An Overview of Patulous Eustachian Tube

Rare Condition in Which Auditory Tubes Remain Open

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Patulous eustachian tube (PET) occurs when the eustachian tube remains open (patulous). It is an uncommon condition affecting only around 1 of every 10,000 people. The eustachian tubes, also called auditory tubes, run from the inner ear to the back of the throat.

Typically, your eustachian tube is in a closed position, which protects your inner ear from bacteria, viruses, and fluid. In order to equalize pressure and drain any fluid inside the inner ear, your eustachian tube opens once or twice every hour. It will also open when you swallow, yawn, or sneeze, remaining so for around a half-second.

External auditory canal of human ear
Alan Gesek / Stocktrek Images / Getty Images 

PET Symptoms

If you are experiencing PET you may have one or more of the following symptoms:

  • Autophony: Hearing one's own voice in the ear
  • Tinnitus: Ringing in the ears
  • A sensation that the ear is clogged

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


The causes of PET is usually idiopathic (of unknown origin). However, there are several factors that may predispose you to develop chronically open eustachian tubes, including:

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

Non-Invasive Treatments

Before receiving treatment, you may find that sniffing or lowering your head can cause some temporary relief of autophony. Mild symptoms may not require any treatment.

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

Initial treatments involve proper 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.

The most common treatment for a patulous eustachian tube is nasal sprays. Saline is the most common choice in the United States.

While many inner ear conditions can benefit from nasal decongestants or steroids, the practice will likely worsen your symptoms of PET. If this occurs, treatment should be stopped.

If steroids are used, the treatment should be gradually tapered under the supervision of a doctor to prevent a rebound of symptoms and withdrawal side effects.

Nasal estrogen creams and other intranasal bulking agents have a lot of anecdotal support, although there remains a lack of clinical evidence supporting their use.

Invasive Treatments

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

The most common surgical intervention is the placement of a tympanostomy tube. This procedure is only around 50% effective and may either help resolve symptoms, cause the worsening of symptoms, or do nothing.

Unfortunately, there is not enough evidence to predict which patients will respond positively to the surgical placement of ear tubes. However, ear tube placement is a fairly simple procedure with few side effects and the synthetic tubes can be removed if they do not provide relief for you.

Other more invasive therapies that are being studied, and are not available in all areas, include:

  • Injecting the eustachian tube with cartilage filling agents
  • Surgical placement of cartilage inside the eustachian tube
  • Cauterizing the eustachian tube
  • Manipulation of the muscles around the eustachian tube

Inserting a catheter inside the eustachian tube, injecting the eustachian tube, or musculature manipulation all allow for a narrowing of the eustachian tube. While this does not return the normal function of the tube, it reduces the amount of airflow into the middle ear, which helps to reduce the symptoms of autophony.

Surgically placing cartilage inside the eustachian tube has a similar purpose to catheter placement and is used only if the catheter has failed. If the patulous eustachian tube is over-corrected surgically, it may lead to another problem called serous otitis media.

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4 Sources
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