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What is Patulous Eustachian Tube? - Caravaggio - 01-28-2019 Patulous Eustachian Tube Overview By Kristin Hayes, RN  | Reviewed by Susan Olender, MD Updated November 30, 2018 Your eustachian tubes, also called auditory 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 your eustachian tube remains wide open or patulous. It is an uncommon condition only affecting about 3 out of 1000 people. Causes of Patulous Eustachian Tube The cause of patulous eustachian tube is usually unknown. However, there are several factors that may predispose you to develop 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 (TMJ) significant weight loss neurological disorders (stroke, multiple sclerosis, trauma to facial nerves) excessive gum chewing or frequently forced nose blowing Symptoms Related to Patulous Eustachian Tube If you are suffering from a patulous Eustachian tube you may have one or more of the following symptoms: autophony this is the most common symptom and a classic sign of patulous eustachian tube (more on this symptom below) tinnitus (ringing in the ears) a feeling that the ear is stuffed up or clogged Autophony Autophony is a condition where you hear unusually loud feedback of your own voice, breathing, and heartbeats. This is a classic hallmark symptom of a 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 a 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 in the U.S. However your doctor could recommend a mixture such as: 1 part salicylic and 4 parts boric acid powder, diluted hydrochloric acid, chlorobutanol, or benzyl alcohol with saturated potassium iodide. These alternate nasal spray mixes have not received FDA support yet. While many inner ear conditions can receive symptom relief from using nasal decongestants or steroids, this practice will likely worsen your symptoms of PET 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, surgical treatments may be more effective. The most common surgical intervention is the placement of a tympanostomy tube. 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 the surgical placement of ear tubes. However, ear tube placement is a fairly simple procedure with few side effects and the synthetic tubes can be removed if they do not provide relief for you. Another less invasive method for treating patulous eustachian tubes is referred to as mass loading. In this procedure, your doctor will mold Blu Tack (a pressure-sensitive adhesive) to your eardrum. 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 eardrum, which reduces its reaction to low-frequency sounds. Other more invasive therapies that are continually being studied, and not available in all areas include: injecting the eustachian tube with Teflon, silicon, cartilage, or other filling agents - caution should be exercised, as an 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 the 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.