I've had a problem with my ears for 4 years. I've been to about 10
different doctors, most of whom could not help me. They prescribed
decongestants and other medications, none of which helped.
Finally, about a month ago, I saw an ENT doctor who diagnosed my problem as patulous eustachian tubes. His diagnosis was based on a thorough exam and my description of the problem (see below). He said I could do 2 things for the problem: nothing, or have tubes put into my ears. He said he sees patients with this problem several times a year.
Today I went to another doctor for a second opinion. He said he's seen only about 4 other patients with my problem. He agrees that my problem probably is patulous eustachian tubes, but he does not recommend the surgery. In fact, he said, tubes could make the problem worse. He prescribed nose drops (I can't read his writing on the prescription, but it starts with "prem" and consists of several ingredients to be mixed by the pharmacist). I think this is probably a similar medication prescribed to me 3 years ago by another doctor. It didn't work.
Here's a description of my problem: My ears have the sensation of being plugged. At their best, they just feel plugged. At worst, I can hear myself breathing and talking from inside my head. Also, sometimes I feel pain. The problem seems to get worse when I'm tired, but feels slightly better when I lie down.
So my questions are: Do you think I have patulous eustachian tubes? And what can I do about it? I don't want to go through surgery if it won't help and might hurt--but if it will help, I'd be willing to do it. And I don't want to take medication that won't help. I'm at my wit's end.
Reply: ----------------------
It is difficult to tell for sure from your description whether or not you have a patulous eustachian tube. In most cases, the patient complains of clicking or popping of the ears that is closely associated with each respiration. The pathophysiology associated with a patulous eustachian tube is a tube that remains open at all times such that the normal inspiratory and expiratory movements of air during normal respiration cause cyclic airflow through the eustachian tube as well. This is then ultimately transferred into the middle ear space whereby the ear drum repetitively moves inward and outward. Such movement of the ear drum is not only felt but heard. Pain would be an unusual symptom associated with a patulous eustachian tube. However periodic plugging of the ears would be likely.
Under normal conditions, the eustachian tube is closed at rest. It typically opens during yawning or swallowing or it may be forced open with nose blowing or valsalva manuevers. Patulous eustachian tubes are open at all times. Many cases of patulous eustachian tubes occur following significant and relatively rapid weight loss. Physical examination may reveal a relatively normal appearing ear drum although it may be possible for the examiner to actual visualize movement of the ear drum with respiration. A test known as a tympanogram may also be helpful in certain cases revealing hypermobility.
Presently, most otolaryngologists will recommend tympanostomy and tube insertion for the treatment of patulous eustachian tubes. If the diagnosis is correct, tube insertion is generally highly effective in relieving symptoms. There is little rationale for the use of topical nasal sprays which act to decongest. Decongestion may help a dysfunctional eustachian tube that won't open because of a swollen lining, but it is unlikely to help a patulous eustachian tube. Tube insertion on the other hand allows the cyclic air movements to pass on through the artificial tube in the ear drum without causing any movement of the ear drum itself, thereby eliminating the most bothersome symptoms. Occasionally, the placement of tympanostomy tubes in the ear drums will cause a subtle qualitative change in hearing but this is usually an acceptable trade-off for the initial bothersome symptoms.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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