"Step-up"surgical treatment strategy for patulous Eustachian tube / 临床耳鼻咽喉头颈外科杂志

Patients with patulous Eustachian tubes(PET) usually suffer from annoying symptoms, such as tinnitus, autophony and aural fullness, due to the excessive opening of the Eustachian tube. There is no uniform standard of treatment, and conservative therapy combined with"Stepup"surgical intervention strategy is the main treatment. In this article, we reviewed various surgical treatments of patulous Eustachian tube in recent years, including key points of surgical operation, effectiveness, safety and complications. Full communication and evaluation are needed to establish appropriate patients' expectations preoperatively. A "Stepup" treatment strategy will be carried out, including conservative treatment, tympanic membrane surgery, Eustachian tube pharyngeal orifice constriction surgery, Eustachian tube tympanic orifice plug surgery and Eustachian tube muscle surgery, which aims to maintain normal Eustachian tube function and good middle ear ventilation.

Disfunción del conducto faringotimpánico. El ETDQ-7 como herramienta para el diagnóstico clínico / Pharyngothympanic tube dysfunction. The ETDQ-7 as a tool for clinical diagnosis

RESUMEN En la actualidad se hace referencia en la bibliografía a una gran variedad de métodos para evaluar la disfunción del conducto faringotimpánico (DCFT), la gran mayoría de ellos requiere de instrumental de alta complejidad y personal altamente capacitado. Pese a lo mencionado, ninguno de dichos métodos ha sido validado como herramienta gold standard para el diagnóstico de esta patología. En este contexto, se presenta una herramienta complementaria para el diagnóstico de la DCFT, el Eustachian Tube Dysfunction Questionnaire -7 ítemes (ETDQ-7); cuestionario autoadministrado que considera 7 preguntas en base a una escala de Likert, fue creado para evaluar la sintomatología asociada a la disfunción del conducto con una puntuación que va desde lo más leve (1 punto) a lo más grave (7 puntos) de acuerdo con los síntomas percibidos, y posee un puntaje máximo de 49 puntos, correspondiente a una disfunción severa. La presente revisión tiene como objetivo buscar, organizar, clasificar y describir la información disponible en publicaciones científicas indexadas sobre el ETDQ-7 como herramienta para el diagnóstico clínico complementario de la DCFT. Se incluyeron 11 artículos científicos que hacen referencia al uso del ETDQ-7 en diferentes países. Los resultados recabados sugieren que el ETDQ-7 sería una valiosa herramienta, de alta sensibilidad, especificidad y validez clínica, que permitiría discriminar la presencia de la DCFT. No se encontró evidencia respecto a la aplicación o validación de este cuestionario en nuestro país.

ABSTRACT At present, great variety of methods are described to evaluate the dysfunction of the pharyngotympanic duct (DCFT), the vast majority of them require highly complex instruments and highly trained personnel. Despite this, none of these methods has been validated as the gold standard for the diagnosis of this pathology. In this context, a complementary tool for the diagnosis of the DCFT is presented. The Eustachian Tube Dysfunction Questionnaire-7 items (ETDQ-7), a self-administered questionnaire that includes 7 questions based on a Likert scale, was created to evaluate the symptomatology associated with the dysfunction of the duet. It is scored ranging from the mildest symptomatology (1 point) to the most severe (7 points), according to the perceived symptoms, with a maximum score of 49 points, corresponding to a severe dysfunction. The present review aims to search, organize, classify and describe the available information in scientific indexed journals about the ETDQ-7 as a tool for complementary diagnosis of the DCFT. Eleven scientific articles were included, referred to the use of ETDQ-7 in different countries, describing it as a valid tool which allows to discriminate the presence of a DCFT.

Management of Acquired Cholesteatoma Associated With Patulous Eustachian Tube and Habitual Sniffing

OBJECTIVES: To investigate the effect of surgical treatment with eustachian tube (ET) catheter insertion in patients with acquired cholesteatoma associated with patulous eustachian tube (PET) and habitual sniffing. METHODS: Nine ears of nine patients (two men and seven women; age, 20 to 65 years; average, 37.9±12.0 years) of acquired cholesteatoma associated with PET and habitual sniffing who underwent cholesteatoma surgery with simultaneous additional ET catheter insertion were examined in this study. Successful treatment was defined as stoppage of sniffing, a relief of a PET handicap inventory-10 (PHI-10), an improvement of autophony grade and no cholesteatoma recurrence. RESULTS: ET catheter insertion was performed in all ears. Follow-up duration ranged from 16 to 37 months (average, 25.4 months). Cases consisted of nine pars flaccida type (100%). All patients obtained relief from aural symptoms and stopped sniffing. Postoperative PHI-10 scores were significantly lower than preoperative scores (P<0.001). During an average follow-up of 25.4 months, no cholesteatoma recurrence has occurred to date. One patient developed otitis media with effusion (OME) post-catheterization; OME resolved spontaneously without treatment. Four patients had a consecutive ET catheter insertion on the other side to resolve PET-related aural symptoms. CONCLUSION: In case of acquired cholesteatoma with PET and habitual sniffing, ET catheter insertion performed simultaneously with cholesteatoma surgery could help reduce aural symptoms and stop sniffing. Moreover, the procedure might help in preventing cholesteatoma recurrence.

Efficacy of autologous fat injection to treat patulous Eustachian tube / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the efficacy of autologous fat injection of eustachian tube pharyngeal orifice in the treatment of Patulous eustachian tube (PET). METHODS We selected 18 patients who had no obvious improvement after medical treatment of PET over 1 months. They were treated with autologous fat injections to narrow the pharyngeal ostium of the eustachian tube. The treatment results were documented, including the patient's supervisory feeling and visual analogue scale (VAS). RESULTS The total effective rate was 83.3％ after 12 months of follow-up (symptoms significantly reduced in 27.8％ of patients and partial improvement is 55.6％), 16.7％ the symptoms remain unchanged, no one worsened. No patients had any complications. CONCLUSION Autologous fat injection of the eustachian tube is a effective and safe treatment for PET with the percentage of significant or partial relief of 83.3％, It is easy to conduct in clinical practice which could potentially serve as an alternative treatment for PET.

Trans-tympanic Cartilage Chip Insertion for Intractable Patulous Eustachian Tube

BACKGROUND AND OBJECTIVES: Patulous Eustachian tube (PET) causes troublesome autophony. We treated PET using tragal cartilage chip insertion to fill in the concavity within the tubal valve and evaluated the feasibility of this method. SUBJECTS AND METHODS: This study used a prospective design. Eleven patients with PET disorder were included. Tragal cartilage chip insertion via a transcanal approach into the Eustachian tube (ET) was performed in 14 ears of those patients. They were followed-up for at least 12 months after surgery and were evaluated by symptom questionnaire scores. RESULTS: The average follow-up was 16.4 months. Thirteen of fourteen ears received immediate complete relief of autophony symptoms. Autophony symptoms at the last follow-up were as follows: four ears (28.6%) had complete relief; five ears (35.7%) showed satisfactory improvement; four ears (28.6%) showed significant but unsatisfactory improvement; and one ear (7.1%) was unchanged. The PET symptom questionnaire in the affected ears showed a significant reduction in autophony (p=0.047) and improvement in breathing sound conduction (p=0.047). There were no complications such as otitis media or occlusion symptom. CONCLUSIONS: Transtympanic cartilage chip insertion into the ET provides a safe and accessible surgical option for the treatment of PET.

Submucosal injection of pharyngeal ostium of Eustachian tube for diagnosis of patulous Eustachian tube / 临床耳鼻咽喉头颈外科杂志

To evaluate the clinical value of submucosal injection of pharyngeal ostium of Eustachian tube in diagnosing patulous Eustachian tube(PET).Twenty-six patients(32 sides),whose the symptoms were consistent with PET,were enrolled from March 2014 to May 2016.The symptoms and signs of all patients were evaluated after submucosal injection of saline into the Eustachian tube.Immediately after submucosal injection of saline into the Eustachian tube,the symptoms and signs disappeared in 24 cases(29 sides),and improved in 2 cases(3 sides).The resolution and/or improvement of symptoms and signs lasted for less than 24 hours in 12 patients,for more than 24 hours in 9 patients,and for more than 48 hours in 4 patients.No adverse reactions were observed.Submucosal injection may be a simple and practical method for auxiliary diagnosis of PET,and may be used in preoperative evaluation of Eustachian tuboplasty.

Diagnosis and treatment of patulous Eustachian tube / 基础医学与临床

Based on extensive research of anatomy and physiological function of the Eustachian tube,the authors review the literatures to determine the mechanism of patulous Eustachian tube (PET).The purpose of this review is to summarize the current knowledge on the patulous Eustachian tube,present the current diagnostic protocols for PET and determine the comparative efficacy of variable treatments for this condition.In addition,development prospects are summarized in this article.

Objective Tinnitus / 한양의대학술지

Objective tinnitus originates from the para-auditory structures of the head and neck and can be heard or documented by examiner. Three representative forms of objective tinnitus, according to the causal organs are myoclonic tinnitus, vascular tinnitus and tinnitus caused by the patulous Eustachian tube. Etiologies, pathologic mechanisms, diagnostic approaches, and proper treatment methods of objective tinnitus are comprehensively discussed with a review of literatures. Objective tinnitus can be cured in many cases. Clinicians need to be well aware of the clinical characteristics of objective tinnitus since early, correct diagnosis with proper management are mandatory for its cure.

Therapeutic Efficacy of Angiocatheter Insertion Surgery in the Bony Orifice of Patulous Eustachian Tube / 대한이비인후과학회지

Patulous Eustachian tube is a benign, but bothersome condition, which can cause severe physical and psychological problems. We investigated the clinical features and the therapeutic result of the surgery in three patients, whose patulous Eustachian tube symptom were treated by the surgical insertion of a specially designed, tripod-tipped-bone wax-filled angiocatheter into the bony orifice of the Eustachian tube. Immediate disappearance of the troublesome symptoms was observed in all six patients. No serious complications were observed during the follow-up period. Factors considered for this surgical therapy and the method of designing our specific angiocatheter are introduced in detail. Surgical therapy for patients with serious patulous Eustachian tube symptoms by inserting the tripod-tipped-bone wax-filled angiocatheter seemed promising. Further studies on its long-term therapeutic effects might be necessary using a large number of the patients.

<b>Kampo Treatment for Suspected Cases </b><b>of Patulous Eustachian Tube </b> / 日本東洋医学雑誌

Patulous Eustachian tube (patulous ET) is not a rare disease, for which the prevalence rate is considered to be higher than 5%. Autophonia and ear fullness are common symptoms of patulous ET. Various treatments in cluding drug therapies and surgical procedures are attempted, although they do not give satisfactory results.<br>In oriental medicine, patulous ET is considered a Qui deficiency and/or blood deficiency. And Kamikihito is known as a popular Kampo prescription for patulous ET. Here we report the effect of hochuekkito on Patulous ET. Hochuekkito was administered to 10 patients, and complete improvement was had in 4 cases, partial im provement in 1 case and 5 cases had no change. Elevated ET tonus, gains in fatty tissue surrounding the ET, and influence on psychogenic factors were speculated as mechanisms by which hochuekkito brought about its effect.<br>Through this report, we expect that hochuekkito can be an alternative treatment for patulous ET.

One case report of acupuncture on the patulous eustachian tube / 全日本鍼灸学会雑誌

[Introduction]The patulous eustachian tube is an intractable disorder for rational symptoms such as a blocked ear, hearing breath sounds and autophony. Most of the causes are unclear. Therefore, we report a rare case of acupuncture on the patulous eustachian tube.<BR>[Case]K. X., 43years old, male, Occupation:staff of an association.<BR>Chief Complaint:Auto phony. Self breath sound listening. <BR>Clinical history:In Oct 20xx, he was aware of suddenly hearing breath sounds and autophony.<BR>The same year Oct, the "Y"Otolaryngology Clinic diagnosed it as normal hearing ability and patulous eustachian tube. It was not improved by pharmacotherapy.<BR>In the same month, an otoscope examination was taken at the "Z"Medical College of Otolaryngology and it was diagnosed as a patulous eustachian tube again. Acupuncture treatment was started from Dec. of the same year.<BR>Present illness:Weber test (-), hearing ability (normal), hypertonus of splenius capitis muscle<BR>[Acupuncture treatment]Selection of acupoints was considered where the patient said "symptoms decreased with mandibular exercise". Therefore, the trigeminal nerve regional acupoints that influence the masseter and posterior region of the neck were chosen.<BR>[Progress]In total, 25 acupuncture treatments were performed once a week from the onset.<BR>The patulous eustachian tube symptoms were evaluated by Numerical Rating Scale (NRS) from the first treatment.<BR>Barometric change and psychological stress exacerbated symptoms repeatedly, but the NRS of symptoms was relieved to about 50%by acupuncture at the first hospital visit.<BR>[Discussion and conclusions]It was suggested that the symptoms of patulous eustachian tube were relieved by stimulation of acupoints on the splenius capitis muscle and trigeminal nerve region.

Free Fat Autograft with Topical Anticholinergic for Patulous Eustachian Tube / 대한이비인후과학회지

Patulous eustachian tube is a distressing condition for the patient with such symptoms as autophonia and a sensation of fullness in the ear. No specific therapy has been established. We treated two cases by free fat graft using intranasal endoscopy with postoperative topical anticholinergic (ipratropium bromide). The result suggests that this method should be an effective treatment. So we report with review of the literatures.

Two Cases of Free Fat Graft at Patulous Eustachian Tube / 대한이비인후과학회지

Previously the patulous eustachian tube has been regarded as troublesome but benign condition. Recently some cases have been reported in conjunction with middle ear complications. In spite of its intractability, pathophysiology and specific therapy for this condition has not been fully investigated. We experienced two cases of abnormally patulous eustachian tube, the 23-year-old patient who complained autophonia and the 36-year-old female patient who complained autophonia with tinnitus, and they were treated with autologous free fat injection. We report these cases with a brief review of the literatures.