Q: What is a Patulous Eustachian Tube?

A: The symptoms of ear pressure, hearing yourself breathe, and hearing a distortion in your own voice as if you are talking through a kazoo are typically caused by failure of the eustachian tube to close. The symptom of hearing yourself breathe is called “autophony. Normally the eustachian tube remains closed except when we yawn or swallow, at which time it briefly opens to equalize the air pressure in the middle ear. A eustachian tube that is excessively open is called “patulous.” Frequently, the eardrum will pop inward and outward with each breath, like the plastic windows wrapped around a screened porch in the wintertime. The patient will also hear himself breathe in as if listening to a stethoscope placed over the throat. Finally, the patient will often complain of a buzzing distortion of his or her own voice, as the sound of speech travels up the eustachian tube faster than it reaches the outer ear through the room. The condition is most common in patients who are particularly slender or athletic, and often occurs during aerobic exercise. The symptom is usually relieved by lowering the head, which increases venous congestion in the head. Some patients will feel an incessant need to sniff the eardrums inward, which can stretch the eardrums and make them more floppy.

Generally speaking, a patulous eustachian tube is harmless and requires no treatment. If the symptoms are intermittent, most patients are satisfied with reassurance and a thorough explanation. If symptoms are particularly bothersome, the first line of treatment is generally to evaluate and manage any nasal allergies, as the eustachian tube is actually an outpouching from the back of the nose. I recommend a trial of Flonase or Nasacort AQ, 2 puffs in each nostril daily for at least one month. Both brands are available without a prescription. If that does not work, the next option is a myringotomy, which is actually a hole in the eardrum with a rubber tube to keep the hole open. This does not correct the eustachian tube, but can ventilate the pressure so that the eardrum does not flop in and out with each breath. Some patients find this helpful, although results are not perfect and not predictable. Eustachian tuboplasty to try to close or reduce the opening of eustachian tube has been attempted by some surgeons, also with variable results. Eustachian tube balloon dilation is a relatively new procedure for clogged eustachian tubes. Balloon dilation is not an option for a patulous eustachian tube, because further dilating a patulous eustachian tube is likely to make symptoms worse rather than better.