The condition of patulous eustachian tube, as opposed to dysfunctional eustachian tube, is less frequently diagnosed. Symptoms related to this, such as autophony, aural fullness, ‘being under water’, ‘hearing their own breathing’, and hearing sensitivity (varying in either direction) can occur in other conditions such as eustachian tube dysfunction and canal dehiscence. In this interesting study, the authors diagnosed this problem on the basis of symptoms and tried paper patching to see if this resolved symptoms instantly or in the long term. Twenty-one patients were selected and paper patching was done under the microscope, with rectangular pieces of cigarette paper applied to the superior part of the tympanic membrane. Observations were made from a casual query after the procedure as to whether or not the symptoms disappeared. In 76.2% of patients the symptoms disappeared immediately. In some cases the symptoms disappeared only partly and therefore more paper patches were applied. In the long term the symptoms reappeared in half the number of ‘cured’ patients and this was because the paper patches were dislodged. Some patients experienced slight discomfort but there were no adverse effects. The authors explain the improvement on the basis that a lax tympanic membrane, which can be a feature of a patulous eustachian tube, allows a higher admittance for lower frequencies; stiffening by paper patching reduces this and relieves the symptoms. The presence of retraction pockets tensing up the tympanic membrane or a cholesteatoma may circumvent this phenomenon. High admittance of lower and mid-frequencies is related to the upper and lower parts of the tympanic membrane respectively. Other studies in literature have been described, one of which used clay to stiffen the tympanic membrane. The method described by the authors is simple, non-invasive and can be conveniently undertaken in a clinic setting and therefore, if successful, conforms to cost effectiveness.

Paper patching of the tympanic membrane as a symptomatic treatment for a patulous eustachian tube syndrome.
Boedts M.
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Madhup K Chaurasia

United Lincolnshire Hospitals NHS Trust; University of Leicester, UK.

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