In response to a previous question about patulous eustachian tubes, you wrote:
"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."
My ENT contradicts that advice, saying that tube insertion is no longer done for treatment of patulous eustachian tubes, because it was found to be ineffective.
One treatment he suggested was to put a few drops of chlorinated swimming pool water in my nose every day. He reported that a recent study actually has indicated that this works to prevent patulous eustachian tubes. Can you please comment on this treatment and also on your current position regarding tube insertion for this condition?
Thank you.
Reply: -------------------
Perhaps your otolaryngologist misspoke or was misunderstood, but frankly it would be incorrect to state in general that tympanostomy tubes have been found to be ineffective in the management of the patulous eustachian tube. It is true that tympanostomy tubes do not relieve one symptom in particular that some patients with this condition experience which is known as "autophony" or a perceived increase in the resonance of one's own voice. Some patients describe this as an open or hollow sensation.
However, the classic symptom of a patulous eustachian tube which in my experience tends to be the most bothersome for patients that I have treated, is the audible movement of the ear drum and intermittent pressure changes felt in the ear that are consistently associated with the patients respiration. This phenomenon is caused by the persistently open eustachian tube which allows unrestricted back and forth flow of air with each inspiration and expiration. This then results in an inward and outward movement of the ear drum with each respiration which can usually be heard and felt.
With this in mind it then becomes easy to understand why tympanostomy tubes can be helpful since with a tube in place in the ear drum, the air flow passes through the tympanostomy tube preventing any movement of the ear drum thus alleviating the symptom. As I mentioned though, the tubes do not alleviate the sensation openness or hollowness which some patients complain about. If the latter is the sole or predominant complaint, then tympanostomy tubes are unlikely to be helpful.
It is true that there is no universally accepted treatment for the routine management of this condition. This is because there is no known treatment that will alleviate all symptoms that the patient may experience. However, most patients with patulous eustachian tubes complain about symptoms that are related to the movement of the ear drum associated with respirations. If they are willing to accept that tubes will not alleviate autophony, then tympanostomy tubes are appropriate if their symptoms are sufficiently bothersome, thus my previous comment that most otolaryngologists will recommend that tubes be considered. As to your otolaryngologist's recommendation regarding chlorinated water drops in the nose, this is but one of a wide variety of treatments that have been proposed in the treatment of this condition which are designed to induce inflammation inside the eustachian tube. This theoretically leads to reduced tubal patency and thereby reduced air flow through the tube. Just to illustrate the wide variety of treatments of this nature that have been proposed, the following is a list of different substances that have been studied either as an intranasal application or a direct application on the tube by a physician: trichloroacetic acid, nitric acid, phenol, estrogen cream, boric acid powder, salicyclic acid, 2% iodine, dilute hydrogen chloride, benzyl alcohol, chlorobutanol, and other more invasive treatments such as cautery of the eustachian tube or injection of gelfoam or teflon into the eustachian tube have also been reported. It should be clearly understood that there are currently no clinical trials that have reliably demonstrated the safety and efficacy of any of these aforementioned treatments. On the other hand, there is plenty of information available regarding the safety and efficacy of tympanostomy tubes.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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