Abstract
The eustachian tube (ET) is normally closed, but it opens temporarily during swallowing. Patients with a patulous ET (PET) have various aural symptoms such as aural fullness, autophony, and hearing their own breathing. These symptoms are caused by abnormal transmission of sound from the pharynx to the middle ear via an open ET with little attenuation. We introduce a novel injection technique for the treatment of PET using autologous cartilage. This procedure is minimally invasive and has been successfully used to treat PET in 2 patients.
1
Introduction
The eustachian tube (ET) is normally closed, but it opens temporarily during swallowing. Patients with a patulous ET (PET) have various aural symptoms such as aural fullness, autophony, and hearing their own breathing. These symptoms are caused by abnormal transmission of sound from the pharynx to the middle ear via an open ET with little attenuation. The diagnosis of PET can be confirmed by visualization of medial and lateral movements of the tympanic membrane coincident with forced nasal breathing. Numerous medical and surgical treatments have been reported for PET.
We introduce a novel injection technique for the treatment of PET using autologous cartilage. This procedure is minimally invasive and has been successfully used to treat PET in 2 patients. This study was approved by the institutional review board of our hospital.
2
Case reports
2.1
Case 1
A 45-year-old man complained of right ear autophony and aural fullness for 8 years. He denied weight loss, and he had previously undergone right myringotomy with ventilation tube insertion for the treatment of PET by an outside otologist. He complained of louder breathing sounds after ventilation tube insertion. We removed the ventilation tube and applied a paper patch to the perforated drum. One month later, we removed the paper patch and confirmed the PET by visualizing medial and lateral movements of the right tympanic membrane coincident with nasal breathing. The left ear drum was normal. The patient had been treated with topical nasal anticholinergic spray and topical estrogen drops for 6 months, but those were ineffective. We decided to use autologous cartilage injection for the treatment of PET. The patient consented to the procedure, recognizing this was a novel and unproven technique. Under local anesthesia, cartilage was harvested from the tragus and cut into small pieces using a scalpel and scissors, so that it could pass through a 19-gauge needle ( Fig. 1 ). A Bruning injector syringe was filled with 0.8 mL of the pastelike minced cartilage. We injected the cartilage submucosally into the anterior (0.4 mL) and posterior aspects (0.4 mL) of the nasopharyngeal ET orifice using a 30°, 4-mm nasal endoscope. The patient achieved complete symptomatic relief. Two years postoperatively, he remains free of symptoms ( Fig. 2 ). He had no complications such as otitis media with effusion (OME).
