Diagnosis and Management of Patulous Eustachian Tube Dysfunction

PROGRAM DESCRIPTION: This course is a part two, building on the course, Surgical Management of Obstructive Eustachian Tube Dysfunction. This course will expand on the principles presented in part one regarding the pathophysiology and diagnosis of disorders of the Eustachian tube, focusing on aspects specific to the development of patulous Eustachian tube, associated co-morbidities and potential risk factors and nuances for diagnosis. Medical and evolving surgical treatments will be discussed in detail. Patulous Eustachian tube can arise de novo or it can be a sequela of conditions associated initially with long-standing obstructive Eustachian tube dysfunction. It is far more common than previously believed as patients often report aural fullness without mentioning autophony. They may be frequently sniffing to temporarily relieve symptoms to such an extent as to induce negative middle ear pressure that can cause retraction, fixation pockets, middle ear effusion and even cholesteatoma. Tympanostomy tubes intended to alleviate the resultant negative middle ear pressure can also be effective in relieving patulous symptoms, especially in pediatric patients, which can create a misleading impression of chronic obstructive dysfunction. Balloon dilation of the Eustachian tube balloon dilation is contraindicated in such cases and surgeons must always consider the possible diagnosis of patulous Eustachian tube in every patient. A demographic analysis revealed allergic rhinitis to be the most common co-morbidity associated with patulous Eustachian tube, followed by weight loss, laryngopharyngeal reflux and stress/anxiety. In summary, methods for diagnosis (eg history, otoscopy, endoscopy, continuous impedance) and treatments will be reviewed.

OUTCOME OBJECTIVE 1: Describe mechanisms of patulous Eustachian tube pathophysiology and be able to diagnose the condition out of the differential diagnosis of aural fullness/otalgia

OUTCOME OBJECTIVE 2: Treat patulous Eustachian tube dysfunction with appropriate medical therapy and office procedures

OUTCOME OBJECTIVE 3: Assess surgical anatomy, pathology and novel surgical techniques

BACKGROUND STATEMENT: Patulous Eustachian tube is far more common than previously thought. The diagnosis is rapidly rising as a result of improved awareness by otolaryngologists, rapid weight loss from GLP-1 agonists and bariatric surgery, and as an uncommon complication of Eustachian tube balloon dilation.

Comprehensive Otolaryngology Track Statement : Disorders of the Eustachian tube problem are most commonly treated by Comprehensive Otolaryngologists, although subspecialists such as Pediatric Otolaryngology, Rhinology and Otology also share a great interest in treating these conditions.