Are you worried that you are able to hear your own voice or breathing? Does your voice sound louder than normal? You may be experiencing symptoms of a condition called a patulous eustachian tube. Let’s find out more about it. 

What is The Eustachian Tube?

The eustachian tube is a small tube that connects the middle ear to the back of your throat (nasopharynx). The eustachian tube (ET):

  • Aids in equalising ear pressure.

  • Drains the fluid from the middle ear into the nasopharynx.

  • Protects the ear from reflux of nasopharyngeal secretions.

  • Protects your ear from self-generated sounds (such as self-vocalisation and breathing).

Most often, the ET is closed. However, during certain activities (such as yawning, swallowing, sneezing and during the Valsalva maneuver) it remains open to equalise the pressure within the middle ear. 

 The funny feeling or ear popping sound you hear during your flight travel is due to the opening up of the eustachian tube to accommodate the rapid pressure changes caused by the ascent or descent of the flight.

What is a Patulous Eustachian Tube?

Patulous Eustachian tube (PET) is a benign but symptomatically disturbing condition in which the ET stays open most of the time, instead of remaining closed. 

 When this occurs, you may experience symptoms including:

  • Autophony (hearing one’s voice or breathing).

  • A sensation of fullness in the ear.

  • Dizziness or vertigo.

  • Ringing sensation in the ear (tinnitus).

  • Discomfort or ear pain (one or both ears).

  • Hearing loss.

Prevalence of PET

Although there is no specific information available for India, the global data suggests that approximately 1% of adults have a patulous eustachian tube (PET), which is a form of eustachian tube dysfunction (ETD).

Causes of PET

Causes of PET include:

  • Sudden weight loss.

  • High levels of estrogen (such as in pregnancy, birth control pills or hormone replacement therapy).

  • Enlargement of adenoids and tonsils, especially in children.

  • Radiation therapy to head and neck.

  • Stress and exhaustion.

  • Environmental allergies.

  • Certain medications (such as diuretics).

  • Neurological disorders (stroke, multiple sclerosis, etc.).

  • Nasal polyps or tumours.

  • Smoking.

Diagnosis of PET

The diagnosis is made based on your medical history, symptoms, and examination of the ear. Tests may include:

  • Otoscopic examination of the tympanic membrane during rapid nasal breathing.

  • Nasopharyngeal endoscopy may show a defect in the eustachian tube valve.

  • Impedance tympanometry.

  • CT (computed tomography) to rule out superior semicircular canal dehiscence syndrome.

Treatment of PET

While every patient is different and no standard treatment has been found to work for every patient, there are several treatment options used to successfully manage symptoms in different patients.  

Lifestyle Modifications

Remember to:

  • Stay well hydrated.

  • Avoid regular use of nasal decongestants.

  • Avoid caffeine.

  • Recline or lower your head between your knees. It can temporarily relieve the symptom as in these positions, there is transient swelling of the tissues, forcing the eustachian tube to close. 

  • Maintain a healthy weight, especially if you are underweight.

Medical Management

Medical management used to treat PET includes:

  • Nasal sprays: Saline nasal spray is the most common treatment. If steroids are used, they need to be tapered gradually to prevent recurrence of symptoms or withdrawal of symptoms.

  • Medications: Nasal spray or topical creams containing anticholinergics or estrogen are often used. Mucous thickening or bulking agents (sodium iodide, Lugol-gel etc.) help in inducing physiological edema, providing temporary relief. Your doctor may also prescribe systemic antihistamines in cases of allergies.

Surgical Management

Surgical repair can be considered in chronic and severe cases that have failed to respond to conservative or medical treatment. Surgical procedures include:

  • Tympanic membrane manipulation (tympanostomy tube insertion and mass loading of the TM).

  • Injecting the eustachian tube with cartilage-filling agents.

  • Transtympanic plug surgery (Kobayashi plug).

  • Cauterising the eustachian tube.

  • Endoscopic ligation of the patulous tube (especially in case of valve defect).

Take Away

Many people experiencing any of the above-mentioned symptoms turn to antihistamines or decongestants for quick relief. Some doctors may even recommend them for PET. However, these medications may or may not provide any relief. On the contrary, they can worsen the symptoms. Therefore, you must seek medical help if and when the symptoms do occur.

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.