Extensive Turbinate Surgery: A Potential Risk Factor for a Patulous Eustachian Tube

ObjectiveTo describe a series of patients who developed a patulous Eustachian tube (PET) after turbinate surgery and to explore potential anatomical and clinical factors contributing to its development.MethodsThis retrospective case series examines three patients who presented with PET symptoms after turbinate surgery at a single tertiary care institution in Saudi Arabia. It reviews their clinical presentation, tympanic membrane mobility, nasal endoscopic findings, surgical history, and weight loss history.ResultsAll three patients developed autophony within weeks to months following turbinate surgery. Positional symptom relief and characteristic tympanic membrane mobility were observed in all cases. Nasal endoscopy demonstrated postoperative fibrosis or adhesions involving the posterior inferior turbinate with mechanical traction on the Eustachian tube orifice, resulting in abnormal patency. One patient presented with a history of significant weight loss, but it was temporally remote. One patient experienced symptomatic improvement following Eustachian tube shim insertion.ConclusionsThis case series suggests that turbinate surgery may contribute to PET development, particularly when fibrosis develops postoperatively near the Eustachian tube orifice. While weight loss may represent a permissive factor in certain patients, local postoperative anatomical changes appear to play a critical role. Careful surgical technique and increased awareness of this potential complication may help reduce the risk of iatrogenic PET.