In patulous eustachian tube (pET) dysfunction, the eustachian tube stays open most of the time. The eustachian tube is a passageway from the back of the nose to the middle ear that may be opened or closed by action of a valve-like device. Under normal circumstances, it remains closed for most of the day, opening only on occasion to equalize air pressure in the middle ear and the exterior environment.
If the tube remains open, the patient complains of hearing one's own voice or one's breathing as too loud (autophony), hearing echoes of one's own voice, or hearing ocean waves much like the sound produced by holding a shell over one's ear.
The condition is benign but may generate, over time, serious and even extreme responses to the abnormal sounds.
Symptoms of pET include variable intensity of the sensation of fullness in the ear; oceanic roaring sounds associated with breathing; loud, echoing sensations and a sense of hearing one’s own speech at a high volume. There may also be a stopped-up feeling in the ear.
Dizziness may, on occasion, accompany the abnormal sound sensations. The heightened sounds of chewing may be loud enough to interfere with eating.
Patulous eustachian tube results when the eustachian tube is open continuously or for long periods. Under normal conditions, the eustachian tube remains closed because the natural elasticity of the structure tends towards closure or because of surface tension of the interior of the tube (lumen) and pressure by the muscles outside the tube. If any (or all) of these forces fail, the tube does not close.
For reasons that are not clear, the condition is often associated with recent weight loss, and with a high concentration of estrogens in the blood due to pregnancy or medication. Other possible causes of pET dysfunction are neuromuscular disorders such as multiple sclerosis, poliomyelitis, Parkinson’s disease and neurovascular accident. Adhesions and scarring of the pharyngeal recess and of the posterior lip of the pharyngeal opening of the eustachian tube can also result in the disorder.
Patulous eustachian tube is most prevalent in women who have had a significant recent weight loss and in pregnant women. Adults and adolescents are most often affected. Instances of this occurring among children are very rare.
Various epidemiological studies suggest that the incidence of the condition in the general population is 0.3% to 6.6%. Of those affected however, only about 20% seek medical treatment.
A clinical history and patient description of the symptoms are often sufficient for the diagnosis. There are several tests that may be used to confirm the diagnosis, including the detection of movement of the ear drum along with respiration, (tympanometry) and others.
Temporary relief may be achieved by having the affected person lie down or bend forward with the head between the knees. Sniffing can also provide momentary relief.
In some cases, estrogen-based nasal drops or anticholinergics may b. effective. Weight gain may also cause pET to recede.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
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For information about clinical trials sponsored by private sources, contact:
Patulous eustachian tube dysfunction has been treated surgically by cutting the hook around which the tendon of the tensor veli palatini muscle passes (pterygoid hamulotomy) combined with transposition or transection of the tendon of this muscle. Good results have been obtained in approximately 70 percent of persons undergoing this procedure.
The drug Patul-end has received an orphan drug designation for its use in the treatment of patulous eustachian tube. More studies are needed to determine the long-term safety and effectiveness of this drug for the treatment of patulous eustachian tube. For more information, contact:
Ear Foundation (of Santa Barbara)
2420 Castillo Street
Santa Barbara, CA 93105-5307
Telephone: (805) 563-1111
Fax: (805) 563-2277
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FROM THE INTERNET
Patulous Eustachian Tube. emedicine. Last updated: August 6, 2002. 7pp.
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