significantly influence ET opening under low adhesion conditions, ET opening was highly sensitive to changes in cartilage stiffness under high adhesion conditions. Therefore, our multi-scale computational models indicate that changes in mucosal adhesion as would occur during inflammatory OM alter the biomechanical mechanisms of ET function. Copyright © 2016 John Wiley & Sons, Ltd.

Eustachian Tube Mucosal Inflammation Scale Validation Based on Digital Video Images.

The most common cause for Eustachian tube dilatory dysfunction is mucosal inflammation. The aim of this study was to validate a scale for Eustachian tube mucosal inflammation, based on digital video clips obtained during diagnostic rigid endoscopy. A previously described four-step scale for grading the degree of inflammation of the mucosa of the Eustachian tube lumen was used for this validation study. A tutorial for use of the scale, including static images and 10 second video clips, was presented to 26 clinicians with various levels of experience. Each clinician then reviewed 35 short digital video samples of Eustachian tubes from patients and rated the degree of inflammation. A subset of the clinicians performed a second rating of the same video clips at a subsequent time. Statistical analysis of the ratings provided inter- and intrarater reliability scores. Twenty-six clinicians with various levels of experience rated a total of 35 videos. Thirteen clinicians rated the videos twice. The overall correlation coefficient for the rating of inflammation severity was relatively good (0.74, 95% confidence interval, 0.72-0.76). The intralevel correlation coefficient for intrarater reliability was high (0.86). For those who rated videos twice, the intralevel correlation coefficient improved after the first rating (0.73, to 0.76), but improvement was not statistically significant. The inflammation scale used for Eustachian tube mucosal inflammation is reliable and this scale can be used with a high level of consistency by clinicians with various levels of experience.

Visualization of the eustachian tube lumen with Valsalva computed tomography

Assess the feasibility of using the Valsalva maneuver to visualize the cartilaginous eustachian tube lumen with computed tomography (CT) in subjects with no ear disease. Prospective case series study. Thirty-eight consecutive patients undergoing CT of the sinuses for nose-related complaints with normal radiographic findings consented for a CT of the temporal bone while performing the Valsalva maneuver. Multiplanar reconstruction was performed along the axis of the tube. Images were assessed for visualization of the whole length of lumen of the tube, or partial visualization with ratio of visualized to nonvisualized segments. The Valsalva maneuver allowed visualization of the whole length of the tube in 27/76 (35%) ears examined. It consistently visualized the distal one-third of the cartilaginous tube in 71/76 (94%) ears. Paradoxical collapse of the eustachian tube was present in three ears along with evidence of poor Valsalva technique. Valsalva CT consistently allows visualization of the lumen of the distal one-third of the eustachian tube in a majority of patients with no eustachian tube-related complaints. This technique might be helpful in localizing eustachian tube pathology in patients with obstructive tube symptoms.

A Novel Functional Imaging Method of the Eustachian Tube

Objectives: (1) Image the Eustachian tube (ET) lumen by computed tomography (CT) scanning during ET function (ETF) testing, (2) characterize the differences in image quality for different scanning protocols, and (3) establish a novel research methodology for studying ET anatomy and physiology. Methods: In a cadaver head without craniofacial or otologic abnormalities, the tympanic membrane was perforated and ETF test was done using the forced response test (FRT) in a CT scanner. Opening (OP), steady (PS), and closing (CP) pressures were measured during forced air flow from the middle ear (ME) to the nasopharynx across the open ET. Temporal bone CT scans with continuous 0.625 mm thickness were done at a low and standard radiation doses before and during the steady flow (SF) phase of the FRT, after instilling iodinated contrast into the ME and ET, and after the FRT cleared the contrast from the ET. Image analysis was done using the CT scanner console software to view the ET and peritubal structures in standard views and after image reconstructions. Results: The average OP, PS, and CP values were 488 ± 249, 376 ± 101, and 211 ± 62 daPa. While a distinct ET lumen could not be demonstrated during the FRT done with air, CT with intra-luminal contrast clearly demonstrated the entire ET lumen. Post-contrast FRT demonstrated residual contrast outlining the lumen. Conclusions: Standard temporal bone CT doses provided a slightly better signal-to-noise than the low-dose CT for the air but not for the contrast. Combining ETF testing and CT imaging has potential research applications.

Eustachian tube lumen opening into an abnormally pneumatized sphenoid bone.

The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education

Balloon dilation of the eustachian tube in a cadaver model: Technical considerations, learning curve, and potential barriers

The surgical management options for eustachian tube dysfunction have historically been limited. The goal of the current study was to evaluate the technical considerations, learning curve, and potential barriers for balloon dilation of the eustachian tube (BDET) as an alternative treatment modality. Prospective preclinical trial of BDET in a cadaver model. A novel balloon catheter device was used for eustachian tube dilation. Twenty-four BDET procedures were performed by three independent rhinologists with no prior experience with the procedure (eight procedures per surgeon). The duration and number of attempts of the individual steps and overall procedure were recorded. Endoscopic examination of the eustachian tube was performed after each procedure, and the surgeon was asked to rate the subjective difficulty on a five-point scale. Successful completion of the procedure occurred in each case. The overall mean duration of the procedure was 284 seconds, and a mean number of 1.15 attempts were necessary to perform the individual steps. The mean subjective procedure difficulty was noted as somewhat easy. Statistically shorter duration and subjectively easier procedure were noted in the second compared to the first half of the series, indicating a favorable learning curve. Linear fissuring within the eustachian tube lumen without submucosal disruption (nine procedures, 37%) and with submucosal disruption (five procedures, 21%) were noted. The significance of these physical findings is unclear. Preclinical testing of BDET is associated with favorable duration, learning curve, and overall ease of completion. Clinical trials are necessary to evaluate safety and efficacy.

Three-dimensional finite element analysis of Eustachian tube function under normal and pathological conditions

A primary etiological factor underlying chronic middle ear disease is an inability to open the collapsible Eustachian tube (ET). However, the structure–function relationships responsible for ET dysfunction in patient populations at risk for developing otitis media (OM) are not known. In this study, three-dimensional (3D) finite element (FE) modeling techniques were used to investigate how changes in biomechanical and anatomical properties influence opening phenomena in three populations: normal adults, young children and infants with cleft palate. Histological data was used to create anatomically accurate models and FE techniques were used to simulate tissue deformation and ET opening. Lumen dilation was quantified using a computational fluid dynamic (CFD) technique and a sensitivity analysis was performed to ascertain the relative importance of the different anatomical and tissue mechanical properties. Results for adults suggest that ET function is highly sensitive to tensor veli palatini muscle (TVPM) forces and to periluminal mucosal tissue (PMT) elasticity. Young children and cleft palate subjects exhibited reduced sensitivity to TVPM forces while changes in PMT stiffness continued to have a significant impact on ET function. These results suggest that reducing PMT stiffness might be an effective way to restore ET function in these populations. Varying TVPM force vector relationships via changes in hamulus location had no effect on ET opening in young children and cleft palate subjects but did alter force transmission to the ET lumen during conditions of elevated adhesion. These models have therefore provided important new insights into the biomechanical mechanisms responsible for ET dysfunction.

Three-Dimensional Computed Tomography Imaging of the Eustachian Tube Lumen in Patients with Patulous Eustachian Tube

Background: The eustachian tube (ET) has a complicated anatomy, which is related to middle ear pathology. The anatomy of the ET has been well investigated in cadavers, but may not accurately reflect that in living subjects. Three-dimensional (3D) computed tomography (CT) was used to examine the ET in patients with patulous ET. Method: The subjects were 35 patients (17 males, aged 59 ± 16 years, and 18 females, aged 44 ± 15 years) with patulous ET which could be continuously traced from the pharyngeal orifice to the tympanic orifice (53 ears). CT was performed in the sitting position at rest, followed by 3D reconstruction. The course of the ET from the middle ear to the pharynx was visualized in 3D surface images. Morphological measurements of the curvature angle (angle C) and the inclination angle (angle I) were determined from 3D coordinates on the CT images. Results: The full length of the ET could be visualized in most patients suffering from patulous ET in the sitting position. Angle C was 21.7 ± 5.8° in the patients aged <40 years (n = 20), which is significantly larger than 16.7 ± 6.8° in the patients aged >59 years (n = 18; Student’s t test, p < 0.05). Angle I was 26.5 ± 4.2° in the patients aged <40 years (n = 20), also significantly larger than 21.6 ± 5.8° in the patients aged >59 years (n = 18; Student’s t test, p < 0.05). Conclusion: CT in the sitting position is a potential diagnostic tool of the ET and middle ear pathology.

Localization of aquaporins, water channel proteins, in the mouse eustachian tube

Conclusion. Immunolocalization of the subtypes of water channel proteins, aquaporins (AQPs), was detected in the mouse eustachian tube (ET). AQPs are located continuously from the serous glands and the capillary vessels to the luminal side in the ET epithelium and may play an important role in the transportation of water to the surface of the ET lumen through the epithelium. Objectives. Although the water supply to the surface of the ET lumen is considered to be essential for closing of the ET, the pathway of the water in the ET is not fully understood. Since AQPs, a group of water transport proteins, have been reported to regulate water homeostasis, we examined the location of AQPs in the mouse ET. Materials and methods. Nine subtypes of AQPs were examined in paraffin embedded ETs of adult mice using the avidin-biotin peroxidase complex method of immunohistochemistry. Results. Four subtypes of AQPs were detected in the mouse ET. AQP-1 was detected in fibroblasts, endothelial cells of capillary vessels and cartilage cells. AQP-3 was distinctly detected in the basal membrane of epithelial cells. AQP-4 was detected in the basal membrane of epithelial cells. AQP-5 was expressed in the luminal side of the ET epithelial cells and also in the apical surface of the cells of the serous glands.

Anatomy of the Bony Portion of the Eustachian Tube in Tubal Stenosis: Multiplanar Reconstruction Approach

We sought to clarify possible pathological conditions of the bony portion of the eustachian tube (ET) in patients with ET stenosis. We measured the total length, the cross-sectional area of the bony frame, and the air space of the ET lumen at an interval of 1 mm on the reconstructed computed tomographic images of the ET using a multiplanar reconstruction method on 20 normal subjects (control group) and 25 patients with stenotic ET judged by the inflation test (stenotic group). In the cross-sectional areas, both the bony frame and air space were significantly smaller in the stenotic group than in the control group. The soft tissue ratio was significantly greater in most parts of the mid-bony portion and the tympanic orifice of the stenotic group than in those of the control group. At the anterior tip of the bony portion, only the bony frame was found to be significantly smaller in the stenotic group than in the control group. We suggest that a smaller framework of the bony ET may possibly be related to the pathogenesis of ET stenosis.

Composition and method for treatment of otitis external

A process, composition and method for increasing and enhancing mammalian eustachian tube lumen patency and pressure equalization performance is disclosed wherein an aerosolized mixture of lipid crystals comprised of a mixture of one or more lipids surfactants and one or more spreading agents selected from the group consisting of sterols, lipids, fatty acids, cholesteryl esters, phospholipids, carbohydrates, and proteins, in powder form, and one or more propellants, in which the lipid surfactants and spreading agents are not soluble, are administered through a mammalian airway orifice. Upon administration, the propellant(s) are evaporated from the mixture and the lipid crystals are deposited within a subject mammalian eustachian tube whereupon said lipid crystals come into contact with lumen surfaces of the tube forming an amorphous spread film thereupon substantially decreasing the opening pressure of the lumen. In a second preferred embodiment, a therapeutically active agent effective in the treatment of otitis media is added to the mixture of lipid crystals and upon administration of said aerosol mixture, the amorphous spread film formed thereby carries said therapeutically active agent through the eustachian tube to the tissues of the middle ear. In an alternate preferred embodiment, the afore-mentioned reduction of surface tension and delivery of therapeutically active agents is provided by a mixture of lipid crystals comprised of surfactant(s), therapeutically active agents and a propellant in which such other components are not soluble.

Imaging of the patulous eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique

Objective—To evaluate the 3D anatomy of the ET and its surrounding tissues in cases with or without patulous Eustachian tube (ET) using CT with the multiplanar reconstruction (MPR) technique.Material and Methods—Twenty patients with a patulous ET and 25 without middle ear problems were investigated. After performing a temporal bone CT examination, MPR images of the ET were reconstructed and measurements were made.Results—The ET lumen and its surrounding tissues were clearly identified. In the patulous ET group, the ET lumen was open throughout the cartilaginous portion and the volume of the low-density area was smaller in size than in the controls. In unilateral patulous ET patients, the anatomical features were found to be similar on both sides, in spite of the fact that the non-involved side did not show symptoms associated with a patulous ET.Conclusion—For the first time, we were able to obtain clear reconstructed images of the patulous ET and its surrounding structure and to study its anatomical features. This method is useful for obtaining a better understanding of the ET and ET-related diseases such as patulous ET.

Relationship of petrous temporal bone pneumatization to the eustachian tube lumen.

Objectives were to determine the incidence of petrous apex pneumatization and to define the relationship between a pneumatized petrous temporal bone and the eustachian tube lumen. Retrospective study with institutional review board approval including only adult patients. One hundred head computed tomography (ct) scans and 204 petrous temporal bone CT scans performed at a tertiary teaching hospital were reviewed. The two senior authors (s.h.s., p.c.s.) independently reviewed the petrous temporal bone CT scans for grade of pneumatization. Pneumatized CT scans were then reviewed for the presence of a direct communication with the eustachian tube lumen. Significance was determined using the chi test and Pearson correlation of ranks. The incidence of peritubal cells opening into the eustachian tube anterior to the tympanic orifice was 92%. The direct communication of peritubal cells with the bony eustachian tube may play a role in the development of persistent cerebrospinal fluid rhinorrhea after cerebellopontine angle surgery.

Postnatal change on the location of Ostmann's fatty tissue in the region lateral to Eustachian tube

Objective: To delineate a possible role of protective function by Ostmann's fatty tissue (OF) in the lateral region to Eustachian tube (ET). Study design: Morphometric and histopathological examination on human temporal bones. Methods: OF in the region lateral to the cartilaginous portion of the ET between the ET lumen and the tensor veli palatini muscle (TVP) was studied histopathologically and morphometrically by analyzing a series of vertically cut histologic sections for the ET structures. Sections were obtained from 25 individuals with age ranging from 33 gestational weeks to 38 years at the time of their death. Results: In fetus and neonates, the region lateral to ET was filled with mesenchyme. OF appeared first in this region at 2–3 weeks postnatally, and increased in volume with development of the ET. In the cases of older children and adults (Group-B), the ratio of the volume of OF in the region to that of ET lumen (OF/L) was significantly higher in the posterior half than in the anterior half of the cartilaginous portion of ET. However, in the cases of infants and younger children (Group-A), there was no significant difference in the ratio between the two regions. In the posterior half of the cartilaginous portion of ET, OF/L was significantly higher in Group-B than in Group-A, while in the anterior half, there was no significant difference in the ratio between two age groups (Group-A and B). Conclusions: In Group-B, the dominant OF in the area of the posterior half of the cartilaginous region, which includes the narrowest portion of ET, may be responsible for restorating the ET lumen back to its closed static condition after active tubal opening by contraction of TVP. This is thought to be important for protection of the middle ear. On the other hand, in Group-A, poor OF near the narrowest portion of ET may cause insufficient restoration of the ET lumen and increased risk of developing otitis media (OM).

Otitis media with effusion and histopathologic properties of adenoid tissue

Objective: Adenoidectomy is being generally used for the treatment of otitis media with effusion (OME). The purpose of current study was to determine objectively the significance of the histopathology of adenoid tissue on the development of otitis media with effusion. Methods: The records of all the patients operated on with the diagnosis of adenoid enlargement with or without OME were reviewed and pathologic specimen were re-evaluated regarding histopathological properties by one pathologist unfamiliar with the diagnosis. Sixty-one patients with adenoid hyperplasia were enrolled in the study group, 38 males and 23 females. Age ranged between 3 and 13 years (mean age was 7.03±3.26 years). All the patients of study group were those operated on due to the adenoid hyperplasia and uni- or bilateral OME. Control group was composed of 39 male and 26 female patients (age range was between 3 and 13 years, and mean age was 7.06±3.04 years) with solely adenoid hyperplasia. Results: The squamous metaplasia was present in 47 (77%) and 14 (22%) patients of study and control groups, respectively. The fibrosis of connective tissue interspersed follicles of adenoid was present in 29 (48%) and 6 (9%) patients of study and control groups, respectively. The statistical analysis revealed a significant prevalence of squamous metaplasia ( P<0.001) and fibrosis of connective tissue interspersed follicles of adenoid ( P<0.001) for a surgical indication of adenoid hyperplasia with OME than for without OME. The prevalence of other parameters was not significantly different between two groups. Conclusions: Adenoid tissue not only exerts an obstructive influence on the eustachian tube lumen when enlarged, but also impedes (hinders) mucociliary drainage of the middle ear by the way of non-ciliated metaplastic epithelium and fibrosis of connective tissue.

Postnatal changes in the connective tissue in the region lateral to the eustachian tube: possible relationship to tube function.

In order to delineate the possible role of connective tissue (CT) in the region lateral to the eustachian tube (ET) between the ET lumen and the tensor veli palatini muscle (TVPM), we studied the postnatal changes in the CT in histologic sections of human ET. In fetuses and neonates, the lateral region was filled with mesenchyme. Loose collagenous CT appeared first at 2 weeks of age, and in subjects older than 4 years of age, the collagen formed dense, meshlike structures attaching to both the subepithelial CT layer of the ET and the tendonlike membrane of the TVPM. Along the long axis of the ET, those attachments were distributed mainly in the region at the posterior part of the cartilaginous portion of the ET. Attachments to the subepithelial CT layer of the ET were distributed mainly in the upper half of the region. The dense, meshlike collagenous CT might help the ET to be opened by drawing the lateral wall of the ET lumen through inferolateral movement of the tendonlike membrane of the TVPM when the TVPM contracts. It may work to open mainly the parts that include the narrowest portion of the ET, and also the upper aspect of the ET lumen. Incomplete development of this structure in infants may be one of the factors associated with dysfunction in ET opening.

CT imaging of the patulous eustachian tube—comparison between sitting and recumbent positions

Objective: The objective was to evaluate the three-dimensional anatomy of the eustachian tube (ET) and its surrounding tissues of patulous ET patients in the sitting positions by the horizontal computed tomography (CT) system with the multiplanar reconstruction (MPR) technique, and to compare the findings with those obtained in the recumbent position. Methods: Two patients with severe bilateral patulous ET were investigated. After performing temporal bone CT examination both in the sitting and recumbent position, MPR images of the ET were reconstructed and measurement was made on a workstation. Results: The ET lumen was identified at most of the portion from the pharyngeal orifice to the tympanic orifice in both positions. At the cartilaginous portion, the air space in the ET lumen was larger in the sitting position than in the recumbent position. At the bony portion of the ET, there did not seem to be any significant difference in the results of measurement in both cases. Conclusion: For the first time, we were able to obtain reconstructed images of patulous ET patients in the sitting position and to compare the findings with those of the recumbent position. We suggest that this method is useful for better understanding of the ET and ET-related diseases such as patulous ET.