Patulous Eustachian Tube

The Eustachian Tube connects the middle ear cavity to the throat. The function of this tube is to continually equalize the pressure in the middle ear cavity so that a buildup of negative or positive pressure does not occur. The eustachian tube is surrounded by muscles that function to open and close the tube depending on the situation. This allows for “normal” functioning of the tube.

Often, the Eustachian Tube functions poorly leading to ear infections and fluid build-up in the middle ear cavity. This occurs because the tube does not open appropriately.

Patient with Patulous Eustachian Tube (PET) have the opposite problem, with the eustachian tube remaining open and not closing appropriately.

Symptoms:

In PET, because the tube remains open for prolonged periods, patients can have significant symptoms. These can include “muffled hearing”, autophony (sensing your own voice in your ear), feeling your breathing in the ear, or the constant urge to “clear” the ear. Tinnitus, fullness, or blockage may also be symptoms of PET. Often, exercising makes these symptoms worse, because of the increased respiratory rate and the decreased blood flow to the eustachian tube muscles.

Diagnosis:

Diagnosis of PET is made by directly visualizing the eardrum with a microscope, looking for motion with deep breathing or speech. In addition, a tympanogram is often performed to document motion of the eardrum. A history of weight loss or chronic otitis is often found, though is not necessary to make the diagnosis.

Treatment:

Treatment of PET depends on the severity of the symptoms. Often, estrogen nasal spray is attempted to “bulk up” the tissue surrounding the Eustachian tube opening in the back of the nose. This is not thought to be very successful in treating the symptoms of PET.

Surgical Treatment:

Surgical treatment of PET is a procedure to improve the function of the eustachian tube. This includes either injecting a “filler” compound or inserting cartilage into the area of the eustachian tube opening in the back of the nose. This procedure is performed using a scope through the nasal cavity and placing the cartilage or filler, thus causing swelling in this area and allowing improved function of the eustachian tube. The cartilage is taken from the tragus of the ear and placed in a pocket that is created.

PET surgery is performed with a general anesthetic and is an outpatient procedure. In conjunction with this procedure, a very short-acting ear tube is placed into the eardrum to equalize the pressure within the middle ear during the healing phase. This tube generally falls out by itself several months after it is placed. Pain is usually fairly minimal after surgery. There is no restriction on flying postoperatively as the ear tube will function to prevent any pressure buildup in the middle ear.

Patients are instructed not to blow their nose and to sneeze and cough with their mouth wide open in the postoperative period. Typically, patients are seen approximately 2-3 weeks after surgery for a postoperative check.