How safe and effective are surgical treatments for patulous Eustachian tube (PET)?
Background: PET can result in multiple symptoms, including voice autophony, breathing autophony, and aural fullness. Possible etiologies include peritubal fat tissue atrophy, venous tone loss of the pterygoid venous plexus, and peritubal musculature dysfunction. Although PET is a well-recognized pathologic entity, standardized treatment algorithms, most of which aim to narrow or close the ET pharyngeal orifice, have yet to be established.
Explore this issue:September 2015
Study design: Retrospective review of 14 studies comprising a total of 226 patients (253 ears), published between 1960 and 2014.
Setting: MEDLINE, Google Scholar, and Cochrane databases.
Synopsis: The most commonly reported techniques were ET plugging, PE tube placement, and suture ligation. Additional techniques included hydroxyapatite injection, autologous cartilage implantation, diathermy, gelatin injection, cauterization, pterygoid hamulotomy, and tensor veli palatine muscle transection/transposition. A wide variety of outcome measurements were used, and overall symptom improvement ranged between 22% and 100%.
Four studies (each with four or fewer patients) reported symptomatic improvement in 100% of study participants. Three studies reported symptomatic improvement in more than 80% of study patients. Surgical approaches with the lowest reported efficacy included ET diathermy and ventilation tube placement. Few complications were reported; the most common were middle ear effusion, otorrhea, foreign body sensation, pain, epistaxis, and tinnitus.
Few studies reported objective measures for middle ear or audiologic function following PET surgery. For most surgical approaches, revision procedure frequency was less than 20%, with no major complications reported. Limitations included small study populations and difficulty comparing techniques due to lack of a defined assessment criteria or scoring system.
Bottom line: Surgical intervention for PET appears to be generally safe, with few unique risks isolated to the individual interventions performed.
Citation: Hussein AA, Adams AS, Turner JH. Surgical management of patulous Eustachian tube: a systematic review. Laryngoscope. 2015;125:2193–2198.