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Patulous Eustachian Tube Treatment & Management

  • Author: Alpen A Patel, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
Updated: Apr 03, 2015

Medical Therapy

Patients with a patulous eustachian tube who are pregnant and those with mild symptoms (most patients) need informative reassurance alone. Patients who have symptoms during pregnancy are symptom-free after delivery.

Advise patients to do the following:

  • Increase or regain lost weight
  • Avoid diuretics
  • Recline or lower head when symptoms occur

Topical administration (nasal preparation) with anticholinergics may be effective for some patients.

Estrogen (Premarin) nasal drops (25 mg in 30 mL normal saline, 3 gtt tid) or oral administration of saturated solution of potassium iodide (10 gtt in glass of fruit juice tid) has been used to induce swelling of the eustachian tube opening.

Nasal medication containing diluted hydrochloric acid, chlorobutanol, and benzyl alcohol has been demonstrated to be effective in some patients. This has been reported to be well tolerated with little or no adverse effects. Approval by the Food and Drug Administration (FDA) is pending.


Surgical Therapy

The following methods may be used for treatment of a narrow lumen caused by inflammatory response or scar tissue:

  • Bezold's remedy of insufflation of a solution of salicylic acid and boric acid (1:4 ratio) (Repeat treatments are always necessary.)
  • Eustachian tube diathermy with sequential application of ureteric diathermy probe
  • Cautery with 20% silver nitrate

Electrocoagulation has been discarded because of morbidity (ie, damage to middle cranial fossa dura, damage to mandibular nerve).

The following methods may be used for treatment of a narrow lumen caused by extrinsic compression:

  • Paraffin injection
  • Teflon injection anterior to the eustachian tube orifice: Serious complications may occur.
  • Gelfoam injection: Results are good, but temporary; very little morbidity is associated. Autologous fat or cartilage graft plugging of the eustachian tube at its nasopharyngeal orifice, in conjunction with myringotomy and ventilation tube placement, has been successful in some patients. [3]
  • Alter function of palatal muscles with or without pterygoid hamulotomy: Stroud et al (1974) described transposition of tensor veli palatini tendon medial to pterygoid hamulus (transpalatal approach). Transection of tensor veli palatini is another option.
  • Occlusion of the eustachian tube: Bluestone and Cantekin (1981) recommend occlusion of bony eustachian tube with an intravenous indwelling catheter via anterior tympanotomy. A catheter is filled with methyl methacrylate glue, and the tympanostomy tube is inserted to aerate the middle ear and prevent development of serous effusion. The catheter can be removed at any time. A modification of the Bluestone technique involves placement of the catheter through myringotomy.
  • Myringotomy and insertion of a ventilating tube: This may provide temporary relief for some patients. These steps are relatively simple to perform and reversible and have minimal complications. Occasionally, myringotomy and insertion of a ventilating tube result in increasing the patient's discomfort.
  • Surgical scar tissue removal in nasopharynx: This may benefit patients with adhesions from a prior operation.

Rotenberg et al described the successful use of multilayer endoscopic ligation for the treatment of autophony in patulous eustachian tube. Transnasal endoscopy was used in 14 ears to guide treatment combining fat plugging, endoluminal cauterization, and suture ligation, with complete subjective resolution of autophony in nine ears (64.3%) and partial, but sustained and satisfactory, subjective improvement in three others (21.4%).[4]

In a study of 21 patients with patulous eustachian syndrome, Boedts reported that 76.2% obtained relief from autophony via paper patching of the tympanic membrane, with relief being permanent in a portion of these cases. Such patching may reduce autophony by adding greater stiffness to the tympanic membrane.[5]



Eustachian tube diathermy has been associated with complications such as intermittent secretory otitis media, trigeminal nerve damage, and middle cranial fossa dural burns.

Serous effusions have developed in patients treated by silver nitrate or Teflon injections. Teflon injections are also associated with serious complications, including cerebral thrombosis and death. These complications followed inadvertent injection of Teflon into the internal carotid artery, which occurred in the era before the common use of endoscopic placement. Gelfoam or Teflon injections can also result in total obstruction of the eustachian tube. Middle ear effusions can develop in patients undergoing tensor veli palatini transection and/or transposition with or without pterygoid hamulotomy.


Outcome and Prognosis

Patients with vestibular symptoms experience improvement of vertigo with treatment of patulous tube.


Future and Controversies

A discussion of the merits of different treatments is restricted by insufficient numbers and by lack of adequate long-term follow-up data to allow valid conclusions to be drawn. Very little basic research has been performed to investigate mechanisms responsible for normal eustachian tube function. Until more basic research and properly conducted trials are performed, this situation is likely to remain.

Contributor Information and Disclosures

Alpen A Patel, MD, FACS Lead Physician for Hospital Utilization, Mid-Atlantic Permanente Medical Group; Staff Physician, Department of Otolaryngology, Towson Medical Center

Alpen A Patel, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Society of University Otolaryngologists-Head and Neck Surgeons, American Association of Physicians of Indian Origin, American Academy of Otolaryngic Allergy, Phi Beta Kappa

Disclosure: Nothing to disclose.


Samuel C Levine, MD Professor of Otolaryngology and Neurosurgery, University of Minnesota Medical School

Samuel C Levine, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society, Minnesota Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance Institute; Board of Directors, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Vesticon<br/>Received none from Vesticon, Inc. for board membership.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

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Anatomy of the ear.
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