Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities

Bryan Ward, Yehia Ashry, Dennis S. Poe

Research output: Contribution to journalArticle

Abstract

Objective: The objective is to describe a large cohort of patients presenting with patulous Eustachian tube (pET) dysfunction. Study Design: Retrospective patient series. Setting: Tertiary referral center. Patients: All outpatient visits (2004-2016) that were assigned ICD9 code (381.7-Patulous Eustachian tube) were screened. Only patients with observed tympanic membrane movements during ipsilateral nasal breathing or acoustic reflex decay testing demonstrating transmitted nasal breathing were included (n = 190, n = 239 ears). Main Outcome Measures: Demographics and nasopharyngoscopy/otomicroscopy findings by comorbidities. Results: The majority (54%) was female and mean age of symptom onset was 38.0 (SD 20.0) years. Common symptoms included voice autophony (93%), breath autophony (92%), aural fullness (57%), pulsatile tinnitus (17%), and crackling or rumbling sounds (14%). Symptoms increased in frequency and duration with time (65%), were exacerbated with exercise (27%), and improved with placing the head in a dependent position (65%), sniffing (28%), upper respiratory infection (8%), and ipsilateral internal jugular vein compression (12%). In 52% pET was bilateral. Common comorbidities include environmental allergy (49%), weight loss (35%), laryngopharyngeal reflux (33%), anxiety (31%), autoimmunity (13%), and neuromuscular disease (8%). Allergy and anxiety patients were younger and more likely to have tonic contraction of the tensor veli palatini on exam (p < 0.05, χ 2). Allergy patients also had relief with sniffing and tympanic membrane retraction (p < 0.01, χ2). Weight loss patients reported mean loss of 19.7 kg (SD 23.1), and were older, more rapidly diagnosed, and more likely to have persistent symptoms (p < 0.05). Initially, all patients were treated medically, with 47% eventually electing surgical intervention. Conclusion: pET is progressive, often bilateral, and possibly underdiagnosed. In this large series of pET, in addition to weight loss and chronic medical conditions, allergy and stress/anxiety were identified as novel risk factors. Most patients can be treated medically.

Original languageEnglish (US)
Pages (from-to)1362-1369
Number of pages8
JournalOtology and Neurotology
Volume38
Issue number9
DOIs
StatePublished - Oct 1 2017

Keywords

  • Autophony
  • Eustachian tube
  • Patulous Eustachian tube

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

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