May 27, 2018

Patulous Eustachian Tube - A Rare Ear Problem

In a normal human middle ear, there is a tunnel that connects to the back of the nose. When pressure builds up in the middle ear such as going up in an airplane, an individual is able to "pop" the ear thereby releasing the pressure and alleviating the clogging sensation.

When this tunnel, called the eustachian tube, becomes swollen shut, an individual is unable to pop the  ear causing a persistent clogged ear sensation. This particular scenario is called Eustachian Tube Dysfunction.

Watch the video below that further demonstrates how the eustachian tube works.

However, patulous eustachian tube is the extreme opposite of Eustachian Tube Dysfunction. With patulous eustachian tube, the eustachian tube is TOO widely open. Although this would obviously prevent pressure buildup in the middle ear, a too widely open eustachian tube causes other problems.

One would hear nasal breathing in and out thru the nose as the air passes by the opening of the eustachian tube. Whenever talking or singing, one would hear the voice echoing up into the ear and head. Patients often state that it feels like they are talking in a barrel. These symptoms are known as autophonia.

This condition is often temporarily alleviated by placing the head down below the knees or by constantly sniffing in thru the nose forcefully.

Although this condition may occur out of the blue, there are certain situations that seem to make it more likely to occur including rapid weight loss and exercise. Inappropriate eustachian balloon tuboplasty surgery over the last few years has become one of the more common causes of this condition.

Treatment is all geared towards trying to close the eustachian tube so that it does not remain persistently open.

Here is a list of treatments that can be tried with some success, though does not always consistently work across patients. The treatments are listed in the order I typically try with patients.

• SSKI (Super Saturated Potassium Iodide) - Place 10 drops in juice and drink 3x per day
• Hypertonic Saline (1.8%) - 3-5 drops 3x per day
• Placement of a hole in the eardrum... and if it helps, to place a tube across the eardrum
• PatulEND 2-4 drops 2x per day (video of instructions for use or read below)
• Premarin nasal spray/drops - 3-5 sprays/drops 3x per day (0.83mg/ml)
• Surgical treatment to plug up the eustachian tube. One promising surgical method is to insert a catheter into the eustachian tube via the nose, an endoscopic technique first described by Dr. Dennis Poe in Boston.
• Placing a weight of some kind on the eardrum using ointment or a steri-strip.
• Injection of filler agents (fat, collagen, hydroxyapatite) to the opening of the eustachian tube via trans-nasal endoscopic technique.

When using nasal drops, technique is important as one is trying to get the liquid to where the eustachian tube opening is located in the very back of the nose. With use, the patient should lie down (Mygind's Position) or tilt their head far back (head-tipped-back position), then turn 45 degrees towards the effected ear. With proper placement, there should be a mild temporary stinging sensation in the ear.

For illustrations on proper use:

This first way is the "Head-Tipped-Back Position". Note that the head also needs to be turned slightly towards the affected ear (45 degrees).

In this position, the nasal drop will "fall" down to where the eustachian tube is located:
Mygind's Position is the alternative position which accomplishes the same thing, but the person is laying down looking up. For some people, this position is more comfortable than bending the head back. Note that the head also needs to be turned slightly towards the affected ear (45 degrees).

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.

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