A. Definition (First described in 1864): An abnormally patent (open) Eustachian tube, connecting the back of the nose to the middle ear. Autophony: when one hears one's own voice, breathing, walking and chewing (This is an extremely unpleasant experience). Ear fullness: fluctuating sensation with breathing.
B. Causes: All often made better by bending forward or with flu. Developmental Weight loss, dehydration, pregnancy, decongestants, Parkinson's, post-radiotherapy; in patients, no obvious cause.
C. Differential Diagnosis Rare condition: SSCD - Superior Semi-Circular Canal Dehiscence. These patients are missing a bony covering over an inner ear balance canal.
D. Clinical and Investigations: Obvious movement of the eardrum. Examination of the postnasal space with the telescope. Ultrasound (Tympanometry). Pure tone audiogram. CT scan (to exclude SSCD).
E. Management (Aimed at improving quality of life)
- General: Weight gain, stop decongestant drops. Medical drops to cause swelling of the eustachian tube opening, e.g. Patulend.
- Procedures Ear: Insertion of grommets. Nose: Prestick on drum. Blocking of the ear component of the eustachian tube. Injecting various materials into the nasal opening to cause it to narrow down, e.g., hyaluronic acid, fat, cartilage. These injection techniques offer temporary relief (lasting from 1 to 2 years) and can be repeated.