Patulous Eustachian tube dysfunction following rapid weight loss associated with semaglutide use: A case report

Patulous Eustachian tube dysfunction (PETD) is an uncommon condition characterized by an abnormally patent Eustachian tube, leading to symptoms such as aural fullness and autophony. Rapid weight loss is a recognized risk factor due to loss of peritubal adipose support. With the increasing use of semaglutide and other glucagon-like peptide-1 receptor agonists for obesity management, substantial and rapid weight reduction has become more common, raising the potential for underrecognized otologic complications. A 79-year-old male presented with intermittent bilateral aural fullness and ear "popping" without associated pain, vertigo, or systemic symptoms. His history was notable for intentional weight loss of approximately 200 lb following initiation of semaglutide therapy. Otoscopic examination was unremarkable, and prior tympanometry demonstrated normal middle ear pressure. In the absence of findings suggestive of obstructive Eustachian tube dysfunction, a clinical diagnosis of patulous Eustachian tube dysfunction was made. The patient was managed conservatively with hydration, intranasal saline, and avoidance of decongestants. Rapid, extreme weight loss associated with GLP-1 receptor agonist therapy may precipitate PETD and should be considered in patients presenting with aural fullness and normal middle ear findings. Recognition of this association supports appropriate conservative management and may prevent unnecessary interventions.