Learning Objectives:
Presenting features of Patulous Eustachian Tubes
Surgical management of Patulous Eustachian Tubes
Introduction: A variety of surgical techniques have been used in the management of Patulous Eustachian Tubes, however the long-term efficacy and safety of these methods remains uncertain. We highlight this issue using the the case of an 84 year old man with bilateral Patulous Eustachian Tubes who has had multiple surgical procedures over a two year period.
Methods: The patient presented with bilateral autophony, tinnitus and hearing loss. The diagnosis was confirmed by observation of tympanic membrane movement on respiration at otomicroscopy. Initial surgical management involved endoscopic reduction of the Eustachian tubes, first by injection of calcium hydroxylapatite and cautery to the torus tubarius, and followed by insertion of fat into the Eustachian tube with suturing when symptoms recurred. Further symptoms prompted more invasive surgical management with transtympanic occlusion of the Eustachian tubes with conchal cartilage.
Results: Endoscopic injection of fillers and cautery to the Eustachian tubes did provide symptomatic benefit in this patient's case, though the effects were short lived. Insertion of fat and suturing endoscopically was difficult practically and did not produce long-term symptom control. Open ear surgery with placement of tragal cartilage into the Eustachian tube performed initially on the right followed by the left four months later has led to complete resolution of symptoms. The patient did, however, develop bilateral middle ear effusions with conductive hearing loss, requiring myringotomy and grommet insertion.
Conclusions: Endoscopic surgical techniques for reducing patulous Eustachian tubes may provide symptomatic benefit with few ill effects, but have limited long-term efficacy. Transtympanic occlusion with cartilage is presented is an alternative approach with an improved outcome.
