The Blocked Ear

Patulous Eustachian Tube

A condition that is characterised by autophony (the hearing of one’s own voice), intermittent pressure, popping and clicking in the ear. These symptoms are often improved when the head is placed in a dependent condition, or when you have a cold.

patulous tube2 (click on link to see an otoscopic image of a patient with patulous eustachian tube. The ear drum can be seen moving during gentle nasal respiration)

It is caused by the Eustachian tube remaining open in the resting state, transmitting a relatively increased pressure to the middle ear.

The Eustachian tube connects the middle ear to the nasopharynx  (the back of the nose), and acts as a pressure release valve of the ear.  In its resting state it is closed, and opens on swallowing or on performance of a Valsalva manoeuvre. In a patulous eustachian tube this tube is too open, and thus transmits sound, pressure and respiration into the middle ear.

About one third of patients develop this condition following significant weight loss, and paradoxically is more common in pregnancy. In most cases it is self limiting and or mild. Many people find symptoms worsen when under a degree of stress or pressure.

Standard treatments aim to create nasal mucosal congestion. Glycerol drops or oestrogen drops are the commonof these but are generally poorly tolerated. Surgical intervention includes tympanostomy tube insertion, successful in about 25% in at least reducing some symptoms, injection of materials around the opening of the tube, and more recently limited reports of cartilage implants being placed.