A Patulous Eustachian Tube (PET) is an uncommon physical disorder where the narrow tube connecting the middle ear to the back of the nose and throat remains involuntarily open. The term “patulous” means open, describing the tube’s chronic failure to close properly, which is a change from its normal state of being closed most of the time. While not medically serious, the ongoing symptoms can be significantly distressing and disruptive to daily life.
Normal Function Versus Patulous Tube
The Eustachian tube, also called the pharyngotympanic tube, functions for pressure equalization, protection, and drainage. It primarily works to match the air pressure in the middle ear with the ambient atmospheric pressure outside the body. This is accomplished by briefly opening when a person swallows, yawns, or chews, which allows air to move into the middle ear space.
In a healthy state, the tube remains collapsed and closed at rest, protecting the delicate middle ear structures from the continuous sound and pressure fluctuations of the nasopharynx. The closure is maintained by the tube’s intrinsic elasticity, surface tension from moist mucosal linings, and the surrounding tissue pressure.
Patulous Eustachian Tube occurs when this protective closure mechanism fails and the tube stays abnormally open. This creates a continuous, direct air passage between the middle ear and the nasopharynx, transmitting sounds and pressure changes directly into the middle ear space. The open tube allows pressure variations, such as those created by breathing, to be transferred to the middle ear.
This abnormal transmission of internal sounds is the primary cause of the unique and bothersome symptoms experienced by those with PET. The condition essentially turns the middle ear into a continuous echo chamber for internal body sounds.
The Defining Symptoms
The hallmark symptom of a patulous Eustachian tube is autophony, which is the unusually loud hearing of one’s own voice, breathing, and other self-generated sounds. This phenomenon occurs because the sounds vibrate directly onto the eardrum through the open tube, bypassing the normal dampening mechanisms.
A person may describe their voice as sounding amplified, booming, or like they are speaking into a barrel or bucket. This echoing effect can be severe enough to interfere with normal speech production, causing some individuals to speak more quietly or avoid talking.
Other common sensations include a feeling of fluctuating fullness or blockage in the ear, along with hearing the distinct sounds of inhalation and exhalation. Some people also experience roaring tinnitus, which is a ringing or buzzing sound synchronous with their nasal respiration. This is distinct from standard Eustachian Tube Dysfunction (ETD), which is usually an obstructive condition causing muffled hearing and a persistent plugged feeling due to negative pressure.
Common Triggers and Management Options
The cause of PET is often unknown, but several factors are strongly linked to its onset and worsening. Significant or rapid weight loss is a common trigger, as it can lead to the loss of the fatty tissue pad (Ostmann’s fat pad) that helps keep the tube closed. Dehydration from exercise, diuretics, or insufficient fluid intake can also precipitate symptoms by causing mucosal tissues in the tube to shrink. Hormonal changes, particularly high estrogen levels during pregnancy or from oral contraceptives, are recognized risk factors. Nasal decongestant sprays may also contribute, as they can dry out the mucosal lining of the tube.
Initial management often focuses on non-invasive and lifestyle adjustments aimed at increasing mucosal congestion or reducing the effect of gravity. Lying down or placing the head between the knees can temporarily relieve symptoms by increasing blood flow and causing the tissues around the tube to swell slightly. Maintaining proper hydration and avoiding decongestants and caffeine are simple steps that may help resolve mild symptoms.
If conservative approaches are unsuccessful, medical treatments are considered, with the goal of causing mild swelling to narrow the tube’s opening. This may involve the use of specialized nasal drops, such as saline or ascorbic acid solutions, or drops containing estrogen to thicken the mucosal lining. For severe, persistent cases, surgical options are available to physically narrow or bulk up the tube opening. This is often achieved by injecting bulking agents, such as fat or cartilage, into the tube wall to prevent it from remaining open.