Mid-term evaluation of the surgical management of patulous Eustachian tube dysfunction: a STROBE observational study

Eur Arch Otorhinolaryngol. 2024 Jun;281(6):2883-2891. doi: 10.1007/s00405-023-08388-w. Epub 2023 Dec 27.

Abstract

Introduction: Patulous Eustachian tube (PET) is a condition affecting approximately 0.3% to 6.6% of the population, with autophony being the predominant complain. The management of PET lacks a well-defined standard in the literature as no effective medical treatments have been documented but various surgical options are available. This study aims to report mid-term outcomes following surgical management of PET.

Materials and methods: All patients who underwent surgical intervention for PET between September 2017 and June 2022 were enrolled. Data encompassing general demographics, quality of life (GBI), and procedure-specific data were collected.

Results: A total of 30 PET cases (in 19 patients) underwent surgical intervention including 9 injections of hyaluronic acid, 13 fat injections, 6 endoscopic shim insertions, 1 cartilage graft, and 1 injection of hydroxy apatite. After an average follow-up of 22 ± 14 months, 16 cases (53%) achieved complete symptom relief, while 8 cases (26.6%) reported partial relief. Additionally, 11(36%) cases required multiple surgeries. No specific surgical technique demonstrated superiority. Quality of life improved in 77% of cases based on 10 out of 13 GBI collected. Recurrence of PET symptoms occurred on average 10.6 ± 9.7 months after initial surgery, with an estimated global risk of 75% at 3 years. Transient serous otitis media was observed in only 4 cases (13.3%).

Conclusion: Surgical intervention for PET was found to be effective, achieving complete symptom relief in 53% of cases and significantly improving quality of life 2 years post-surgery. However, a substantial portion of cases necessitated one or more re-interventions. The durability of effectiveness appears to diminish over time.

Keywords: Autophony; Eustachian tube; Patulous Eustachian tube.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cartilage / transplantation
  • Durapatite
  • Ear Diseases* / surgery
  • Endoscopy / methods
  • Eustachian Tube* / physiopathology
  • Eustachian Tube* / surgery
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / therapeutic use
  • Male
  • Middle Aged
  • Otologic Surgical Procedures / methods
  • Quality of Life*
  • Treatment Outcome

Substances

  • Hyaluronic Acid
  • Durapatite