June 11, 2021

Simple "Sticker" Treatment for Patulous Eustachian Tube?


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. You can watch a video 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.

Treatment

Over the years, a number of different treatment strategies have been proposed to address patulous eustachian tube with some success including:

• 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.
• Injection of filler agents (fat, collagen, hydroxyapatite) to the opening of the eustachian tube via trans-nasal endoscopic technique.

"Sticker" Treatment

However, I recently became aware of a fascinating and fairly simple way to treat the symptoms of patulous eustachian tube with a high degree of success. This "sticker" treatment of patulous eustachian tube was described by Dr. Kevin Gietzen on an ENT forum I belong to.

Basically, he places a trimmed steri-strip (normally used to close skin incisions) across the eardrum from anterior to posterior... That's it! It typically lasts for 1-3 months and patients with persistent symptoms can have it reapplied when the steri-strip falls off and symptoms recur.

Rarely, it may make symptoms worse such that the steri-strip would have to be removed (which would be painful... just like taking any very sticky tape off the skin). However, Dr. Gietzen reports 90%+ have significant improvement in symptoms.

When using a steri-strip, he trims it such that it is 15-20mm long and 4-5mm wide. The steri-strip needs to be long enough so one can fold a couple mm’s of one end on itself to use as the portion that can be grasped with Alligator forceps. If the strip is too long, it can catch easily on the ear canal hairs and be difficult to direct into the canal. If it’s too short, it can be uncomfortable for the patient as the Alligator forceps get deeper and deeper into the ear canal as one attempts to place the steri-strip. Also, about 1/2 the length of the strip is in the ear canal when the steri-strip is placed successfully.

To determine whether steri-strip placement will help, one can first liberally apply ointment to the posterior half of the eardrum to see if it helps with symptoms. 

It is theorized that this treatment technique works by putting a "weight" on the eardrum stiffening it, especially on the posterior aspect of the eardrum which is the most mobile part. 

This approach was first investigated by Dr. Manohar Bance who used blue tack.

Reference:
Simple mass loading of the tympanic membrane to alleviate symptoms of patulous eustachian tube. J Otolaryngol Head Neck Surg. 2010 Jun;39(3):259-68.


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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