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Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities
Bryan K Ward1, Yehia Ashry, Dennis S Poe
1*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.
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, χ). Allergy patients also had relief with sniffing and tympanic membrane retraction (p < 0.01, χ). 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.
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