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Scientific Oral Presentations

Otology/Neurotology

Session: Scientific Oral Presentations 6 - Otology/Neurotology

Patient Symptom Response to Various Diagnostic Maneuvers for Patulous Eustachian Tube

Monday, September 30, 2024
10:24 AM – 10:30 AM EDT
Location: MBCC, 231
Disclosure(s):
Aatin K. Dhanda, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Dominique L. Paderin:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Najm S. Khan, MBS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Masayoshi Takashima, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Omar G. Ahmed, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kenny F. Lin, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The pathophysiology of Patulous eustachian tube (PET) is incompletely understood. Typical symptoms include ear pressure, autophony of voice and autophony of breathing. Observation of patient symptoms in response to various diagnostic maneuvers provides new insight as to causation, and characterizes the effect of nasal airflow on PET symptom burden.

Methods: A retrospective cohort of 40 PET patients were queried from the electronic health record, and practice patterns were interrogated. Diagnostic tests including cotton test (application of cotton to inferior meatus), Cottle maneuver, nasal tip elevation, ear canal occlusion (ECO), and serial nasal occlusions (ipsilateral vs. contralateral) were applied, and patient response was assessed subjectively. Patient symptom responses to diagnostic maneuvers were graded as worse, no change, improved or eliminated. Descriptive statistics were assessed.

Results: Ear pressure was a complaint present in 92.5% (37/40) of patients, autophony 72.5% (29/40), and amplified breathing 55% (22/40). Most patients 55.55% (20/36) experienced improvement with ECO. Ipsilateral nostril occlusion eliminated symptoms in 20.7% (6/29) and improved symptoms in 41.4% (12/29). Contralateral nostril occlusion worsened symptoms in 38.5% (10/26). Half (50%) (11/22) of patients reported improvement with Cottle Maneuver, and 13.6% (3/22) reported symptom elimination. Nasal tip elevation improved symptoms in 23.1% (3/13) of patients but worsened symptoms in 7.7% (1/13) of patients. There were patients that experienced complete elimination of symptoms with each diagnostic test, though least common with ear canal occlusion. Response to Cotton test was uniformly positive, although this was only applied to patients suspected of having empty nose syndrome.

Conclusions: Symptoms of patulous eustachian tube may be improved or eliminated in response to various clinical maneuvers. These tests implicate aberrant nasal airflow as a possible cause of PET symptoms. This is one of the first studies to evaluate various diagnostic maneuvers in the understanding of PET.

    Presenting Author(s)

  • AD

    Aatin K. Dhanda, MD

    Resident
    Department of Otolaryngology - Head and Neck Surgery / Houston Methodist Hospital
    Houston, Texas, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Dominique L. Paderin

    Medical Student
    Texas A&M College of Medicine
    College Station, TX, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Najm S. Khan, MBS

    Medical Student
    Department of Otolaryngology - Head and Neck Surgery / Houston Methodist Hospital
    Piscataway, NJ, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Masayoshi Takashima, MD

    Professor and Chair, Department of Otolaryngology - Head and Neck Surgery
    Houston Methodist Academic Institute / Houston Methodist Hospital
    Houston, Texas, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Omar G. Ahmed, MD

    Assistant Professor
    Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, TX, USA
    Houston, TX, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • KL

    Kenny F. Lin, MD

    Assistant Professor
    Houston Methodist
    Houston, TX, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • JV

    Jeffrey T. Vrabec, MD

    Attending physician
    Houston Methodist Hospital
    Houston, TX, United States

    Disclosure information not submitted.