Patulous Eustachian Tube (PET) is a disorder where the Eustachian tube, typically closed at rest, remains abnormally open, either intermittently or constantly. The tube’s primary role is to protect the middle ear, clear secretions, and equalize pressure. When it stays open, it creates an open channel between the middle ear and the nasopharynx. Its duration is highly variable and depends directly on the underlying cause and the management approach chosen. For some, symptoms are transient and resolve quickly, while for others, the condition can become chronic and persistent, requiring ongoing intervention.
The Mechanism and Causes of Patulous Eustachian Tube
The Eustachian tube is a narrow passage connecting the middle ear to the upper throat. Normal function relies on it being closed except when swallowing, yawning, or sneezing. Closure is maintained by the tube’s intrinsic elasticity and the surrounding soft tissue pressure, particularly a fat pad known as Ostmann’s fat pad. In Patulous Eustachian Tube, this closure mechanism fails, and the tube becomes abnormally patent, allowing pressure changes from breathing to affect the middle ear.
The most commonly cited cause for this malfunction is rapid or significant weight loss, which is thought to be associated with up to one-third of reported cases. The loss of overall body fat includes the reduction of the fatty tissue surrounding the Eustachian tube, causing the tube to lose the external pressure needed to keep it closed. Activities and substances that cause dehydration, such as intense exercise or the use of stimulants and diuretics, can similarly reduce the volume of the soft tissue and fluids around the tube, triggering temporary symptoms.
Hormonal fluctuations, such as those that occur during pregnancy or with the use of high-estrogen oral contraceptives, are also recognized as potential triggers for Patulous Eustachian Tube. Pregnancy hormones can affect the surface tension and mucus in the respiratory system, potentially influencing the tube’s patency.
Certain neurological conditions that cause muscle atrophy, or scarring from radiation therapy or past surgeries like adenoidectomy, can also impair the muscle function or structural integrity needed for proper tube closure. A small number of cases are considered idiopathic, meaning the specific cause is unknown.
Distinctive Symptoms and Clinical Diagnosis
The abnormally open Eustachian tube creates a set of characteristic symptoms that are highly bothersome to the affected individual. The most distinct symptom is autophony, which is the unusually loud hearing of one’s own voice, breathing, and the sounds of blood flowing, sometimes described as a “bucket on the head” effect. This happens because the tube directly transmits self-generated sounds and pressure variations from the nasopharynx to the middle ear.
Many patients also experience a persistent feeling of aural fullness or a blocked ear. These symptoms are often exacerbated by physical exertion or when standing upright, and they may temporarily improve when lying down or bending over at the waist. The change in body position increases venous pressure in the head, which can cause the soft tissues around the tube to swell slightly and temporarily close the opening.
A physician confirms the diagnosis by observing the eardrum, often using a procedure called nasopharyngoscopy. The open tube allows pressure changes from breathing to reach the middle ear, causing the eardrum to visibly move in synchrony with the patient’s inhales and exhales. The diagnosis can be further supported by specific maneuvers, such as observing the eardrum’s movement during a brisk sniff or with a shift in the patient’s body position.
Factors Determining How Long PET Lasts
The duration of Patulous Eustachian Tube is directly linked to the nature and reversibility of the underlying cause. In cases of transient or acute Patulous Eustachian Tube, the condition typically resolves quickly, often within a few days or weeks, once the temporary trigger is removed. This might occur if the symptoms were caused by acute dehydration from an illness or intense exercise, or if they were a side effect of a short-term medication.
If the underlying cause is easily identifiable and reversible, the prognosis for a short duration is favorable. For example, symptoms triggered by a temporary period of high caffeine intake or a short course of diuretics will likely cease once those factors are eliminated.
However, Patulous Eustachian Tube becomes chronic or persistent when the cause involves a sustained structural change, such as the significant loss of fatty tissue around the tube following rapid weight loss or bariatric surgery. When the fat pad that helps keep the tube closed has permanently reduced, the condition will persist unless the lost tissue is restored or the tube is medically or surgically narrowed. In these persistent cases, the condition often stabilizes, but symptoms will only resolve if the root cause is successfully addressed or an intervention is performed.
Treatment Approaches and Prognosis
Management of persistent Patulous Eustachian Tube begins with conservative, non-invasive strategies aimed at alleviating symptoms and addressing reversible factors. Simple measures include:
- Increasing fluid intake to improve hydration.
- Using saline nasal spray to moisten the mucosal lining and encourage slight swelling of the tissues near the tube opening.
- Avoiding activities that worsen symptoms, such as vigorous exercise and excessive sniffing.
- Temporarily modifying position, such as lying down with the head low.
If conservative measures are not sufficient, medical interventions may be used to increase the bulk or congestion of the tissue around the tube. This can involve the use of prescription nasal drops designed to irritate the mucosal lining, or the topical application of estrogen nasal ointment to promote tissue swelling. These medical treatments aim to narrow the tube’s opening, reducing the transmission of sound and pressure, but they must be used carefully due to potential side effects.
For individuals with severe, chronic Patulous Eustachian Tube that does not respond to conservative or medical management, surgical options are considered. These procedures focus on narrowing or partially occluding the lumen of the Eustachian tube. Techniques include injecting bulk-forming agents, such as fat or cartilage, into the tissue surrounding the tube orifice, or placing a small device to partially plug the opening. While Patulous Eustachian Tube can be frustrating and significantly reduce quality of life, a high percentage of patients achieve symptom control or resolution through a targeted, stepwise treatment approach.