Aural fullness-dominant patulous eustachian tube: Clinical characteristics based on objective findings

Patulous Eustachian tube (PET) presents with diverse symptoms, including voice autophony, breathing autophony, and aural fullness. Among these, aural fullness is considered non-specific and its clinical significance in PET remains unclear. This study aimed to clarify the clinical characteristics of aural fullness-dominant PET by comparing objective findings according to the dominant symptom.

Patients who visited a specialized Eustachian tube clinic between June 2019 and December 2025 were screened. Among 394 patients evaluated using a self-administered questionnaire, 109 patients with definite PET diagnosed according to the 2016 Japan Otological Society criteria were included. Patients who selected only one of the three characteristic PET symptoms were classified into Group A (voice autophony, n = 45), Group B (breathing autophony, n = 10), and Group C (aural fullness, n = 54). Patient background factors and objective findings-including respiratory tympanic membrane (TM) movement, tubo-tympano-aerodynamic graphy (TTAG), sonotubometry (ST) probe tone level, and Patulous Eustachian Tube Handicap Inventory-10 (PHI-10) score-were compared among groups. Multivariable logistic regression analysis was performed to identify factors independently associated with aural fullness-dominant PET.

Age, sex, and habitual sniffing did not differ significantly among the three groups. The prevalence of respiratory TM movement differed significantly, being lower in Group C than in Groups A and B (p < 0.005). TTAG positivity exceeded 70% in Groups A and B, while Group C showed a slightly lower rate without statistical significance. ST probe tone levels were significantly higher in Group C than in Group A (p < 0.05). PHI-10 scores did not differ among groups. In multivariable analysis, absence of respiratory TM movement was independently associated with aural fullness dominance (odds ratio 0.24, 95% confidence interval 0.08-0.68, p = 0.008), whereas TTAG findings and probe tone levels were not.

Aural fullness-dominant PET exhibits fewer overt dynamic TM findings despite sharing other objective features of Eustachian tube opening with autophony-dominant cases. These results suggest that aural fullness in PET is influenced not only by the degree of tubal opening but also by differences in pressure transmission and symptom perception. Symptom-oriented evaluation integrating subjective complaints with multiple objective assessments is essential for accurate clinical characterization of PET.