Last month, while editing an audio segment for Urgent Care RAP on eustachian tube dysfunction, I learned about a medical condition I had NEVER heard of. Not only was it new to me, but it also immediately ascended to my list of greatest fears, ranking in third place just below waking up with a spider in my mouth.
In the urgent care setting, we encounter patients with eustachian tube dysfunctions daily, and most of us are well-versed in both recognizing and treating this when they present. This dysfunction commonly occurs when the eustachian tube is obstructed, preventing the management of fluid/pressure in the middle ear. This results in patients presenting with ear fullness, difficulty hearing, and discomfort.
What you may not know is that there is actually another type of eustachian tube dysfunction, which occurs when the eustachian tube remains abnormally open, called a patulous dysfunction, and it is the stuff horror movies are made from.
Patulous Dysfunction
Occurs when the valve of the eustachian tube fails to close, inhibiting its ability to protect the inner ear from loud noises. The open tube allows a direct pathway for noise to travel from your nasal-sinus cavity to your ears.
Symptoms often come and go, and patients may present with a sense of fullness and ringing of the ears. It notably leads to disturbing symptoms such as hearing one’s own voice and breathing too loudly. Even the ever-present sound of blood pumping becomes amplified in patients' ears. This results in significant patient distress.
This condition is hard to diagnose on physical exam in the UC and is often suspected based on symptoms alone.
Causes:
Most cases are idiopathic, complicating treatment further, but may result from:
- Weight loss
- Hormonal changes
- Allergies
- Acid reflux
- Stress and anxiety
- Radiation therapy
Treatment
Common recommendations include increasing hydration and limiting caffeine/decongestants. These often provide limited relief, and you should refer patients to ENT for possible surgical treatment.
If the thought of constantly hearing yourself breathing loudly and literally walking to the beat of your own blood pumping in your ears doesn’t frighten you - then I don’t know what does! To learn more about eustachian tube dysfunction, listen to this month’s Urgent Care RAP segment with Matt DeLaney and Brett Murphy.
