An Overview of Patulous Eustachian Tube

Rare Condition in Which Auditory Tubes Remain Open

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

Some doctors recommend a nasal solution containing salicylic and boric acid powder (in a 1-to-4 proportion), diluted hydrochloric acid, chlorobutanol, benzyl alcohol, and saturated potassium iodide.

Though studies have shown it to be 63.5% to 100% effective in treating mild ear symptoms, the remedy has not been approved by the Food and Drug Administration (FDA).

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.

Another less-invasive procedure is referred to as mass loading in which a pressure-sensitive clay-like adhesive called Blu Tack is applied to the eardrum. Anesthesia is not required, and the procedure is generally well-tolerated.

This is thought to be helpful by reducing the sensation of echo in your inner ear by thickening your eardrum, which reduces its reaction to low-frequency sounds.

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

  • Injecting the eustachian tube with Teflon, silicone, cartilage, or other 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 all else fails, the otolaryngologist may recommend the complete closure of the eustachian tube. This procedure alone is insufficient to help manage symptoms as you lose the ability to regulate pressure in the middle ear.

For this reason, your physician will need to place permanent ear tubes to help maintain equilibrium. It is an impactful surgery and one that is only used as a last resort.

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