Tympanic Membrane Manipulation to Treat Symptoms of Patulous Eustachian Tube

Abstract

Cartilage tympanoplasty provides a safe and accessible surgical option for the treatment of PET and significantly reduces the symptoms of autophony, conducted breath sounds, and aural fullness. Further studies are needed to investigate whether addressing PET symptoms simultaneously from both the tympanic membrane and the eustachian tube orifice can improve patient symptoms even further.

Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction

“…27 In patients in whom tympanostomy tubes are effective, they may work by mass loading the tympanic membrane or by providing a route for pressure equalization, thereby minimizing excursions of the tympanic membrane. 28 In this series, 33% of patients underwent tympanostomy tube placement prior to pursuing additional treatment, and 20% (n = 5) reported that the tube made their symptoms worse. Some patients undergoing ET surgery also had a tympanostomy tube placed during the procedure in order to address temporary ET dilatory dysfunction caused by the procedure.…”

“…Although placement of a tympanostomy tube has been reported to reduce symptoms in up to 54% of patients with PETD, it may also exacerbate them . In patients in whom tympanostomy tubes are effective, they may work by mass loading the tympanic membrane or by providing a route for pressure equalization, thereby minimizing excursions of the tympanic membrane . In this series, 33% of patients underwent tympanostomy tube placement prior to pursuing additional treatment, and 20% (n = 5) reported that the tube made their symptoms worse.…”

“…Improved endoscope technology, knowledge of the location of the defect in the valve within the lumen of the ET, and attention to the surgical anatomy of the relationship between the ET and the internal carotid artery have likely improved the accuracy and safety of injections. Finally, techniques have also been developed to mass load the tympanic membrane, with the majority of patients reporting improvements in symptoms 28 with minimal changes in hearing. 35 As a retrospective study, there are inherent limitations related to the charting of data and bias introduced by the time at which patients call with return of symptoms.…”

Endoscope‐assisted silicone plug insertion for patulous Eustachian tube patients

“…Various surgical approaches for severe PET have been reported, 2 such as suture ligation, 6 soft-tissue bulking agent 7 or hydroxyapatite 8 injection, implantation of autologous cartilage, 1 infusion of gelatin sponge solution, 9 transection of the tensor veli palatine muscle, 10 ventilation tube placement, and tympanic membrane manipulation. 11,12 Plugging of the ET was reported using a catheter, 13 angiocut catheter filled with bone wax, 14,15 cartilage, 16 and silicone plug. 3,4,17 The silicone plug (Kobayashi Plug ) has advantages over other materials due to its safety and exchangeability when necessary.…”

Tests of Eustachian tube function: a review

“…In individuals suffering from eustachian tube dysfunction (ETD), the tube opening may be obstructed, resulting in the typical complaints of ear fullness, muffled hearing, ‘popping’ sounds or tinnitus . Less frequently, the ET may be permanently patulous, resulting in the symptoms of aural pressure or autophony …”