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Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities

Ward, Bryan K.*; Ashry, Yehia; Poe, Dennis S.

doi: 10.1097/MAO.0000000000001543
MEDICAL NEUROTOLOGY
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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, χ2). 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.

*Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland

Department of Otolaryngology—Head and Neck Surgery, Boston Children's Hospital, Boston, Massachusetts

Address correspondence and reprint requests to Bryan K. Ward, M.D., Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287; E-mail: bward15@jhmi.edu

No external funding was acquired for this work.

The authors disclose no conflicts related to the diagnosis of Patulous Eustachian tube. Dennis Poe—Acclarent, no equity interest; completed trial for Eustachian tube dilation balloons, financial interest in nasal spray for otitis media (not yet in phase I trials).

IRB #—P00010498.

Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company