What is Patulous Eustachian Tube: Causes, Symptoms, Treatment, Diagnosis

Patulous Eustachian Tube is a benign but symptomatically discomforting condition pertaining to the ears. This is a condition in which the eustachian tube remains open all the time which under normal circumstances should be closed. Anatomically speaking, the eustachian tube is a tube like structure that runs between middle ear and throat.

The function of the eustachian tube is to maintain the pressure between the middle ear and the external environment ear pressure around the eardrum.^[1,2]

Normally, the eustachian tube opens only on occasions to regulate the ear pressure and remains closed for most of the time. However, in people with Patulous Eustachian Tube, the tube remains open all the time resulting in a variety of discomforting symptoms. The symptoms may range from mild to severe where a person will start feeling fullness in the ear to something as severe as a vertigo or dizziness and even hearing loss.^[1,2]

There is no specific known cause for Patulous Eustachian Tube but pregnancy and weight loss are some of the risk factors that have been identified. There are also certain neurologic conditions like multiple sclerosis or motor neuron disease that can cause Patulous Eustachian Tube.^[1,2]

Use of oral contraceptives and diuretics has also been associated in some cases of Patulous Eustachian Tube. There is no specific treatment for this condition even though there are quite a few treatments given for it with limited success.^[1,2]

As stated, there is specific cause for Patulous Eustachian Tube but there are quite a few risk factors that make a person vulnerable to this condition. These conditions include neurological disorders like multiple sclerosis, stroke, or motor neuron disease of the ALS type. People who start losing weight either intentionally or due to some other illness also are prone to having a Patulous Eustachian Tube. Pregnant females also carry an increased risk of having an open eustachian tube.^[2]

People who undergo a surgical procedure in the nose and throat are also at risk for developing Patulous Eustachian Tube. Stress and anxiety also play a part in the development of this condition along with exhaustion, fatigue and overexertion.^[2]

Why weight loss increases the risk of Patulous Eustachian Tube can be explained by the fact that the fatty tissues and muscles support the eustachian tube and help it in opening and closing. Thus a loss in muscle mass due to weight loss interferes with the working of the tube resulting in Patulous Eustachian Tube.^[1]

Hormonal changes in the body, which is quite common during pregnancy, results in alternating the equilibrium of the fluids and mucous in the body. This in turn has an effect on the eustachian tube causing Patulous Eustachian Tube. The same theory goes for overexertion and use of diuretics where the body loses fluids.^[1]

Additionally, people with TMJ dysfunction where the jaw does not function properly are also predisposed to Patulous Eustachian Tube. This is because if the jaw does not work normally it may affect the working of the eustachian tube as there are some nerves and muscles which are common in both the jaw and the eustachian tube.^[1]

The primary symptom of Patulous Eustachian Tube is hearing the sound of the one’s own heartbeat, pulse, and breathing. These are the sounds that are normally blocked by the brain. Additionally, people with Patulous Eustachian Tube will observe that they are sounding louder than normal when they speak while the person he or she is speaking to will find the speaker’s voice as quiet and deep.^[2]

Sometimes, people with Patulous Eustachian Tube hear an echo of their own voice. This makes it tough for them to speak due to the echo and they tend to speak more quietly and sometimes they even avoid talking. Other symptoms that can be seen in a person with Patulous Eustachian Tube include hearing dysfunction where the sounds appear muffled, tinnitus, ear fullness, and always having an urge to clear the ear.^[2]

Since Patulous Eustachian Tube is not so common and most importantly it does not have a clear cut cause, it is quite tough to diagnose it. Thus, there are no clear rules laid out to diagnose this condition. The physician will perform a general ear evaluation and take a detailed history of the patient. The back of the throat and nose may also be evaluated along with the ear.^[2]

The physician may also order a test called tympanometry in which air pressure is used to check whether the eardrum and the middle ear are transmitting vibrations normally. This can rule out other causes for the symptoms and point towards Patulous Eustachian Tube.^[2]

People with only minor symptoms of Patulous Eustachian Tube do not require any treatment and they can manage this condition on their own. The best way to do it is by sniffing gently. This closes the eustachian tube temporarily. However, this should not be practices too often as it can increase the pressure in the middle ear resulting in damage to the eardrum or the middle ear.^[2]

Another way to manage the symptoms of Patulous Eustachian Tube is by putting the head between the knees. This exercise causes the tissues ion the head to swell up slightly which pushes the eustachian tube to close. If lack of fluid in the ears is believed to be the cause of Patulous Eustachian Tube then there are certain treatments aimed at moistening the membrane to allow it to function normally are quite effective. These treatments include saline nasal drops, hormone nasal drops, and drinking fluids consistently.^[2]

There are also some surgical procedures that are quite effective in treating Patulous Eustachian Tube. The first surgical procedure is minimally invasive and involves insertion of a tube called grommet into the ear. The tube balances the pressure by allowing passage of air through the eardrum. It is a simple procedure and can be done as an outpatient. However, the efficacy of this procedure is not that good.^[2]

The second procedure is quite extensive and involves reconstruction of the entire eustachian tube by removing the lining of the tube and inserting implants that make the tube narrow. This blocks the tube for a few months after which the eustachian tube starts functioning normally again.^[2]

In conclusion, Patulous Eustachian Tube is quite a rare but symptomatically quite discomforting problem. It is mostly temporary. Since there is no specific cause identified and the symptoms are quite similar to other ear dysfunctions it is quite a challenge for physicians to diagnose it and form a treatment plan.^[1,2]

Symptomatically, Patulous Eustachian Tube can significantly hamper the daily life of the patient to the extent that there can be severe hearing loss. As of now, researchers are still working to find a definite treatment for this condition. If the symptoms do not go away with gentle sniffing or other remedies mentioned above then a visit to an ENT specialist is recommended for a confirmed diagnosis and other treatment options for Patulous Eustachian Tube.^[1,2]

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