Patulous Eustachian Tube (PET): An Overview
Introduction
The eustachian tube, a small passage connecting the middle ear to the back of the throat, is crucial in maintaining balanced air pressure and proper fluid drainage within the middle ear. Under normal circumstances, it opens and closes intermittently. However, the tube remains abnormally open in patients with a patulous eustachian (PET). This disruption in normal function can lead to various symptoms and complications.
Symptoms and Impact
Autophony: A sensation of hearing your voice, breathing (aerophony), or even heartbeat unusually loudly. This is often described as a "hollow" or "echoing" quality to one's sounds, sometimes likened to "talking into a barrel."
Hyperacusis: Increased sensitivity to sounds, where everyday noises can become uncomfortable or even painful.
Dizziness or Imbalance: If one Eustachian tube remains open while the other is closed, it creates a pressure differential between the middle ears. This can lead to asymmetrical pressure in the inner ear, which is responsible for balance and can result in dizziness.
Aural Fullness: A feeling of fullness or pressure in the affected ear(s).
Pulsatile and non-pulsatile Tinnitus: While the mechanism is not fully understood, rhythmic ringing synchronized with the heartbeat and constant ringing in the ears have been associated with PET.
Fluctuating Symptoms: PET symptoms are often intermittent, can worsen throughout the day, and may be exacerbated by exercise. Some individuals experience relief when lying down.
Causes of PET
The exact cause of PET often remains elusive. However, several factors have been linked to its development:
Weight loss: Rapid weight loss can reduce the fatty tissue surrounding the eustachian tube, causing it to remain open.
Hormonal Changes: Pregnancy, hormonal contraceptives, or even menopause can influence the muscle tone around the Eustachian tube.
Dehydration: The dryness of the mucous membranes lining the Eustachian tube can contribute to its dysfunction.
Neuromuscular Disorders: Conditions like strokes, multiple sclerosis, or Parkinson's disease can affect the muscles controlling the tube's opening and closing.
Testing for PET
Diagnosing PET can be challenging due to the intermittent nature of the condition. Several approaches can be utilized to uncover signs and symptoms:
Clinical Examination: The traditional ear examination might not reveal any abnormalities. To unmask the condition:
Exercise provocation: Ask the patient to perform exercises like climbing stairs to potentially trigger symptoms.
Positional changes: Observe if autophony changes when the patient lies down or sits up. Repeating "1, 1, 1, 1" while changing positions can be helpful.
Neck pressure: Gentle pressure on the neck might partially close the Eustachian tube, providing temporary relief.
Occlusion effect: If the patient isn't experiencing symptoms during the visit, occluding the ear canal and asking them to speak can recreate autophony for comparison.
Microscopic Examination: Examining the eardrum (TM) with a microscope while the patient is sitting upright and performing a nasal breathing test can reveal subtle movements of the TM synchronous with breathing.
Cream Application: Creaming to the TM can sometimes relieve if the resonant cavity model causes autophony.
Endoscopic Examination: An endoscope can examine the eustachian tube and reveal the wasting of the fat pad or changes in the tube's shape.
Palate Examination: Palpating the palate can help identify a submucous cleft palate, a potential contributing factor to PET.
Medical Treatments for PET
Treatment approaches for PET vary based on the severity of symptoms and underlying cause:
Conservative Measures:
Weight Gain: If rapid weight loss is the culprit, gradual weight gain may help resolve the problem.
Hydration: Increasing fluid intake and using saline nasal sprays can help maintain moisture in the Eustachian tube.
Nasal Decongestants: Short-term use may help reduce swelling and promote tube closure.
Intranasal Steroids Can reduce inflammation and help improve Eustachian tube function.
Minimally Invasive Procedures:
Eustachian Tube Balloon Dilation: A balloon catheter is inserted into the Eustachian tube to expand it, potentially improving function.
Intratympanic Injections: Substances like hyaluronic acid or steroids can be injected into the middle ear to thicken the lining and promote Eustachian tube closure.
Surgical Options:
Eustachian Tube Surgery: Various techniques exist, including cartilage grafting or placing implants to promote tube closure.
Role of Physical Therapy in PET Management
Physical therapy's direct role in managing PET needs to be improved and well-established. However, specific physical therapy interventions may offer supportive benefits, such as:
Vestibular Rehabilitation: If dizziness or imbalance is present, vestibular rehabilitation exercises can help improve balance and reduce dizziness symptoms.
Stress Management Techniques: Stress and anxiety can exacerbate symptoms like tinnitus and hyperacusis. Relaxation techniques such as deep breathing exercises or mindfulness meditation may prove helpful.
Education and Counseling: Providing patients a clear understanding of their condition, its potential causes, and available treatment options can empower them to manage their symptoms effectively.
Conclusion
Patulous Eustachian Tube (PET) can significantly impact an individual's quality of life. The hallmark symptoms of hearing one's breathing or voice in an echo-like manner, along with fluctuating aural fullness, can be distressing. Diagnosing PET requires clinical assessment, patient history, and specialized tests. While currently, there's no guaranteed cure, a range of medical treatments and supportive therapies can help manage symptoms and improve overall well-being. If you suspect you may have PET, consulting an ear, nose, and throat (ENT) specialist is crucial for proper diagnosis and discussion of appropriate management options.
Disclaimer: The information provided in this article is for general knowledge and informational purposes only and does not constitute medical advice. It is essential to consult a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
References and Further Readings
Bance M, Tysome JR, Smith ME. Patulous Eustachian tube (PET), a practical overview. World J Otorhinolaryngol Head Neck Surg. 2019 Oct 11;5(3):137-142. doi 10.1016/j.wjorl.2019.08.003. PMID: 31750425; PMCID: PMC6849362.