What Is a Patulous Eustachian Tube?

Patulous eustachian tube (PET) occurs when the auditory tube, which connects the inner ear to the back of the throat, stays open. Though rare, it is not a serious medical condition. It does, however, cause annoying symptoms, including tinnitus, a sense of fullness in the ear, and hearing your voice and breathing.

Under normal circumstances, the eustachian tubes stay mostly closed to protect the inner ear from bacteria, viruses, and fluid. The tubes briefly open once or twice an hour to equalize pressure and drain fluid. With PET, the tube malfunctions and stays open even when it doesn't need to.

This article discusses patulous eustachian tube. It explains the symptoms and causes of this eustachian tube dysfunction. It also explores treatments for PET and how drinking enough water may relieve symptoms.

Symptoms of a Patulous Eustachian Tube

If you're experiencing PET, you may have one or more of the following symptoms:

• A feeling that your ear is clogged
• Autophony, or hearing your own voice in your ear
• Tinnitus, a ringing sensation in the ear
  

Autophony is the classic, hallmark symptom of a patulous eustachian tube. It is a condition in which you hear unusually loud feedback from your own voice, breathing, and heartbeat. Autophony is a symptom seen with other disorders involving the ear, such as superior semicircular canal dehiscence, an abnormal opening in the ear canal.

What Causes a Patulous Eustachian Tube?

The causes of PET are what medical professionals call idiopathic, meaning they are of an unknown origin. However, there are several factors that may predispose you to develop chronically open eustachian tubes, including:

• Excessive gum chewing
• Frequent and forced nose-blowing
• High levels of estrogen (such as occurs with pregnancy, birth control pills, or hormone replacement therapy)
• Nasal decongestants
• Neurological disorders such as stroke, multiple sclerosis, or trauma to the facial nerves
• Radiation therapy to the head or neck
• Significant and rapid weight loss
• Temporomandibular joint syndrome (TMJ), or a misaligned bite
  

Treatments for Patulous Eustachian Tube

Mild PET symptoms may not require treatment. You may find that sniffing or lowering your head can cause some temporary relief of autophony.

However, if the symptoms are severe enough and have persisted for more than six weeks, then you will want to start treatments focused on resolving patulous eustachian tube.

Non-Invasive Treatments

First-line treatments for PET include the following non-invasive treatments:

• Avoid caffeine: Coffee, tea, and cola can exacerbate PET symptoms. Eliminating caffeine may help to relieve PET symptoms.
• Hydration: Drinking sufficient water is essential and can be supplemented with nasal saline drops or irrigation of the nose to help keep mucous membranes moist.
• Intranasal bulking agents: Nasal estrogen creams and other intranasal bulking agents have generated much anecdotal support. But there remains a lack of clinical evidence supporting their use for PET.
• Nasal sprays and drops: Patulous eustachian tube is often treated with nasal sprays or drops. Saline is the most common choice in the United States. Another option is PatulEND, a patented nasal drop formula containing nutrients that may relieve PET symptoms. An over-the-counter treatment, it is only available online and limited independent research is available.

Surgery

When less invasive methods prove insufficient to resolve symptoms of patulous eustachian tubes, surgical treatments may be more effective.

• Typanostomy tube surgery: This procedure places tubes to hold the eustachian tube open, provide ventilation, and allow excess fluids in the ear to drain. This fairly simple procedure is only about 50% effective.
• Cauterization: Heat or chemicals are used to cauterize the eustachian tube, which destroys the problematic tissue.
• Injections: Cartilage-filling agents are injected into the eustachian tube.
• Musculature manipulation: This procedure uses a small tool is used to manipulate the muscles and other soft tissues around the eustachian tube.
• Cartilage implants: Cartilage is placed inside the eustachian tube.
  

Summary

Patulous eustachian tube (PET) occurs when the eustachian tube remains open. You may not know you have it unless you are experiencing some red-flag symptoms. These include the feeling that your ear is clogged, experiencing a ringing sensation (a condition known as tinnitus), or hearing your own voice in your ear (autophony). Of the three, the latter is the hallmark symptom of PET.

The cause of PET is unknown, though it's thought that certain habits and conditions may predispose you to it, from using nasal decongestants to dropping a significant amount of weight quickly.

Many physicians turn to noninvasive treatments first. These usually involve proper hydration in some form. The most common invasive treatment involves the placement of a tympanostomy tube in the ear. It holds the ear open, provides ventilation, and allows excess fluids in the ear to drain. However, this procedure is effective only about half the time.