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Patulous Eustachian tube
Classification and external resources
ICD-9 381.7
eMedicine ent/359

Patulous Eustachian tube, also known as patent Eustachian tube, is the name of a rare physical disorder where the Eustachian tube, which is normally closed, instead stays intermittently open. When this occurs, the patient experiences autophony, the hearing of self-generated sounds. These sounds, such as one's own breathing, voice, and heartbeat, vibrate directly onto the ear drum and can create a "bucket on the head" effect.

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Symptoms

Patulous Eustachian tube sounds very similar to the standard congestion one gets from a cold or allergies, though there are subtle differences. The effect is often described as "drier"; with normal congestion, breathing and talking echo in the head with a muffled sound. With patulous Eustachian tube, all breaths echo on the eardrum without the muffled effect. Similarly, external noises such as the voices of other people are also not muffled. In addition, patulous Eustachian tube generally feels dry with no clogged feeling or sinus pressure.

Some patients with this condition are debilitated by the perceived volume of their voice, causing them to speak very quietly. Their own voice may also sound lower to other people, because the trachea has more volume when the Eustachian tube is open. The patient may also sound as if they have congestion when speaking. Some sufferers may have difficulty in normal activities. Increased breathing rate, such as that brought on by physical activity, would cause more air to be pushed onto the eardrum more frequently, which can become quite loud and sometimes lead to a period of increased tinnitus after exertion.

Diagnosis

Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly view the tympanic membrane with a light and observe that it vibrates with every breath taken by the patient. A tympanogram may also help with the diagnosis. Patulous Eustachian tube is likely if brisk inspiration causes a significant pressure shift.

Patulous Eustachian tube is frequently misdiagnosed as standard congestion due to the similarity in symptoms and rarity of the disorder. Audiologists are more likely to recognize the disorder, usually with tympanometry or nasally delivered masking noise during a hearing assessment, which is highly sensitive to this condition.[1].

When misdiagnosis occurs, a decongestant medication is sometimes prescribed. This type of medication aggravates the condition, as the Eustachian tube relies on sticky fluids to keep closed and the drying effect of a decongestant would make it even more likely to remain open and cause symptoms. The misdiagnosed patient may also have tubes surgically inserted into the eardrum, which increases the risk of ear infection and will not alleviate patulous Eustachian tube. If these treatments are tried and failed, and the doctor is not aware of the actual condition, the symptoms may even be classified as psychological.

Incidentally, patients who instead suffer from the even rarer condition of superior canal dehiscence are at risk for misdiagnosis of patulous Eustachian tube due to the similar autophony in both conditions.

Causes

Patulous Eustachian tube is a physical disorder. The exact causes may vary depending on the person. Weight loss is a commonly cited cause of the disorder due to the nature of the Eustachian tube itself. Fatty tissues hold the tube closed most of the time in healthy individuals. When circumstances cause overall body fat to diminish, the tissue surrounding the Eustachian tube shrinks and this function is disrupted.[2]

Activities and substances which dehydrate the body have the same effect and are also possible causes of patulous Eustachian tube. Examples are stimulants (including caffeine) and exercise. Exercise may have a more short-term effect than caffeine or weight loss in this regard.

Pregnancy can also be a cause of patulous Eustachian tube due to the effects of pregnancy hormones on surface tension and mucous in the respiratory system.[3]

Treatment

There are few standard medical treatments and "home remedies" for patulous Eustachian tube, only one has been developed as a result of scientific studies monitored by the FDA. Recently, Patulous Eustachian Tube disorders have been alternatively identified as Di Bartolomeo Syndrome.

Historically, to temporarily alleviate symptoms, patients may try to tilt their head to one side or upside down, lie down on their backs, or sit in a chair with their head between their knees. Similarly, a routine of lying down four times per day with legs elevated to around 20 inches for at least two weeks may give longer improvement in some cases. Depending on the underlying cause of the disorder, the individual may need to remove caffeine from their diet, reduce exercise, or gain weight.

Medically, the pharmaceutical Patul-END nasal drops have been improved. The new formulation is drug free and available Over-the-Counter without a prescription. At this point in time it is available only by direct order from the developer J. Di Bartolomeo, M.D. through the research website http://www.earfdn.org. In extreme cases surgical intervention may attempt to "bulk up" the Eustachian tube tissues with fat, gel foam, or cartilage or scar it closed with cautery. These methods are not always successful.

More recently, Canadian doctors have found that applying a pea-sized dollop of Blu-Tack to the eardrum reduces vibrations and may provide relief. Trials are said to be starting soon and the procedure itself can be performed in under a minute without anesthesia by an ear nose and throat doctor. The Blu-Tack has to be replaced at regular intervals. [4]

External links

References

  1. ^ Hori, Y., Kawase, T., Hasegawa, J., Sato, T., Yoshida, N., et al. (2006). Audiometry with nasally presented masking noise: Novel diagnostic method for patulous eustachian tube. Otol Neurotol, 27, 596-599.
  2. ^ Patulous Eustachian Tube Overview at eMedicine [1]
  3. ^ Hillman, Edawrd J. (1995). Otolaryngologic Manifestations Of Pregnancy. BCM
  4. ^ "Could a blob of Blue-Tack really make you hear better? http://www.dailymail.co.uk/health/article-1208835/Could-blob-Blue-Tack-really-help-hear-better.html

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