Patulous Eustachian Tube - Causes, Symptoms, Diagnosis, and Management

Introduction:

The eustachian tube is present between the middle ear and throat. It is usually closed at rest to prevent the entry of nasopharyngeal secretions in the middle ear. It only opens slightly for a while during swallowing and to harmonize air pressure around the eardrum. If the eustachian tube remains open, the sound gets transmitted from the nasal cavity to the middle ear, resulting in hearing sounds while speaking and other body sounds like breathing or even sounds produced while blood is pumping. The incidence of patulous eustachian tubes is less than 0.3 percent.It is more common in females than males. The article discusses the patulous eustachian tube. Its causes, symptoms, diagnosis, and treatment.

What Is a Patulous Eustachian Tube?

Patulous eustachian tube is a rare condition in which the eustachian tube functions abnormally and does not close properly, leading to symptoms. Several factors can cause the condition to develop. Management strategies include nasal sprays and surgical interventions to improve eustachian tube function.

What Are the Causes and Risk Factors of the Patulous Eustachian Tube?

Most of the reasons for eustachian tube dysfunction or patulous eustachian tube are still unknown, but some of the risk factors for the patulous eustachian tube are:

• Sudden weight loss.

• Stress and anxiety.

• Previous history of radiotherapy.

• Neuro-muscular disorders cause muscle stiffening, like multiple sclerosis (an autoimmune disease affecting the brain and spinal cord).

• Temporo-mandibular joint syndrome (pain and tenderness in the temporo-mandibular joint).

• Hormonal changes in pregnancy.

• Scarring of nasopharyngeal muscles after surgery like adenoidectomy (a surgical procedure to remove adenoid glands).

• Medications like birth control pills and diuretics.

• History of acid reflux disease (stomach acid goes back into the esophagus).

• Muscle wasting.

• Vigorous exercise.

• Increased consumption of caffeine.

• Smoking.

• Trauma to ears.

• Hormonal therapy-estrogen therapy for carcinoma of the prostate.

• Cranio-facial abnormalities

What Are the Signs and Symptoms of the Patulous Eustachian Tube?

The person can see a doctor if they experience the symptoms below.

• Hearing of own voice (autophony).

• A feeling of fullness in ears.

• Hearing the respiration and other body functions sounds loud.

• Echoing voice while speaking.

• Spinning sensation in the head (vertigo).

• Hearing loss in severe cases.

• Movement of the tympanic membrane with respiration.

• Floppy eardrums (retracted eardrums).

• Ringing sound in ears.

• Discomfort in ears.

• Symptoms relief from lying down.

• Sniffing habit.

How to Diagnose a Patulous Eustachian Tube?

• Tympanometry: It is a test used to check the function of the middle ear. This test is done to check the movement pattern of the tympanic membrane with respiration. A soft earbud is placed in the ear, and a probe changes the air pressure. The results recorded on the graph are then assessed.

• Nasal Audiometry: In this test, the sound is produced in the nose, and audibility is recorded in the ears.

• Sonotubometry: It is one of the methods to check for eustachian tube dysfunction. This method records the sound emitted in the nose from the external ear canal. If the sound recording is more than 5 decibels, it suggests the opening of the eustachian tube reliably. Sonotubometry with postural changes (Ohta’s Method) is also recorded to check for the variation in the pressure from the sound transmitted from the nasopharynx during postural changes.

• Computed Tomography (CT) Scan: This is done to check for any abnormalities present in the course of the eustachian tube.

What Is the Treatment of the Patulous Eustachian Tube?

Various treatment modalities for the patulous eustachian tube are:

1. Conservative Treatment:

• Keep the body rehydrated by consuming more fluids.

• Avoid smoking.

• Reduce intake of too much caffeine.

• Maintaining a balanced weight.

2. Drug Therapy:

• Anticholinergic Drugs: Drugs like Atropine in a dose of 0.5 mg (milligrams) are used intra-tubally by catheter air insufflation. It reduces the symptoms of the patulous eustachian tube by inhibiting fluid secretion from the glands. The doctor also prescribes an anticholinergic nasal spray for symptomatic relief.

• Nasal Saline Drops: It is used to keep mucous membranes moist.

3. Surgical Treatment: In severe cases when there is no improvement from conservative management, surgical procedures are preferred:

• Plug Surgery: In severe cases, if the patient does not respond to conservative treatment for a minimum of six months, a silicone earplug is used for plug surgery. These silicone plugs are designed in different sizes and diameters. The surgery is performed using either a trans-nasal or trans-tympanic approach.

• Autologous Graft Surgery: In this surgical procedure, an autologous fat graft (graft obtained from one's own body) is used in the nasopharyngeal opening, followed by myringotomy (drainage of fluid accumulated in the eardrum surgically) to reduce the pressure of the eardrum and placement of ventilation tube.

• Fillers: Hydroxyapatite and collagen filler injections are used for more minor eustachian tube defects. Hydroxyapatite fillers are injected deep into the mucous membrane of the eustachian tube, thereby adding bulk to the functional valve.

• Eustachian Tube Injections: Materials like silicone, Teflon, polytef paste, and cartilage are used to inject the Eustachian tube opening to reduce or close the opening.

• Cautery: Cauterization of eustachian tube opening using potassium-titanyl-phosphate (KTP) lasers, diathermy, and silver nitrate is done to promote scarring of eustachian tube opening to help relieve the symptoms due to patulous eustachian tubes.

• Tympanostomy Tube: This procedure was mainly preferred for patients with a sniffing habit. In this procedure, a tympanic membrane paper patch is used to load the tympanic membrane to reduce the symptoms of a patulous eustachian tube. For a patient who responds positively to this procedure, permanent augmentation of the tympanic membrane with cartilage is performed to relieve the symptoms completely.

Has Any Research Been Conducted for the Management of Patulous Eustachian Tubes?

Although many surgical procedures are available for managing the patulous eustachian tube, further research is still needed in this area for newer technologies and procedures for the effective treatment of patulous eustachian tubes. Various research projects are ongoing for advanced techniques to completely cure this condition.

Conclusion:

The patulous eustachian tube is a complex and challenging condition that can be faced by anyone. Due to its large number of symptoms, many different treatment procedures have been advocated for its management. Clinical examination and early diagnosis are the keys to effectively managing the patulous eustachian tubes.

If left untreated for an extended period, the patulous eustachian tube can lead to permanent hearing loss, so an early visit to an otolaryngologist to diagnose and identify the best suitable therapeutic procedure should be preferred.