The problem more commonly attributed to the eustachian tube is lack of its patency rather than it being unduly patulous. This lesser recognised condition is due to loss of peritubal fat volume resulting in concavity of the lateral wall and thus compromising the eustachian tube valve function, with loss of middle ear air cushion. The authors describe management of twelve patients who were diagnosed with this condition on the basis of autophony to voice and respiration and aural pressure plus visible excursions of the tympanic membrane on respiration.

A differential diagnosis of superior semicircular canal dehiscence was excluded, where necessary, by computed tomography of temporal bones. The procedure involved injection of Vox, a silicone elastomer implant material on the superolateral segment of the lateral wall of the eustachian tube at its opening in the nasopharynx, under general anaesthesia.

Multiple procedures were required in five out of eleven patients. Seventy-three percent of patients showed improvement as assessed by autophony outcome measure devised by Poe, ten out of eleven said they would recommend this procedure and eight out of eleven reported improvement in quality of life. Anatomic impediments in injecting and ways to overcome them have been elaborately described. Several of these patients had been treated earlier by other otolaryngologists, which suggests that this condition is under recognised. The numbers are few but there are indications that this is a safe and effective procedure.

Polydimethylsiloxane elastomer injection in the management of the patulous eustachian tube.
Mackeith SAC, Bottrill ID.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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