The eustachian tube runs between the throat and middle ear to maintain pressure in the eardrum. In some cases, people have a patulous eustachian tube, which does not open and close as normal. This condition does not cause serious medical problems, but it can affect a person’s quality of life.
It is not clear what causes the condition. Risk factors include weight loss, some medication, and multiple sclerosis. There is no standard treatment, but changing posture and using nasal sprays may help relieve symptoms. In some cases, surgery can be effective.
Keep reading to learn more.
Another name for the eustachian tube is the auditory tube. It runs from the eardrum to the back of the nose and upper throat, helping a person hear and controlling the pressure in the eardrum. It also stops sounds, fluids, and air from traveling from the back of the throat to the ear.
The eustachian tube is usually closed, but it opens up when a person swallows, yawns, or chews food. By opening, it balances the air pressure. Many people will recognize the feeling of pressure in the ear from air travel or from having blocked sinuses or an ear infection.
Patulous is a scientific term meaning open. A patulous eustachian tube is one that is open rather than closed most of the time. This abnormality causes an uncomfortable feeling in the ear, as well as problems with hearing and speech. Over time, it can cause sensitivity to noise.
A patulous eustachian tube does not always have an obvious cause. Some factors may increase a person’s risk of developing this condition. These include:
- some neurological disorders, such as stroke or multiple sclerosis
- weight loss
- scarring after surgery on the nose or throat
- anxiety and stress
- some medications, including diuretics
- conditions that cause problems with the jaw
Fatty tissue and small muscles hold the eustachian tube open or closed, so weight and muscle loss may affect this action.
Hormones have a range of effects on the body. These include changing the balance of fluids and mucus, which could have an effect on the eustachian tube. Diuretics and exercise can also both cause the body to lose fluids.
Temporomandibular joint and muscle disorders are a group of conditions that stop the jaw from working normally. The jaw and middle ear share some nerves and muscles, so a jaw condition could affect the eustachian tube.
One of the main symptoms of patulous eustachian tube is distorted autophony, which means that a person is able to hear their own voice, breathing, or pulse. Usually, the brain blocks out these sounds.
A person with the condition may find that their voice sounds louder than normal. To the listener, a person’s voice may sound congested, quieter, or deeper than usual.
Patulous eustachian tube can make a person hear an echo of their own voice or the sound of waves. This effect can make it harder for a person to form sounds and to speak. They may be conscious of their voice and speak more quietly than normal or avoid talking.
Other symptoms can include:
- muffled hearing
- a ringing or buzzing sound in the ears, called tinnitus
- the ear feeling full or blocked
- feeling the need to clear the ear
- feeling the pressure change in the ear when breathing in and out
It can be difficult to diagnose patulous eustachian tube because the condition is uncommon, has no clear cause, and shares some symptoms with earache and tinnitus. There are no clear guidelines for diagnosis and no specific tests for the condition.
A doctor will usually diagnose the condition by asking the person about their medical history and symptoms. They may examine the ear, back of the nose, and throat.
One standard test is tympanometry, which uses air pressure to check how well the eardrum and middle ear transmit vibrations. This test can check for fluid buildup in the ear, which would suggest a different condition as the cause of the symptoms.
A doctor should be able to distinguish patulous eustachian tube from a sinus infection because there will be no sinus pressure.
Some people who only experience occasional symptoms can manage them without treatment.
Gently sniffing in can cause a vacuum that temporarily closes the eustachian tube. However, people should do this with care, as sniffing too often can cause pressure in the middle ear. This pressure may lead to complications, such as fluid in the middle ear or damage to the eardrum.
A person can lie down or put their head between their knees. In these positions, tissues in the head swell temporarily, forcing the eustachian tube to close.
If the cause of the condition is the eustachian tube drying out, some treatments may help. These aim to moisten the membrane to make it work normally again, and they include:
- drinking more fluids
- saline nasal rinse
- hormone nasal drops
There are also surgical options to treat patulous eustachian tube.
A small plastic tube called a grommet can help stop pressure changes. The tube keeps pressure equal in the ear by allowing air to pass through the eardrum. This minor procedure will not usually require an overnight stay in the hospital, but it may not always work to treat distorted autophony.
In some cases, it may be possible to reconstruct the eustachian tube with grafts or implants. This process removes the lining of the tube and uses fat implants to make it narrower, which completely blocks the tube for a few months. After this, the eustachian tube should work normally again.
Patulous eustachian tube can be a temporary problem. It might happen after exercise or during pregnancy. If symptoms last for a long time or affect daily life, a person can see a doctor for advice and treatment.
Research is ongoing to find more treatments for patulous eustachian tube. The condition can be difficult to diagnose, but distorted sounds and pressure in the ear are key symptoms.
A person should see a doctor if gently sniffing, changing posture, or using a nasal spray do not relieve the symptoms. There are longer term treatment options that can provide relief.