This case study is regarding the diagnostic audiology findings for a patient diagnosed with patulous eustachian tube (ET) dysfunction. A 22-year-old patient complaining of ears stopped up was diagnosed by an ENT physician with patulous ET dysfunction, based on her history of significant weight loss of more than 102 lbs in a year. Diagnostic audiometry as well as tympanometry was conducted to see if the tympanometry pattern coincides with the respiratory cycle. Patient was found to have normal hearing in both ears. Tympanometry patterns was consistent with respiration for a total of 30-second time window.
Patulous ET is described as a nonclosing ET causing nonequalized pressure in the middle ear. The symptoms include aural fullness or plugged/blocked ear, phenomenon of autophony or hearing own voice louder, excessive pressure changes in the middle ear transmitted to inner ear through ossicular chain, hearing loss or vestibular symptoms. Hearing loss mostly occurs as a perception, due to the masking effect of sounds transmitted through the ET to the middle ear. The causes of patulous ET are sudden weight loss, hormonal changes, stress, fatigue, inappropriate use of decongestants, TMJ syndrome, and certain cases have unknown prevalence.
It is typically diagnosed by ear, nose, and throat (ENT) physician using a combination of history and otoscopic examination of tympanic membrane. It has been found that the tympanic membrane movements occur synchronously with inspiration and expiration in such cases.
A 22-year-old female patient complaining of ears stopped up was seen by our ENT physician and was diagnosed with patulous eustachian tube disorder, based on her history of sudden weight loss. Diagnostic audiometry including tympanometry was conducted on the patient. The patient has normal hearing in both ears, and her tympanometry pattern was found to be consistent with respiration for a 30-second time window (sawtooth pattern).
Post-treatment tympanogram on the patient revealed a smooth curve and sawtooth pattern was not observed.
Patulous ET is typically transient in nature. When the condition causing them resolves (weight loss, hormonal changes), the symptoms are gradually diminished. ENT physicians also use insufflation, injection (teflon), cauterization, myringotomy treatment options, depending on the patient.
Audiology-based intervention for pre- and post-treatment patulous ET has a big role to play in deciding the treatment and prognosis of patulous ET in patients.
DiBartalomeo J, Henry D. (1993) Patulous eustachian tube identification using tympanometry. J Amer Acad Audiol 4:53–57.