Management of patulous eustachian tube dysfunction
Reviewed by Praneta Kulloo

Idiopathic sudden sensorineural hearing loss (iSSNHL) is defined as a hearing loss of 30 dB or more at three contiguous frequencies within 72 hours, with acute low-tone hearing loss (ALHL) excluded from this category. Despite standard treatment, outcomes vary: one-third of patients fully recover, one-third experience partial recovery, and one-third see no improvement. The recommended treatment for iSSNHL includes systemic corticosteroids, with intratympanic steroids used as either an initial or salvage therapy. Some low-quality studies suggest hyperbaric oxygen therapy as a possible option, while prostaglandin E1 has been proposed as a complementary treatment in severe-to-profound cases, though evidence remains controversial. ALHL presents as sudden low-frequency hearing loss, potentially linked to endolymphatic hydrops. Recurrent cases may suggest Ménière’s disease. Treatment focuses on addressing the presumed hydrops, combining corticosteroids – similar to iSSNHL – with osmotic diuretics, though clear evidence for diuretic efficacy is lacking. Perilymphatic fistula (PLF) is diagnosed based on clinical symptoms and detection of perilymph-specific protein. Initially, patients are advised to rest for a week to allow for potential spontaneous recovery. If symptoms persist or worsen, surgical closure of the fistula is indicated. Mumps-associated hearing loss typically affects young children and carries a poor prognosis. Treatments are similar to those used for iSSNHL, though high-level evidence supporting their effectiveness is lacking. For bilateral severe-to-profound sensorineural hearing loss (SNHL), cochlear implants remain an effective intervention. Acoustic trauma, often caused by loud noise exposure, is generally managed with early corticosteroid treatment, while prevention through ear protection is strongly emphasised.

Diagnosis and treatment of patulous eustachian tube.
Ikeda R.
AURIS NASUS LARYNX
2024;51(6):947–55.