Eustachian tube dilatation

A patulous Eustachian tube is a condition characterized by the tube remaining abnormally open, impairing pressure regulation in the middle ear. This leads to symptoms related to insufficient protection from sound pressure or nasopharyngeal secretions. The prevalence of this condition is estimated to range between 0.3% and 6.6% of the population.

Causes of Patulous Eustachian Tube:

  • Loss of fat around the tube.
  • Muscle atrophy in the cartilaginous portion of the tube’s valve.
  • Associated factors include:
    • Weight loss (for more details, [click here]).
    • Gastroesophageal reflux disease (GERD).
    • Allergic rhinitis.
    • Pregnancy.
    • Use of oral contraceptives (OCPs).
    • Post-adenoidectomy.
    • Radiation therapy.
    • Temporomandibular joint (TMJ) disorder.

Symptoms of Patulous Eustachian Tube:

  • Excessive autophony (hearing one’s own voice too loudly).
  • Sensation of fullness in the ear.
  • Hearing one’s own breathing sounds.
  • Symptoms improve when lying on the back or bending forward and worsen with exertion.
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Diagnosis of Patulous Eustachian Tube:

  • Comprehensive examination of the ear, nose, throat, head, neck, and cranial nerves.
  • Diagnostic tests include:
    • Otoscopic examination.
    • Imaging of eardrum movement during breathing.
    • Endoscopic examination of the nasopharynx.
    • Toynbee maneuver.
    • Valsalva maneuver.
    • Assessment of eardrum movement with nasal breathing (spontaneous movement during inhalation and exhalation).
    • Tympanic membrane stiffening test.
    • Imaging studies (CT or MRI) in some cases.

Treatment Options for Patulous Eustachian Tube:

Non-Surgical Interventions:

    • Weight gain for underweight patients.
    • Use of topical irritants (e.g., saline or sodium iodide) to induce temporary swelling of the tube opening and relieve symptoms.

Surgical Interventions:

    • Insertion of a ventilation tube in the eardrum (noting that this may occasionally worsen the condition).
    • Cartilage grafting of the eardrum.
    • Placement of a stent to narrow the tube using nasal endoscopy.
    • Injection of hyaluronic acid or hydroxyapatite.
    • Partial or complete closure of the tube with simultaneous placement of a ventilation tube in the eardrum.