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Took Sinus Relief And Antibiotics For Cough. Had Autophony. Do I Have Patulous Eustachian Tube?

Posted on Fri, 1 Mar 2013

Question: Hello. My ENT consultant thinks I might have Patulous Eustachian Tube. I have had autophony for 3 months where I hear my breath, heartbeat and voice magnified and I have to breathe through my mouth as I can't get my breath when the ear is "bad" all day. It goes better at night when I'm lying down but starts after about half an hour when I get up in the morning. I had bad colds for about 4 months before this happened and took lots of mucus medicines, sinus relief and antibiotics. This autophony however is much worse than colds it is getting unbearable and is having a great impact on everyday life. I am using a saline sinus rinse but so far it has done no good. Is there a cure that you know of please? If there is anywhere I can go in the UK for help I will go.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (7 hours later)

Hi

Thanks for query

Autophony occurs when the air flows into the middle ear cavity from the nasopharynx on a continuing basis through a persistently open Eustachian tube causing a roaring noise whenever the patient takes a breath. The exact mechanism causing autophony still remains unknown.

The probable causes include:
1. Serous Otitis media (collection of fluid in the middle ear) secondary to sinusitis or flu.
2. Patulous Eustachian tube, secondary to sudden weight loss.
3. Superior semicircular canal dehiscence - transmitting the conducted sounds and also augmenting trivial sounds such as heart beat.

In your case, I strongly feel it could be due to either serous otitis media or patulous Eustachian tube.

It requires a thorough examination of the ear and nose, aided with investigations such as nasal endoscopy, tympanometry, CT scan of the paranasal sinuses and temporal bone (if necessary) to confirm the diagnosis. Consult a good ENT specialist for a thorough evaluation and management.

The treatment varies depending upon the diagnosis. If it is a patulous tube then surgical intervention is the only choice. Serous otitis media can be treated with medicines and certain home remedies such as steam inhalation.

Hope this answers you query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (8 hours later)

Thank you. So far the consultant says "there is a normal appearance of the tympanic membranes, albeit with no significant obvious movement of the tympanic membranes on performing Val Salva or Toinbee manoeuvres. Flexible naso-laryngoscopy reveals no evidence of pus or polyps and a clear post nasal space. Hearing tests were normal. The voice is now has a nasal sound and the patient complains of a discharge in her throat when the ear is full."

So basically no-one seems to know what to do next. Do you know how the surgery is performed if the tube IS patulous and a center of excellence in the UK? I was taking medicines for ear infections but nothing worked. Steam inhalation did no good either. The ear is not painful and my balance is not affected. Could this still be Otitis media?

Any further advice would be appreciated as this condition is affecting my life greatly. I am a teacher and I cannot work due to the noise in my ear when I speak.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (5 hours later)

Hi

Thanks for writing back

There is a small confusion over here. Are you sure that your doctor has diagnosed your problem as Patulous Eustachian tube. This is because, the report says, your ear drum does not move with Valsalva or Toynbee manoeuvre. In case of Patulous Eustachian tube, the eardrum will move with respiration and the tympanometry test would have confirmed the same. Hence the diagnosis made and report given are contradicting each other.

If according to the report, the ear drum is not moving, then, there could be fluid inside the middle ear. Secondly, Eustachian tube dysfunction can also present in similar way, which is difficult to diagnose with any other means of investigation.

Finally, for treating patulous Eustachian tube a surgical intervention in the form of insertion of the stent from the middle ear into the Eustachian tube is done to reduce the size of the lumen of the tube, enabling it to maintain pressure inside the middle ear.

My suggestion to you is, to get back to the doctor and discuss about this again and request for the tympanometric examination.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar