Introduction:
The eustachian tube is present between the middle ear and throat. It is normally 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 our sounds while speaking and other body sounds like breathing or even sounds produced while blood pumping.
What Is the Incidence of Patulous Eustachian Tubes?
The incidence of patulous eustachian tubes is less than 0.3 % of the general population.
What Is the Prevalence of Patulous Eustachian Tubes?
It is more common in females than males.
What Are the Causes of the Patulous Eustachian Tube?
Most of the reasons for eustachian tube dysfunction are still unknown, but some of the risk factors for the patulous eustachian tube are:
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Sudden weight loss.
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Stress and anxiety.
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Previous history of radiotherapy.
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Neuro-muscular disorders causing muscle stiffening like multiple sclerosis.
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Temporo-mandibular joint syndrome.
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Hormonal changes in pregnancy.
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Scarring of nasopharyngeal muscles after surgery like adenoidectomy.
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Medications like birth control pills and diuretics.
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History of acid reflux disease.
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Muscle wasting.
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Vigorous exercise.
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Increased consumption of caffeine.
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Trauma to ears.
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Hormonal therapy-estrogen therapy for carcinoma of the prostate.
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Cranio-facial abnormalities
What Are the Signs and Symptoms of the Patulous Eustachian Tube?
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Hearing our own voice (autophony).
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Feeling of fullness in ears.
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Hearing our respiration and other body functions sounds loud.
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Echoing voice while speaking.
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Spinning sensation in the head (vertigo).
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Hearing loss in severe cases.
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Movement of the tympanic membrane with respiration.
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Floppy eardrums (retracted eardrums).
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Ringing sound in ears.
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Discomfort in ears.
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Symptoms relief on lying down.
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Sniffing habit.
How to Diagnose a Patulous Eustachian Tube?
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Tympanometry: It is a test used to check the function of the middle ear. This test is done to check the pattern of movement of the tympanic membrane with respiration. A soft earbud is placed in the ear, and a probe is used to change the air pressure. The results recorded on the graph are then assessed.
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Nasal Audiometry: In this test, the sound is produced in the nose, and audibility is recorded in the ears.
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Sonotubometry: It is one of the methods to check for eustachian tube dysfunction. In this method, the sound emitted in the nose is recorded 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 while postural changes.
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Computed Tomography (CT) Scan: It 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:
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Keep the body rehydrated by consumption of more fluids.
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Avoid smoking.
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Reduce intake of too much caffeine.
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Maintaining a balanced weight.
2. Drug Therapy:
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Anticholinergic Drugs: Drugs like Atropine in a dose of 0.5 mg are used intra-tubal by catheter air insufflation. It reduces the symptoms of the patulous eustachian tube by inhibiting the secretion of fluid from the glands. The anticholinergic nasal spray is also prescribed by the doctor for symptomatic relief.
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Nasal Saline Drops: It is used to keep mucous membrane moist.
3. Surgical Treatment: In severe cases when there is no improvement from conservative management, surgical procedures are preferred like:
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Plug Surgery: A silicone earplug is used for plug surgery in severe cases if the patient does not respond for a minimum of 6 months of conservative treatment. These silicone plugs are designed in different sizes with different diameters. The surgery is performed in either trans-nasal or trans-tympanic approach.
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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.
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Fillers: Hydroxyapatite and collagen fillers injections are used for smaller eustachian tube defects. In this method, hydroxyapatite fillers are injected deep into the mucous membrane of the eustachian tube, thereby adding bulk to the functional valve.
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Eustachian Tube Injections: Materials like silicone, teflon, polytef paste, and cartilage are used as an injection in the eustachian tube opening to reduce or close the opening.
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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.
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Tympanostomy Tube: This procedure was mainly preferred for the patient with the 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 was performed with the cartilage to completely relieve the symptoms.
Has Any Research Been Conducted for the Management of Patulous Eustachian Tubes?
Although there are many surgical procedures available for the management of the patulous eustachian tube, further research is still needed in this area for the newer technologies and procedures for the effective treatment of patulous eustachian tubes. Various research is still ongoing for advanced techniques for the complete cure of this condition.
Conclusion:
The patulous eustachian tube is a complex and challenging condition that can be faced by anyone. Due to a large number of symptoms with the patulous eustachian tube, many different treatment procedures have been advocated for its management. Clinical examination and early diagnosis are the keys to the effective management of the patulous eustachian tubes. If left untreated for a long 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.