Patulous Eustachian Tubes Research Articles

Management of Patulous Eustachian Tube

Patients with patulous Eustachian tubes (PET) suffer from annoying aural symptoms, such as voice or breath autophony, and aural fullness due to the ET’s abnormal patency. It may lead to an enormous reduction in quality of life. Various treatment methods, including conservative and surgical therapy, have been reported. In most cases, conservative treatment is sufficient to relieve patients of aural symptoms. However, some chronic and severe cases are resistant to traditional conservative therapy. Recently performed prospective and multicenter trials revealed the efficacy and safety of a silicone plug (Kobayashi plug) insertion for patients with severe PET. Patulous Eustachian tube handicap inventory-10 (PHI-10), tubal obstruction procedures, sitting computed tomography (CT), and ET function tests (tubo-tympano-aerodynamic graphy (TTAG) and sonotubometry) are useful for diagnosis as well as selecting candidates for surgery in severe cases.

What is the full range of medical and surgical treatments available for patients with Eustachian tube dysfunction?

To present the current medical and surgical treatment options for Eustachian tube dysfunction. Balloon dilation or microdebrider Eustachian tuboplasty are feasible treatment options for patients with refractory dilatory dysfunction as an alternative to tympanostomy tube placement. There is increasing evidence that repair of patulous Eustachian tubes by the insertion of a shim or fat graft reconstruction within the lumen of the Eustachian tube orifice may be effective. In patients with Eustachian tube dysfunction that is refractory to medical management, newer surgical techniques may provide symptomatic relief with a reasonable duration. Continued basic science research into the cause of dysfunction, the mechanisms of benefit from intervention and long-term clinical outcomes are necessary.

Amantadine-Induced Patulous Eustachian Tubes in Parkinson’s Disease

Patulous Eustachian tube (PET) is a common condition that produces symptoms of aural fullness and autophony. We describe a Parkinson's disease (PD) patient that experienced a reversible bilateral patulous (hyperpatent) Eustachian tube syndrome induced by treatment with amantadine hydrochloride. The clinical features, relevant anatomy and physiology, and associated risk factors for PET are reviewed.

Eustachian Tube Function in Patients With Eosinophilic Otitis Media Associated With Bronchial Asthma Evaluated by Sonotubometry

To determine eustachian tube function in patients with asthma and with or without eosinophilic otitis media (EOM), a new middle ear disease entity with a highly viscous middle ear effusion containing many eosinophils and usually associated with bronchial asthma. One of the most important causes of otitis media (OM) is eustachian tube dysfunction. Retrospective case review. A referral center. Twenty patients with EOM and patients with asthma but without OM. We studied eustachian tube function using sonotubometry and a questionnaire. Sonotubometry was also performed on 13 control patients with chronic otitis media (COM) and 7 normal controls. The tubal opening duration was significantly longer in patients with EOM than in patients with asthma but without OM, controls with COM, and normal controls, indicating the presence of patulous eustachian tubes in patients with EOM. Responses to the questionnaire also supported the presence of patulous eustachian tubes in the patients with EOM. The presence of a patulous eustachian tube may be a major cause of EOM in patients with bronchial asthma. In patients with asthma who have a helper T-cell 2-dominant predisposition, a patulous eustachian tube easily allows the entry of antigenic materials into the middle ear, causing eosinophil-dominant inflammation.

Update on eustachian tube dysfunction and the patulous eustachian tube

The purpose of this review is to summarize the recent knowledge on eustachian tube dysfunction and the patulous eustachian tube. A clinically useful test for eustachian tube function is still lacking. Narrowing of the isthmus alone was demonstrated to be an insufficient cause of otitis media. Inflammatory mediators identified within the eustachian tube and middle ear cells were causally linked with otitis media with effusion. Increasing evidence was found that allergic disease and reflux may be two of the most important contributors of tubal inflammation causing otitis media with effusion. The adenoid size and proximity to the torus tubaris may also be important in considering which patients with persistent otitis media with effusion may benefit from adenoidectomy. Computed tomography scan has documented loss of soft tissue within the cartilaginous eustachian tube in patients with patulous eustachian tubes. An endoscopic approach to seal the tubal lumen has been found to be effective in relieving patulous symptoms. These studies suggest that allergic rhinitis and gastroesophageal reflux should be investigated in patients with eustachian tube dysfunction. Adenoidectomy should also be considered in patients who have adenoids that obstruct the torus tubaris. Patients with a patulous eustachian tube may benefit from an endoscopic closure. Further research is needed to identify a clinically useful test for eustachian tube dysfunction.

Hearing loss in progressive systemic sclerosis patients: A comparative study

Objective: To investigate the middle and inner ear involvement in patients with progressive systemic sclerosis (PSS). Study Design and Settings: We prospectively evaluated 34 PSS patients. All patients underwent a complete ear-nose-throat physical examination and audiological evaluation with pure tone, impedance, and speech audiometry. In addition, systemic manifestations of the disease and drug therapy were recorded. Finally, all patients were tested for the presence of autoantibodies. The results were compared with those of 45 age-matched healthy subjects. Results: We found a sensorineural hearing loss in 20% and mixed type hearing loss in 3.3% of the patients. There was no correlation of hearing loss with age, systemic manifestations of the disease, presence of autoantibodies, and drug therapy. Ten percent of the patients had patulous eustachian tubes. Conclusion: One fourth of PSS patients had a hearing loss affecting the middle and mainly the high frequencies. This is a lower percentage than that reported by other investigators. A significant prevalence of bilateral patulous eustachian tubes was noticed as well. Further investigation is needed for a better understanding of the mechanism of ear damage in PSS patients. (Otolaryngol Head Neck Surg 2001;124:522-5.)

Function of the eustachian tube in epitympanic retraction pockets

There are different hypotheses for the development of epitympanic retraction pockets. These can occur as the result of an inflammatory process and negative pressure in the middle ear spaces. Anatomic bottlenecks in the middle ear favor diminished inflation of the epitympanic space. The eustachian tube provides pressure equilibration in the middle ear. Its dysfunction involving tubal opening or closing is thought to be the main reason for a permanent negative pressure in the middle ear. A patulous eustachian tube is now claimed for prolonged negative pressure in the middle ear and is caused by a so-called "sniffing" habit. The purpose of this study was to elucidate objectively the frequency of patulous eustachian tubes in ears with epitympanic retraction pockets. We examined passive tubal function in 41 patients with 50 epitympanic retraction pockets by using dual impedance in a pressure chamber. We identified three stages of epitympanic retraction pockets. Stage 1 involved a mobile and controllable retraction pocket; stage 2 corresponded with a fixed but controllable pocket, whereas stage 3 described a fixed pocket that was developing into a cholesteatoma. Results were compared with the function tests of 100 healthy ears in 50 normal individuals. We found 27 patulous eustachian tubes in patients with epitympanic retraction pockets, 22 of which occurred in affected ears while only 2 patulous tubes were found in the group of the healthy ears. Tubal opening pressure (P < 0.001) and tubal closing pressure (P < 0.01) were significantly lower in ears with epitympanic retraction pockets than in healthy ears.

Manometric determinations of pressure changes in the external auditory meatus caused by a patulous eustachian tube.

The pressure changes developing in the nasopharynx and in the external auditory canal during breathing at rest were examined by means of manometry in patients with patulous eustachian tubes and in healthy control subjects who were able to keep their eustachian tubes opened for prolonged periods of time. Findings demonstrated that pressure changes in the nasopharynx in both groups were practically the same, but pressure changes in the external auditory meatuses of the patients with patulous tubes were about one order greater than in the control group. This occurrence might be caused either by relaxation of the fibers of the tympanic membrane or by different degrees of opening of the eustachian tubes.

Functional disorders of the upper airway associated with playing wind instruments.

Several known functional disorders of the upper airway are associated with playing wind instruments. Some of these problems have been known for hundreds of years. Subcutaneous emphysema of the head and neck and parotid, palate paralysis, patulous eustachian tubes, laryngocele, and pharyngocele are some of the more common problems. In evaluating disorders of wind instrumentalists, it is important to obtain a history that is unique to the individual, including information about the work environment, playing technique, and length of time playing. Physicians should understand the differences in wind instruments, mouthpieces, and reeds to understand the pathologic problems that occur in wind instrumentalists. This paper serves as an introduction to some of the signs and symptoms of these problems and how they are unique in wind instrumentalists.

Use of Teflon Paste for Patulous Eustachian Tube Challenged

To the Editor.— In the QUESTIONS AND ANSWERS section (1982;247:883) the response mentioned the use of Teflon paste for an excessively patent (patulous) eustachian tube. In patients with patulous eustachian tubes, good relief can be obtained by cautery with silver nitrate solution on wire wrapped with cotton. This treatment of autophony was reported in detail in an article published in Laryngoscope . 1 Injection of Teflon paste around the tube is dangerous and has resulted in cerebrovascular accidents and death. A former distributor of Teflon paste discontinued its investigational program and withdrew the material for this use after these complications were reported, although it is still available for injection into the vocal cords when they do not meet properly.

The frequency of patulous Eustachian tubes in pregnancy.

Two-hundred and seventy pregnant women (540 ears) were examined for patulous Eustachian tubes. The diagnosis was established by means of a Madsen Zo 70 electroacoustic impedance bridge. Nineteen of the patients were found to have patulous Eustachian tubes in 1 or both ears as evidenced by impedance variations synchronous with the respiration. Only 5 of these women had any subjective symptoms. Nine other women had symptoms, but their Eustachian tubes were closed at the time of examination. The results were related to the duration of the gestation, to oestrogen production and weight gain during pregnancy. A significant correlation was found was found between patulous Eustachian tube and elevated serum oestriol values.

Hyponasality associated with patulous eustachian tubes: report of a case.

Functional hyponasality sometimes occurs as a readily identifiable concomitant of patulous eustachian tubes. This case report suggests that the presence and severity of the speech problem is directly related to autophony and the patient’s ability to tolerate this characteristic symptom of abnormally patent eustachian tubes. Reduction in autophony appeared to produce proportional reduction in denasality. Elimination of aural symptoms consistently resulted in the abrupt return of normal speech.

Patulous eustachian tubes in pregnancy: Miller: p. 156

Patulous eustachian tubes in pregnancy: Miller: p. 156