January 22, 2011

Patulous Eustachian Tube Video

In perhaps one of the most flagrant cases of patulous eustachian tube I've ever seen, the New England Journal of Medicine published a video showing the eardrum moving with respiration.

Normally, the eustachian tube (which extends from the back of the nose to the ear) is closed unless one pops the ears (like when flying in an airplane). As such, one does not normally see the eardrum moving to and fro with breathing.

Symptoms this poor patient with patulous eustachian tube may exhibit include hearing one's own breathing inside the ear as well as autophonia (hearing yourself talk in the ear). Symptoms improve transiently when the head is placed in a dependent position (head between the knees).

Treatment is very difficult. Perhaps the best medical treatment for this condition is PatulEND Nasal Drops that works about 60-70% of the time. It is sold by the Ear Foundation in Santa Barbara, CA. One needs to sniff 2-4 drops of this medication 1-2x per day.

Other medical treatments that can be tried that may partially help with symptoms include placement of ear tubes, SSKI (super-saturated potassium iodide), premarin drops, and reserpine. Perhaps the best treatment I've seen for Patulous Eustachian Tube is that provided by Dr. Dennis Poe at Massachusetts Eye and Ear Infirmary in Boston, MA. He performs a minimally invasive endoscopic insertion of a tiny catheter into the eustachian tube. The catheter is just the right size that one can still pop ears easily to prevent eustachian tube dysfunction, but large enough so that one does not suffer the symptoms of patulous eustachian tube. There are other more invasive surgical obliteration methods that also works well, but with unfortunate trade-offs.

The most common problem seen in the clinic regarding the eustachian tube is actually the complete OPPOSITE problem of patulous eustachian tube. It is eustachian tube dysfunction or the "clogged" ears whereby the ear feels full of pressure and one just is not able to pop the ears to release the pressure. In this situation, the eustachian tube stays closed, even when trying to pop the ears.

Check out the video below or here illustrating the problem with patulous eustachian tube.

PatulEND for patulous eustachian tube SSKI

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


Anonymous said...

I have had a problem with my right ear for 6 years. It started with a brief bout of dizziness/dysequilibrium which quickly passed. I then had the feeling of my right ear being "dead." I get no feedback from it. I also have a tenderness to palpation of my upper jaw. With a family history of brain tumors, I've had LOTS of tests: multiple hearing tests (fine), CT and MRI of the head (fine), a trial of SSKI (did nothing), saw 3 ENTs with NO HELP. I just learned to live with it but now have tried a new strategy. I'm now seeing a D.O. who specializes in the cranium. We'll see where this takes me. It sure is frustrating, though.

Unknown said...

Sir, How SSKI helps in patulous ET? when they are basically mucolytic agents?

Banner Map

Pediatric Neck Masses

Adult Neck Mass Workup