Patulous Eustachian Tube Treatment & Management
- Author: Alpen A Patel, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA more...
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
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.
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:
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. 
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%).
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.
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.
O'Connor AF, Shea JJ. Autophony and the patulous eustachian tube. Laryngoscope. 1981 Sep. 91(9 Pt 1):1427-35. [Medline].
Henry DF, DiBartolomeo JR. Patulous eustachian tube identification using tympanometry. J Am Acad Audiol. 1993 Jan. 4(1):53-7. [Medline].
Rotenberg BW, Busato GM, Agrawal SK. Endoscopic ligation of the patulous eustachian tube as treatment for autophony. Laryngoscope. 2013 Jan. 123(1):239-43. [Medline].
Boedts M. Paper patching of the tympanic membrane as a symptomatic treatment for patulous eustachian tube syndrome. J Laryngol Otol. 2014 Mar. 128(3):228-35. [Medline].
Bluestone CD, Cantekin EI. "How I do it"--otology and neurotology. A specific issue and its solution. Management of the patulous Eustachian tube. Laryngoscope. 1981 Jan. 91(1):149-52. [Medline].
Cairns W. The patulous Eustachian tube syndrome. Palliat Med. 1998 Jan. 12(1):59-60. [Medline].
Chen DA, Luxford WM. Myringotomy and tube for relief of patulous eustachian tube symptoms. Am J Otol. 1990 Jul. 11(4):272-3. [Medline].
DiBartolomeo JR, Henry DF. A new medication to control patulous eustachian tube disorders. Am J Otol. 1992 Jul. 13(4):323-7. [Medline].
Dyer RK Jr, McElveen JT Jr. The patulous eustachian tube: management options. Otolaryngol Head Neck Surg. 1991 Dec. 105(6):832-5. [Medline].
Hazell JW. Tinnitus. II: Surgical management of conditions associated with tinnitus and somatosounds. J Otolaryngol. 1990 Feb. 19(1):6-10. [Medline].
Kano S, Kawase T, Baba Y, et al. Possible new assessment of patulous Eustachian tube function: audiometry for tones presented in the nasal cavity. Acta Otolaryngol. 2004 May. 124(4):431-5. [Medline].
Morita M, Takeda N, Hasegawa S, et al. Effects of anti-cholinergic and cholinergic drugs on habituation to motion in rats. Acta Otolaryngol. 1990 Sep-Oct. 110(3-4):196-202. [Medline].
Poe DS, Abou-Halawa A, Abdel-Razek O. Analysis of the dysfunctional eustachian tube by video endoscopy. Otol Neurotol. 2001 Sep. 22(5):590-5. [Medline].
Robinson PJ, Hazell JW. Patulous eustachian tube syndrome: the relationship with sensorineural hearing loss. Treatment by eustachian tube diathermy. J Laryngol Otol. 1989 Aug. 103(8):739-42. [Medline].
Sehhati-Chafai-Leuwer S, Wenzel S, Bschorer R. Pathophysiology of the Eustachian tube--relevant new aspects for the head and neck surgeon. J Craniomaxillofac Surg. 2006. 34(6):351-4. [Medline]. [Full Text].
Stroud MH, Spector GJ, Maisel RH. Patulous eustachian tube syndrome. Preliminary report of the use of the tensor veli palatini transposition procedure. Arch Otolaryngol. 1974 Jun. 99(6):419-21. [Medline].
Tolley NS, Phelps P. Patulous eustachian tube: a radiological perspective. J Laryngol Otol. 1990 Apr. 104(4):291-3. [Medline].
Virtanen H, Palva T. Surgical treatment of patulous eustachian tube. Arch Otolaryngol. 1982 Nov. 108(11):735-9. [Medline].
Yoshida H, Kobayashi T, Takasaki K, et al. Imaging of the patulous Eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique. Acta Otolaryngol. 2004 Oct. 124(8):918-23. [Medline].