Patulous eustachian tube (PET) dysfunction, where the eustachian tube is abnormally opened at rest, is a notoriously difficult condition to treat. Symptoms can mimic symptoms of superior semicircular canal dehiscence: autophony, aural fullness, hyperacusis and breathing synchronous tinnitus. Treatment has previously comprised of ventilation tubes and surgical attempts to close the eustachian tube orifice (e.g. cautery, teflon). The authors of this paper describe a novel technique of performing a cartilage myringoplasty to treat PET dysfunction on 12 patients. Abnormal ear drum movements are thought to contribute to symptoms. Patients underwent preoperative ear drum patch testing using an eggshell membrane that brought about relief of their symptoms. All patients went on to have surgery.

Surgery involved an endaural incision, tragal cartilage harvest followed by an underlay technique to place the cartilage behind the mobile eardrum segment. Follow-up period for patients varied from six months to five years. All patients had statistically significant improvement in their symptoms of autophony, aural fullness and breathing synchronous tinnitus.

There was a slight air bone gap in some patients, however there was no subjective hearing loss. A cartilage myringoplasty may sound like a major procedure for patients with PET dysfunction but all patients seemed to have a great outcome in this small series. With appropriate patient selection, the procedure may well be beneficial.

Eardrum thickening approach for the treatment of patulous Eustachian tube.
Si Y, Chen Y, Li P, et al.
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Sidhartha Nagala

Royal Hallamshire Hospital, Sheffield, UK.

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