ALL

a chronically patent (open) eustachian tube

• Severe weight loss (causing a loss of fatty tissue surrounding the eustachian tube)

• Mucosal scarring and/or atrophy

• Neuromuscular disorders (causing muscle atrophy)

• Usually asymptomatic

• Autophony: abnormally loud hearing of one's own voice (hallmark of patulous eustachian tube)

• Aerophony: hearing of one's own breathing (most specific symptom)

• Symptoms disappear when patients lie down and with increasing abdominal pressure.

• Otoscopy: detection of tympanic membrane movement that is synchronous with respiration

• Nasal endoscopy: direct visualization of a continuously open eustachian tube and/or defect in the tubal valve

• Tympanometry: detection of tympanic membrane movement that is synchronous with respiration

• Often not required, as the condition does not generally cause ear complications

• General measures

  • Sufficient hydration

  • Nasal application of distilled water

  • Discontinuation of nasal decongestants and nasal steroids

  • Nasal application of pharmacological agents (e.g., anticholinergics and/or estrogens)

  • Oral potassium iodine (used if hydration and topical therapy are not effective)

• Surgery

  • Indication: patients with severe symptoms that diminish their quality of life who do not respond to pharmacological treatment

  • Procedure: tympanic membrane manipulation techniques (e.g., tympanostomy tube insertion) and eustachian tube occlusion techniques (e.g., eustachian tube reconstruction or plugging, injection of bulking agents at its nasopharyngeal orifice)

Although severe weight loss may cause patulous eustachian tube, weight gain is generally not effective at reversing the condition and, therefore, is not recommended.