Patulous Eustachian tube

Patulous Eustachian tube is the name of a rare physical disorder where the Eustachian tube, which is normally closed, instead stays intermittently open. As a result, when it is open, all of the patient's breathing, talking, swallowing, heart beat, etc. vibrates directly on the ear drum creating an effect that sounds like the patient has a bucket on his/her head.

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Diagnosis

Many patients will be misdiagnosed with this disorder due to the fact that the symptoms closely resemble those of standard congestion (due to cold or allergies) or Eustachian tube dysfunction. The problem with this is that treatment for congestion or Eustachian tube dysfunction will make patulous Eustachian tube worse because the disorders are opposite one another. One major symptom that will tell the two apart is if when a patient with patulous Eustachian tube flips their head upside down, the symptoms clear up temporarily. This will not happen with either congestion or Eustachian tube dysfunction. If you have access to an audiologist (hearing scientist) they should be able to diagnose the condition with little difficulty. The use of tympanometry or even the use of nasally delivered masking noise when conducting a hearing assessment is highly sensitive to this condition (a).

What it sounds like

It sounds very similar to the standard congestion one gets from a cold or allergies. If you listen carefully, though, there are a couple subtle differences: (1) The effect sounds drier. When you have normal congestion your breathing and talking echoes in your head, but muffled. With PET you hear ALL of your breaths echo on your ear drum, and they aren't muffled. (2) Everything on the outside world sounds the same. Other people's voices aren't muddled at all, like they commonly are with congestion. Some people are very debilitated by the perceived volume of their voice, causing them to speak very quietly. You may find that lying down or bending over closes the tube and eliminates the problem. Many people lie down to speak on the phone.

What others will notice

Your voice will sound lower to other people because with the Eustachian tube open the trachea has more volume. Most people will ask if you have a cold because your voice sounds "stuffed up."

What it feels like

The easiest way to distinguish PET from congestion is by how it feels. With PET you aren't blowing your nose, and you don't feel any sinus pressure. Your ears don't feel clogged, they feel dry. Also try the temporary treatments listed below and see if those help. If they do, it is likely PET, because they don't usually do anything for congestion.

What it looks like

A doctor looking directly at your ear drum with his light will be able see that every breath you take vibrates the drum. You can also get a tympanogram while briskly inspiring and note a significant pressure shift.

Playing sport

People who suffer from PET can find playing sport difficult as the increased breathing pushing onto the ear drum can become very noisy and can sometimes lead to a period of increased tinnitus after the event.

Cause

PET is a physical disorder. The exact causes may vary depending on the person, however weight loss is a very common cause. [1]The eustachian tube remains closed when normal most of the time, and there is fat tissue surrounding it that holds it closed. Weight loss, even as little as 5 lb (2 kg), may be enough to cause the tissue surrounding the Eustachian tube to shrink. This will cause it to remain open.

Caffeine, especially the amount in coffee, is also a major cause, as it may dehydrate enough to affect the surrounding tissue. Exercise does the same thing, although for a shorter amount of time.

Pregnancy can also be a cause of PET due to the effects of pregnancy hormones on surface tension and mucous in the respiratory system. [2][3]

Treatment

Temporary treatments

• Tilt your head to the side or flip it upside down.
• Lie down on your back.
• Sit in a chair and put your head between your legs.
• Pinch your jugulars (where you take your pulse in your neck) for a few seconds.

More rigorous treatments

• Weight gain [4]
• Lying down 4 times a day for 15 minutes each with legs raised on stairs or a chair—about 20 inches. Recommend first time when you get up in the morning and last time just before going to bed at night. Within about 2 weeks noticed improvement. *Discontinue exercise during this program. [5]
• Jia-Wei-Gui-Pi-Tang [6] - an herbal tea. (This is considered an alternative therapy)
• Discontinue coffee use.
• For the very distressed surgical interventions aimed at "bulking up" the ET (with fat, gel foam, or cartilage) or scarring the ET closed (with cautery) can be tried, but are not always successful.

Long term complications

Because at face value PET seems like standard congestion both to yourself and others, a decongestant is usually prescribed which will make the situation worse. The Eustachian tube relies on sticky fluids to keep it closed, and the decongestant will dry the tube out making it stay open even more. Because of the rarity of PET, even ear-nose-throat specialists often misdiagnose it. And sometimes doctors will tell the patient to have a tube surgically inserted into their ear drum to no avail... a tube which puts the patient at constant risk of an ear infection from normal activities like swimming in a lake. And in some cases, exhausted doctors who have tried every treatment might conclude that the patient has a psychological rather than physical disorder.

References

(A) Hori, Y., Kawase, T., Hasegawa, J., Sato, T., Yoshida, N., et al. (2006). Audiometry with nasally presented masking noise: Novel diagnostic method for patulous eustachian tube. Otol Neurotol, 27, 596-599.