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Tympanic Membrane Manipulation to Treat Symptoms of Patulous Eustachian Tube

Brace, Matthew D.*; Horwich, Peter; Kirkpatrick, David*; Bance, Manohar*

doi: 10.1097/MAO.0000000000000320
Middle Ear and Mastoid Disease

Objective Patulous eustachian tube (PET) can have a significant negative impact on a patient’s quality of life. Previous work has demonstrated that temporarily mass loading and stiffening the tympanic membrane significantly reduces these symptoms. This study examined KTP laser myringoplasty (LM) and cartilage tympanoplasty (CT) as a means to manipulate the tympanic membrane to alleviate PET symptoms.

Study Design Retrospective case review.

Setting Academic tertiary care referral hospital.

Patients Patients (n = 20) were identified from the senior authors’ (M.B.) specialty eustachian tube disorders clinic. Patients met previously established diagnostic criteria for PET. All patients had a clinically apparent flaccid segment of the eardrum and had symptom improvement after simple mass loading of their eardrum in the clinic.

Interventions Patients in this study received either KTP LM (10 patients, 15 ears) or CT (10 patients, 11 ears) to treat their flaccid eardrum segment in an attempt to alleviate PET symptoms.

Main Outcome Measures Preoperative and postoperative questionnaire scores and tympanometry measurements were compared.

Results Patients undergoing CT for PET had a significant reduction in their symptoms of autophony (p ≤ 0.001), conducted breath sounds (p = 0.001), and aural fullness (p = 0.009). KTP LM did not significantly reduce symptoms.

Conclusion Cartilage tympanoplasty provides a safe and accessible surgical option for the treatment of PET and significantly reduces the symptoms of autophony, conducted breath sounds, and aural fullness. Further studies are needed to investigate whether addressing PET symptoms simultaneously from both the tympanic membrane and the eustachian tube orifice can improve patient symptoms even further.

Supplemental digital content is available in the text.

*Division of Otolaryngology – Head and Neck Surgery and †Faculty of Medicine – Dalhousie University, Halifax, Nova Scotia, Canada

Address correspondence and reprint requests to Manohar Bance, M.B., M.Sc., F.R.C.S.(C), Rm 3184, 3rd Floor Dickson Building, VG site, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, Canada B3H 2Y9; E-mail:

The authors disclose no conflicts of interest.

No funding was received for this study

Supplemental digital content is available in the text.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company