Patulous Eustachian Tube (PET)

Eustachian Tubes That Are Stuck Open

Ear Anatomy
Ear Anatomy. Alan Gesek/Stocktrek Images/Getty Images

Your eustachian tubes run from your inner ear to the back of your throat. Typically, your eustachian tube is in a closed position, which protects your inner ear from bacteria, viruses, and fluid. In order to equalize pressure and drain any fluid inside the inner ear, your eustachian tube opens once or twice every hour. It will also open when you swallow, yawn, or sneeze and normally will only remain open for 0.3 to 0.5 seconds.

Patulous eustachian tube (PET) occurs when you eustachian tube remains wide open or patulous. It is uncommon only affecting about 3 out of 1000 people.

Causes of Patulous Eustachian Tube

While not knowing the cause of a disorder can be discouraging, you may not be able to identify a cause for your patulous eustachian tube, as the cause is usually unknown. However there are several factor that may predispose you to developing chronically open eustachian tubes, including:

  • radiation therapy (causes scarring to occur)
  • high levels of estrogen (Pregnancy, high dose birth control, or hormonal therapy for prostate cancer)
  • nasal decongestants
  • fatigue, stress or anxiety
  • temporomandibular joint syndrome
  • significant weight loss
  • neurological disorders (stroke, multiple sclerosis, trauma to facial nerves)
  • excessive gum chewing or frequent forced nose blowing

Symptoms Related to Patulous Eustachian Tube

Normally the eustachian tubes remain closed except to equalize pressure within the middle ear.

When you have a patulous eustachian tube, the eustachian tube is open instead which can result in the following symptoms:

  • autophony - this is the most common symptom and a classic sign of patulous eustachian tube
  • tinnitis (a ringing in the ears)
  • a feeling that the ear is stuffed up or clogged

​Autophony

Also known as: autophonia, tympanophony, tympanophonia

Autophony is a condition wear you hear unusually loud feedback of your own voice, breathing, and heart beats. This is a classic hallmark symptom of patulous eustachian tube and can be noted in other disorders involving your eustachian tube like superior semicircular canal dehiscence. In order to resolve symptoms of autophony, you will have to discuss treatment options for patulous eustachian tube with your doctor.

Non-Invasive Treatment of Patulous Eustachian Tube

Before receiving treatment, you may find that sniffing or lowering your head can cause some temporary relief of autophony. Mild symptoms may not require any treatment. However if the symptoms are severe enough and have persisted for greater than 6 weeks, then you will want to start treatments focused on resolving a patulous eustachian tube. Initial treatments involve proper hydration; drinking sufficient water is essential and can be supplemented with nasal saline drops or irrigation of the nose to help keep your mucous membranes moist.

The most common treatment for a patulous eustachian tube is nasal sprays. Saline is the most common choice, however you may also see: 1 part salicylic and 4 parts boric acid powder, diluted hydrochloric acid, chlorobutanol, or benzyl alcohol with saturated potassium iodide.

These alternate forms of nasal spray have not receive FDA support yet in the United States.

While many inner ear conditions can receive symptom relief from using nasal decongestants or steroids, this practice will likely worsen your symptoms and should not be continued. However do not stop any medications without consulting your physician. If your physician wants you to stop taking steroids, they will give you a taper schedule. Stopping steroids too quickly can be harmful. Nasal estrogen creams have a lot of anecdotal support, however nothing scientific has been done to support or discourage this practice.

Invasive Treatment of Patulous Eustachian Tube

When less invasive methods prove insufficient to resolve symptoms of a patulous eustachian tube,If surgical treatments may be more effective. The most common surgical intervention is placement of a tympanostomy tube, or ear tubes. This therapy is only about 50% effective for patients and either helps resolve the symptoms or increases discomfort. Unfortunately there is not enough evidence to predict if you will respond positively to ear tubes. However, ear tube placement is fortunately an easy procedure to perform and can be removed if it does not provide relief for you.

Another less invasive method for treating patulous eustachian tubes is referred as mass loading. In this procedure, your doctor will mold Blu Tack (a pressure-sensitive adhesive) to your ear drum. You will not require anesthesia for this procedure and it is generally very-well tolerated. This is thought to be helpful by reducing the sensation of echo in your inner ear by thickening your ear drum, which reduces its reaction to low-frequency sounds.

Other more invasive therapies that are continually being studied, and not available in all areas includes:

  • injecting the eustachian tube Teflon, silicon, cartilage, or other filling agents - caution should be exercised, as accidental injection into the carotid artery can cause severe complications
  • surgical placement of cartilage inside the eustachian tube
  • cauterizing off the eustachian tube
  • manipulation of musculature around the eustachian tube

The procedures listed above are more invasive than having ear tubes placed, however depending on the severity of your symptoms and success of other interventions may be additional options for you. Inserting a catheter inside the eustachian tube, injecting the eustachian tube, or musculature manipulation, allows for a narrowing of the eustachian tube. While this does not return normal function of the tube, it reduces the amount of air flow into the middle ear, which helps to reduce the symptoms of autophony.

Surgically placing cartilage inside the eustachian tube has a similar purpose to catheter placement and is used only if the catheter has failed. As a last resort, you can have a surgery where your otolaryngologist completely closes off the eustachian tube. This procedure alone is insufficient to help manage symptoms, as you lose the ability to regulate pressure in the middle ear. For this reason, your physician will also place ear tubes. You will always require ear tubes if you have this procedure, so it is only used as a last resort.

Sources:

Bartlett, C1, Pennings, R, Ho, A, Kirkpatrick, D, van Wijhe, R, & Bance M.(2010). Simple mass loading of the tympanic membrane to alleviate symptoms of patulous eustachian tube. J Otolaryngol Head Neck Surg. 39(3):259-68.

Luu, K, Remillard, A, Fandino, M, Saxby, A & Westerberg BD. (2015). Treatment Effectiveness for Symptoms of Patulous Eustachian Tube: A Systematic Review. Otol Neurotol. 36(10):1593-600. doi: 10.1097/MAO.0000000000000900.

Patulous Eustachian Tube. National Center for Advancing Translational Services website. https://rarediseases.info.nih.gov/gard/10812/patulous-eustachian-tube/resources/1. Updated February 17, 2017. Accessed July 5, 2017.

Poe. D & Hanna, B.MN. (2015). Eustachian tube dysfunction. http://www.uptodate.com (Subscription Required). Updated September 21, 2016. Accessed July 5, 2017.

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