Patulous Eustachian tube: Difference between revisions
Content deleted Content added
→What it looks like: "every breath you take" doesn't need to go to an album of the same name |
→Diagnosis: remove {{Cleanup|date=August 2011}} |
||
| (150 intermediate revisions by more than 100 users not shown) | |||
| Line 1: | Line 1: | ||
{{Short description|Medical condition of the middle ear}} |
|||
{{DiseaseDisorder infobox | |
|||
{{Infobox medical condition (new) |
|||
Name = Patulous Eustachian tube | |
|||
| name = Patulous Eustachian tube |
|||
| image = Gray907.png |
|||
| caption = Eustachian tube |
|||
| pronounce = |
|||
| field = [[ENT surgery]] |
|||
| synonyms = Patent Eustachian tube |
|||
| symptoms = |
|||
| complications = |
|||
eMedicineSubj = ent| |
|||
| onset = |
|||
eMedicineTopic = 359| |
|||
| duration = |
|||
| types = |
|||
}}'''Patulous Eustachian tube''', also known as patent Eustachian tube, is the name of a rare physical disorder where the [[Eustachian tube]], which is normally closed, instead stays intermittently open. As a result, when it is open, all of the patient's breathing, talking, swallowing, heart beat, etc. vibrates directly on the ear drum creating an effect that sounds like the patient has a bucket on his/her head. The medical term for this phenomenon is [[autophony]], the hearing of self-generated sounds. |
|||
| causes = |
|||
| risks = |
|||
| diagnosis = |
|||
| differential = |
|||
| prevention = |
|||
| treatment = |
|||
| medication = |
|||
| prognosis = |
|||
| frequency = |
|||
| deaths = |
|||
}} |
|||
'''Patulous Eustachian tube''' is the name of a physical disorder where the [[Eustachian tube]], which is normally closed, instead stays intermittently open. When this occurs, the person experiences [[autophony]], the hearing of self-generated sounds.<ref name="pmid33150241">{{cite journal | vauthors=Ikeda R, Kikuchi T, Oshima H, Kobayashi T | title=Management of Patulous Eustachian Tube | journal=[[Japan Medical Association Journal]] | volume=3 | issue=2 | pages=101–108 | year=2020 | doi = 10.31662/jmaj.2020-0007 | pmc=7590401 | pmid=33150241}}</ref> These sounds, such as one's own breathing, voice, and heartbeat, vibrate directly onto the ear drum and can create a "bucket on the head" effect, making it difficult for the patient to attend to environmental sounds. Patulous Eustachian tube is a form of Eustachian tube dysfunction, which is said to be present in about 1 percent of the general population.<ref>{{Cite book|title=The Chronic Ear|last1=Dornhoffer|first1=John|last2=Gluth|first2=Michael|publisher=Thieme|year=2016|isbn=9781604068658|location=Stuttgart}}</ref> |
|||
== Signs and symptoms == |
|||
==Diagnosis== |
|||
With patulous Eustachian tube, variations in upper airway pressure associated with respiration are transmitted to the middle ear through the Eustachian tube. This causes an unpleasant fullness feeling in the middle ear and alters the auditory perception. Complaints seem to include muffled hearing and autophony. In addition, patulous Eustachian tube generally feels dry with no clogged feeling or sinus pressure. |
|||
Many patients will be misdiagnosed with this disorder because the symptoms closely resemble those of standard congestion (due to cold or allergies) or Eustachian tube dysfunction. The problem with this is that treatment for congestion or Eustachian tube dysfunction will make patulous Eustachian tube worse because the disorders are opposite one another. One major symptom that will tell the two apart is if when a patient with patulous Eustachian tube flips their head upside down, the symptoms clear up temporarily. This will not happen with either congestion or Eustachian tube dysfunction. |
|||
If you have access to an [[audiologist]] (hearing scientist) they should be able to diagnose the condition with little difficulty. The use of [[tympanometry]] or even the use of nasally delivered masking noise when conducting a hearing assessment is highly sensitive to this condition<ref>Hori, Y., Kawase, T., Hasegawa, J., Sato, T., Yoshida, N., et al. (2006). Audiometry with nasally presented masking noise: Novel diagnostic method for patulous eustachian tube. ''Otol Neurotol, 27, 596-599.''</ref>. |
|||
Patients hear their own voice or its echo from inside.<ref>{{Cite book|title=Fundamental Otology: Pediatric and Adult Practice|last=Gopen|first=Quinton|publisher=Jaypee Brothers Medical Publishers Pvt. Ltd.|year=2013|isbn=9789350902691|location=New Delhi|pages=181}}</ref><ref>{{Cite book|title=Hearing Loss, 4th ed.|last1=Sataloff|first1=Joseph|last2=Sataloff|first2=Robert|publisher=CRC Press|year=2005|isbn=9780824754358|location=Boca Raton, FL|pages=186}}</ref> They describe it as being amplified and unpleasant. Lying head down may help since it increases venous blood pressure and congestion of the mucosa. |
|||
===What it sounds like=== |
|||
It sounds very similar to the standard [[congestion]] one gets from a cold or [[allergies]]. If you listen carefully, though, there are a couple subtle differences: (1) The effect sounds drier. When you have normal congestion your breathing and talking echoes in your head, but muffled. With PET you hear ALL of your breaths echo on your ear drum, and they aren't muffled. (2) Everything on the outside world sounds the same. Other people's voices aren't muddled at all, like they commonly are with congestion. Some people are very debilitated by the perceived volume of their voice, causing them to speak very quietly. You may find that lying down or bending over closes the tube and eliminates the problem. Many people lie down to speak on the phone. |
|||
== |
== Causes == |
||
Patulous Eustachian tube is a physical disorder. The exact causes may vary depending on the person and are often unknown.<ref>{{Cite journal |last=Bance |first=Manohar |last2=Tysome |first2=James R. |last3=Smith |first3=Matthew E. |date=2019-09-01 |title=Patulous Eustachian tube (PET), a practical overview |url= |journal=World Journal of Otorhinolaryngology - Head and Neck Surgery |series=Focused Issue on Diagnosis and Management of the Eustachian Tube Disorders |volume=5 |issue=3 |pages=137–142 |doi=10.1016/j.wjorl.2019.08.003 |issn=2095-8811|pmc=6849362 }}</ref> [[Weight loss]] is a commonly cited cause of the disorder due to the nature of the Eustachian tube itself and is associated with approximately one-third of reported cases.<ref>{{Cite book|title=Glasscock-Shambaugh Surgery of the Ear 6th ed.|last1=Gulya|first1=Aina|last2=Minor|first2=Lloyd|last3=Poe|first3=Dennis|publisher=PMPH-USA|year=2010|isbn=9781607950264|location=Shelton, CT|pages=252}}</ref> Fatty tissues hold the tube closed most of the time in healthy individuals. When circumstances cause overall body fat to diminish, the tissue surrounding the Eustachian tube shrinks and this function is disrupted.<ref>[http://www.emedicine.com/ent/topic208.htm Patulous Eustachian Tube Overview at eMedicine]</ref> |
|||
Your voice will sound lower to other people because with the Eustachian tube open, the trachea has more volume. Most people will ask if you have a cold because your voice sounds "stuffed up." |
|||
Activities and substances which dehydrate the body have the same effect and are also possible causes of patulous Eustachian tube. Examples are stimulants (including caffeine) and exercise. Exercise may have a more short-term effect than caffeine or weight loss in this regard. |
|||
===What it feels like=== |
|||
The easiest way to distinguish PET from congestion is by how it feels. With PET you aren't blowing your nose, and you don't feel any sinus pressure. Your ears don't feel clogged, they feel dry. Also try the temporary treatments listed below and see if those help. If they do, it is likely PET, because they don't usually do anything for congestion. |
|||
Pregnancy can also be a cause of patulous Eustachian tube due to the effects of pregnancy hormones on surface tension and mucus in the respiratory system.<ref>Hillman, Edawrd J. (1995). Otolaryngologic Manifestations Of Pregnancy. ''BCM''</ref> |
|||
===What it looks like=== |
|||
A doctor looking directly at your ear drum with his light will be able see that every breath you take vibrates the drum. You can also get a [[tympanogram]] while briskly inspiring and note a significant pressure shift. |
|||
[[Granulomatosis with polyangiitis]] can also be a cause of this disorder. It is yet unknown why. |
|||
===Playing sport=== |
|||
Patulous Eustachian tube can occur as a result of liquid residue in the Eustachian tube, after suffering a middle ear infection (otitis media). |
|||
People who suffer from PET can find playing sport difficult as the increased breathing pushing onto the ear drum can become very noisy and can sometimes lead to a period of increased tinnitus after the event. |
|||
=== Potential causes list === |
|||
==Cause== |
|||
* Longitudinal concave defect in the mucosal valve <ref>{{Cite journal |last=Poe |first=Dennis S. |date=August 2007 |title=Diagnosis and Management of the Patulous Eustachian Tube |url=https://journals.lww.com/otology-neurotology/abstract/2007/08000/diagnosis_and_management_of_the_patulous.13.aspx |journal=Otology & Neurotology |language=en-US |volume=28 |issue=5 |pages=668 |doi=10.1097/mao.0b013e31804d4998 |issn=1531-7129}}</ref> |
|||
PET is a physical disorder. The exact causes may vary depending on the person, however weight loss is a very common cause. [http://www.emedicine.com/ent/topic208.htm]The eustachian tube when normal remains closed most of the time, and there is fat tissue surrounding it that holds it closed. Weight loss, even as little as 5 lb (2 kg), may be enough to cause the tissue surrounding the Eustachian tube to shrink. This will cause it to remain open. |
|||
* Sudden weight loss<ref>{{Cite journal |last=Muñoz |first=Daniel |last2=Aedo |first2=Cristian |last3=Der |first3=Carolina |date=October 2010 |title=Patulous eustachian tube in bariatric surgery patients |url=|journal=Otolaryngology–Head and Neck Surgery |language=en |volume=143 |issue=4 |pages=521–524 |doi=10.1016/j.otohns.2010.07.004 |issn=0194-5998}}</ref> |
|||
* Radiation therapy |
|||
* High levels of estrogen |
|||
* Nasal decongestants |
|||
* Stress |
|||
* Neurological disorders |
|||
It's worth noting that there hasn't been much comprehensive scientific research conducted to establish a clear correlation between most of the claimed potential causes and patulous eustachian tube disorder. |
|||
Caffeine, especially the amount in coffee, is also a major cause, as it may dehydrate enough to affect the surrounding tissue. Exercise does the same thing, although for a shorter amount of time. |
|||
== Diagnosis == |
|||
Pregnancy can also be a cause of PET due to the effects of pregnancy hormones on surface tension and mucous in the respiratory system. [http://www.emedicine.com/ent/topic208.htm][http://www.bcm.edu/oto/grand/2295.html] |
|||
Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly view the [[tympanic membrane]] with a light and observe that it vibrates with every breath taken by the patient. A [[tympanogram]] may also help with the diagnosis. Patulous Eustachian tube is likely if brisk inspiration causes a significant pressure shift. |
|||
Patulous Eustachian tube is frequently misdiagnosed as standard congestion due to the similarity in symptoms and rarity of the disorder. [[Audiologist]]s are more likely to recognize the disorder, usually with tympanometry or nasally delivered masking noise during a hearing assessment, which is highly sensitive to this condition.<ref>Hori, Y., Kawase, T., Hasegawa, J., Sato, T., Yoshida, N., et al. (2006). Audiometry with nasally presented masking noise: Novel diagnostic method for patulous eustachian tube. ''Otol Neurotol, 27, 596-599.''</ref> |
|||
==Treatment== |
|||
===Temporary treatments=== |
|||
*Tilt your head to the side or flip it upside down. |
|||
*Lie down on your back. |
|||
*Sit in a chair and put your head between your legs. |
|||
*Pinch your jugulars (where you take your pulse in your neck) for a few seconds. |
|||
*Forcibly exhale with a closed windpipe so that no air exits through the mouth or nose (Valsalva maneuver) |
|||
When misdiagnosis occurs, a [[decongestant]] medication is sometimes prescribed. This type of medication aggravates the condition, as the Eustachian tube relies on sticky fluids to keep closed and the drying effect of a decongestant would make it even more likely to remain open and cause symptoms. |
|||
===More rigorous treatments=== |
|||
*Weight gain [http://www.emedicine.com/ent/topic208.htm] |
|||
*Lying down 4 times a day for 15 minutes each with legs raised on stairs or a chair—about 20 inches. Recommend first time when you get up in the morning and last time just before going to bed at night. Within about 2 weeks noticed improvement. *Discontinue exercise during this program. [http://web1.incl.ne.jp/ishikawa/PET/treat.html] |
|||
*Consider using Patul-END™ nasal drops, available from the Ear Foundation, Santa Barbara, California. The supplier's website gives details about obtaining the latest version of the drops, and describes trials of an earlier version. [http://www.earfdn.org] The full texts of two articles on PET are also available online.<ref>Joseph R. DiBartolomeo, M.D., and David F. Henry, Ph.D. A new medication to control patulous eustachian tube disorders. The American Journal of Otology, vol. 13 no. 4, July 1992.</ref> <ref>J.R. Di Bartolomeo, D.F. Henry, and M. Di Bartolomeo. Patulous Eustachian tube disorders: a new nasal medication. From the 2nd European Congress of Oto-Rhino-Laryngology. The New Frontiers of Otorhinologylaryngology in Europe, Sorronto, Italy, June 6 - 10, 1992</ref> |
|||
*[[Jia-Wei-Gui-Pi-Tang]] [http://web1.incl.ne.jp/ishikawa/PET/art1.html] - an herbal tea. (This is considered an alternative therapy) |
|||
*Discontinue coffee use. |
|||
*For the very distressed surgical interventions aimed at "bulking up" the ET (with fat, gel foam, or cartilage) or scarring the ET closed (with cautery) can be tried, but are not always successful. |
|||
Patients who instead suffer from the even rarer condition of [[superior canal dehiscence]] are at risk for misdiagnosis of patulous Eustachian tube due to the similar [[autophony]] in both conditions. |
|||
===Long term complications=== |
|||
Because at face value PET seems like standard congestion both to yourself and others, a decongestant is usually prescribed which will make the situation worse. The Eustachian tube relies on sticky fluids to keep it closed, and the decongestant will dry the tube out making it stay open even more. Because of the rarity of PET, even ear-nose-throat specialists often misdiagnose it. And sometimes doctors will tell the patient to have a tube surgically inserted into their ear drum to no avail... a tube which puts the patient at constant risk of an ear infection from normal activities like swimming in a lake. And in some cases, exhausted doctors who have tried every treatment might conclude that the patient has a psychological rather than physical disorder. Sometimes the [[autophony]] caused by the even rarer condition [[superior canal dehiscence]] is mistakenly diagnosed as being due to PET. |
|||
== |
== Treatment == |
||
Estrogen nasal drops or saturated potassium iodide have been used to induce [[edema]] of the eustachian tube opening. Nasal medications containing diluted [[hydrochloric acid]], chlorobutanol, and benzyl alcohol have been reported to be effective in some patients, with few side effects. [[Food and Drug Administration]] approval is still pending, however.<ref>{{Cite web|url=http://emedicine.medscape.com/article/858909-overview|title=Emedicine - Patulous Eustachian Tube|last1=Patel|first1=K|last2=Levine|first2=S|date=July 31, 2010}}</ref> Nasal sprays have also been a very effective temporary treatment for this disease, as well.<ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/10812/patulous-eustachian-tube|title=Patulous Eustachian Tube {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|access-date=2018-12-12}}</ref> |
|||
*[http://web1.incl.ne.jp/ishikawa/PET/art1.html Japanese study regarding efficacy of Jia-Wei-Gui-Pi-Tang] |
|||
*[http://www.treasureofeast.com/ Where to get Jia-Wei-Gui-Pi-Tang] |
|||
*[http://www.emedicine.com/ent/topic208.htm General Info from eMedicine.com] |
|||
*[http://www.bcm.edu/oto/grand/71196.html General Info from Grand Rounds Archive] |
|||
*[http://www.doctorhoffman.com/patul.htm Detailed description of symptoms and experiences with misdiagnosis from a fellow sufferer] |
|||
*[http://www.earfdn.org Ear Foundation] |
|||
In extreme cases surgical intervention may attempt to restore the Eustachian tube tissues with fat, gel foam, or cartilage or scar it closed with [[cautery]]. These methods are not always successful. For example, there is the case of the early attempts at surgical correction involving injections of tetrafluoroetheylene ([[Polytetrafluoroethylene|Teflon]]) paste but although this treatment was able to give transient relief, it was discontinued due to several deaths that resulted from inadvertent intracarotid injections.<ref>{{Cite book|title=Ballenger's Otorhinolaryngology: Head and Neck Surgery|last1=Snow|first1=James|last2=Ballenger|first2=John Jacob|publisher=PMPH-USA|year=2009|isbn=9781550093377|location=Sheldon, CT|pages=207}}</ref> |
|||
==References== |
|||
{{reflist}} |
|||
Although a temporary solution, surgical [[Tympanostomy tube|ventilation tube]] placement in the ear drum has also proven to be an effective treatment option. This treatment is known as either a unilateral or bilateral [[myringotomy]]. 50% of patients reported relief of patulous Eustachian tube symptoms when given this treatment.<ref>{{cite journal|last1=Chen|first1=DA|last2=Luxford|first2=WM|year=1990|title=Myringotomy and tube for relief of patulous eustachian tube symptoms.|journal=The American Journal of Otology|volume=11|issue=4|pages=272–3|issn=0192-9763|pmid=2399947}}</ref> |
|||
[[Category:Head and neck]] |
|||
[[Category:Auditory system]] |
|||
== References == |
|||
[[el:Τυμπανοπνευμονία]] |
|||
{{Reflist}} |
|||
[[it:Tuba beante]] |
|||
[[ja:耳管開放症]] |
|||
== External links == |
|||
{{Medical resources |
|||
| ICD10 = {{ICD10|H|69.0}} |
|||
| ICD9 = {{ICD9|381.7}} |
|||
| ICDO = |
|||
| OMIM = |
|||
| MedlinePlus = |
|||
| eMedicineSubj = ent |
|||
| eMedicineTopic = 359 |
|||
| DiseasesDB = |
|||
}} |
|||
{{Outer and middle ear disease|state=autocollapsed}} |
|||
{{DEFAULTSORT:Patulous Eustachian Tube}} |
|||
[[Category:Human head and neck]] |
|||
[[Category:Auditory system]] |
|||
[[Category:Otology]] |
|||
[[Category:Audiology]] |
|||
Latest revision as of 01:11, 19 October 2024
| Patulous Eustachian tube | |
|---|---|
| Other names | Patent Eustachian tube |
 | |
| Eustachian tube | |
| Specialty | ENT surgery |
Patulous Eustachian tube is the name of a physical disorder where the Eustachian tube, which is normally closed, instead stays intermittently open. When this occurs, the person experiences autophony, the hearing of self-generated sounds.[1] These sounds, such as one's own breathing, voice, and heartbeat, vibrate directly onto the ear drum and can create a "bucket on the head" effect, making it difficult for the patient to attend to environmental sounds. Patulous Eustachian tube is a form of Eustachian tube dysfunction, which is said to be present in about 1 percent of the general population.[2]
Signs and symptoms
[edit]With patulous Eustachian tube, variations in upper airway pressure associated with respiration are transmitted to the middle ear through the Eustachian tube. This causes an unpleasant fullness feeling in the middle ear and alters the auditory perception. Complaints seem to include muffled hearing and autophony. In addition, patulous Eustachian tube generally feels dry with no clogged feeling or sinus pressure.
Patients hear their own voice or its echo from inside.[3][4] They describe it as being amplified and unpleasant. Lying head down may help since it increases venous blood pressure and congestion of the mucosa.
Causes
[edit]Patulous Eustachian tube is a physical disorder. The exact causes may vary depending on the person and are often unknown.[5] Weight loss is a commonly cited cause of the disorder due to the nature of the Eustachian tube itself and is associated with approximately one-third of reported cases.[6] Fatty tissues hold the tube closed most of the time in healthy individuals. When circumstances cause overall body fat to diminish, the tissue surrounding the Eustachian tube shrinks and this function is disrupted.[7]
Activities and substances which dehydrate the body have the same effect and are also possible causes of patulous Eustachian tube. Examples are stimulants (including caffeine) and exercise. Exercise may have a more short-term effect than caffeine or weight loss in this regard.
Pregnancy can also be a cause of patulous Eustachian tube due to the effects of pregnancy hormones on surface tension and mucus in the respiratory system.[8]
Granulomatosis with polyangiitis can also be a cause of this disorder. It is yet unknown why.
Patulous Eustachian tube can occur as a result of liquid residue in the Eustachian tube, after suffering a middle ear infection (otitis media).
Potential causes list
[edit]- Longitudinal concave defect in the mucosal valve [9]
- Sudden weight loss[10]
- Radiation therapy
- High levels of estrogen
- Nasal decongestants
- Stress
- Neurological disorders
It's worth noting that there hasn't been much comprehensive scientific research conducted to establish a clear correlation between most of the claimed potential causes and patulous eustachian tube disorder.
Diagnosis
[edit]Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly view the tympanic membrane with a light and observe that it vibrates with every breath taken by the patient. A tympanogram may also help with the diagnosis. Patulous Eustachian tube is likely if brisk inspiration causes a significant pressure shift.
Patulous Eustachian tube is frequently misdiagnosed as standard congestion due to the similarity in symptoms and rarity of the disorder. Audiologists are more likely to recognize the disorder, usually with tympanometry or nasally delivered masking noise during a hearing assessment, which is highly sensitive to this condition.[11]
When misdiagnosis occurs, a decongestant medication is sometimes prescribed. This type of medication aggravates the condition, as the Eustachian tube relies on sticky fluids to keep closed and the drying effect of a decongestant would make it even more likely to remain open and cause symptoms.
Patients who instead suffer from the even rarer condition of superior canal dehiscence are at risk for misdiagnosis of patulous Eustachian tube due to the similar autophony in both conditions.
Treatment
[edit]Estrogen nasal drops or saturated potassium iodide have been used to induce edema of the eustachian tube opening. Nasal medications containing diluted hydrochloric acid, chlorobutanol, and benzyl alcohol have been reported to be effective in some patients, with few side effects. Food and Drug Administration approval is still pending, however.[12] Nasal sprays have also been a very effective temporary treatment for this disease, as well.[13]
In extreme cases surgical intervention may attempt to restore the Eustachian tube tissues with fat, gel foam, or cartilage or scar it closed with cautery. These methods are not always successful. For example, there is the case of the early attempts at surgical correction involving injections of tetrafluoroetheylene (Teflon) paste but although this treatment was able to give transient relief, it was discontinued due to several deaths that resulted from inadvertent intracarotid injections.[14]
Although a temporary solution, surgical ventilation tube placement in the ear drum has also proven to be an effective treatment option. This treatment is known as either a unilateral or bilateral myringotomy. 50% of patients reported relief of patulous Eustachian tube symptoms when given this treatment.[15]
References
[edit]- ^ Ikeda R, Kikuchi T, Oshima H, Kobayashi T (2020). "Management of Patulous Eustachian Tube". Japan Medical Association Journal. 3 (2): 101–108. doi:10.31662/jmaj.2020-0007. PMC 7590401. PMID 33150241.
- ^ Dornhoffer, John; Gluth, Michael (2016). The Chronic Ear. Stuttgart: Thieme. ISBN 9781604068658.
- ^ Gopen, Quinton (2013). Fundamental Otology: Pediatric and Adult Practice. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd. p. 181. ISBN 9789350902691.
- ^ Sataloff, Joseph; Sataloff, Robert (2005). Hearing Loss, 4th ed. Boca Raton, FL: CRC Press. p. 186. ISBN 9780824754358.
- ^ Bance, Manohar; Tysome, James R.; Smith, Matthew E. (2019-09-01). "Patulous Eustachian tube (PET), a practical overview". World Journal of Otorhinolaryngology - Head and Neck Surgery. Focused Issue on Diagnosis and Management of the Eustachian Tube Disorders. 5 (3): 137–142. doi:10.1016/j.wjorl.2019.08.003. ISSN 2095-8811. PMC 6849362.
- ^ Gulya, Aina; Minor, Lloyd; Poe, Dennis (2010). Glasscock-Shambaugh Surgery of the Ear 6th ed. Shelton, CT: PMPH-USA. p. 252. ISBN 9781607950264.
- ^ Patulous Eustachian Tube Overview at eMedicine
- ^ Hillman, Edawrd J. (1995). Otolaryngologic Manifestations Of Pregnancy. BCM
- ^ Poe, Dennis S. (August 2007). "Diagnosis and Management of the Patulous Eustachian Tube". Otology & Neurotology. 28 (5): 668. doi:10.1097/mao.0b013e31804d4998. ISSN 1531-7129.
- ^ Muñoz, Daniel; Aedo, Cristian; Der, Carolina (October 2010). "Patulous eustachian tube in bariatric surgery patients". Otolaryngology–Head and Neck Surgery. 143 (4): 521–524. doi:10.1016/j.otohns.2010.07.004. ISSN 0194-5998.
- ^ Hori, Y., Kawase, T., Hasegawa, J., Sato, T., Yoshida, N., et al. (2006). Audiometry with nasally presented masking noise: Novel diagnostic method for patulous eustachian tube. Otol Neurotol, 27, 596-599.
- ^ Patel, K; Levine, S (July 31, 2010). "Emedicine - Patulous Eustachian Tube".
- ^ "Patulous Eustachian Tube | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2018-12-12.
- ^ Snow, James; Ballenger, John Jacob (2009). Ballenger's Otorhinolaryngology: Head and Neck Surgery. Sheldon, CT: PMPH-USA. p. 207. ISBN 9781550093377.
- ^ Chen, DA; Luxford, WM (1990). "Myringotomy and tube for relief of patulous eustachian tube symptoms". The American Journal of Otology. 11 (4): 272–3. ISSN 0192-9763. PMID 2399947.