(0960) Surgical Treatment of Patulous Eustachian Tube

Introduction: Patulous eustachian tube dysfunction (PET) is an uncommon eustachian tube disorder diagnosed through clinical history and specific physical exam findings, including tympanic membrane mobility coinciding with ipsilateral nasal breathing. At present, there are no standardized treatment guidelines for PET. We present a retrospective, single-institution experience of the treatment of PET with placement of a shim into the eustachian tube.

Methods: This is a retrospective, single-institution review. Inclusion criteria includes adult patients (> 18 years old) diagnosed with patulous eustachian tube dysfunction with no evidence of obstructive eustachian tube dysfunction (ETD), who underwent shim placement from 2019 to 2023. Data collection comprised of demographics, comorbid disease, and treatment outcomes. Analysis includes only descriptive statistics given the small sample size.

Results: Among the 12 patients with PET, 11 presented with autophony (voice, breath, or both), and nine presented with aural fullness. A history of rhinitis or sinusitis was prevalent in ten patients, constituting the most common comorbidity, while two patients exhibited concurrent superior semicircular canal dehiscence. Following shim placement, documented improvement in autophony was observed in ten out of eleven patients, whereas only two experienced relief from aural fullness. The most common complication was obstructive eustachian tube dysfunction and otorrhea. Two patients required shim revision surgery due to initial misalignment.

Conclusions: In summary, the majority of patients noticed an improvement in autophony after shim placement, the most prevalent presenting symptom. The most common complications included effusion, persistent aural fullness, hearing loss, and otorrhea; however, conservative, in-office management proved effective in mitigating these symptoms. Our study contributes to the existing body of evidence supporting the safety and efficacy of shim placement as a treatment for PET.