Patulous Eustachian tube

Gaping Tube, open tube or Advanced eustachian tube called a dysfunction of the Eustachian tube ( auditory tube ), in which the tube remains on both sides or just one side, permanently or temporarily opened. Usually the tube under the influence of the surrounding tissue, especially of the tube cartilage and the so-called Ostermann - fat body, closed and opens only briefly under the action of a series of muscles, especially of the tensor veli palatini (Span muscle of the soft palate ).

Symptoms

The main symptom of the gaping Tube is the autophony, that is, the body's own sound is freely supplied through the tube to the middle ear. Own voice is perceived as very loud and booming, the ambient noise in comparison as too low. Even one's own breathing is perceived comparatively loud, sometimes a breath synchronous flutter or flap is described. The patients often complain of a dull ear pressure. Typically, the symptoms disappear with increasing venous pressure in the head area, such as lying down or by pressure on the neck veins. Not infrequently, patients present with gaping Tube subjective compulsion to sharp inhalation through the nose (known as sniffing ), whereby a negative pressure in the nasopharynx produced which is transmitted to the middle ear via the open tube, leading to a temporary closure of the tube. However, compared to the frequency of the gaping tube (about six to seven per cent ), the number of patients with serious medical strikingly low, usually the gaping Tube is asymptomatic. However, in particular, consist in autophony a considerable suffering.

Causes

According to current knowledge, a number of causes for the gaping tube is discussed. These include a previous strong decrease in body weight, hormonal factors (pregnancy, contraceptives), scars in the nasopharynx after adenoidectomy or about a tumor irradiation of the nasopharynx. More complex causes such a desynchronization of swallowing and contraction of the tensor veli palatini, which the tube remains open at the passage of the food into the esophagus from the pharynx, are described. A relationship between craniomandibular dysfunction and tubal occlusion disorder is discussed.

Diagnosis

In addition to the typical symptoms ( autophony, disappearance of symptoms when lying down or when increasing the venous pressure ) often leaves them with a microscope a breathless synchronous eardrum movement. Tympanometrisch can show synchronous with respiration impedance changes. Depending on the severity of tubal disorder these changes are not always detected. Mostly, however, show the eustachian tube function tests ( Valsalva maneuver or similar) an abnormally easy open tube. Experiments, a gaping tube with imaging agents to detect (magnetic resonance imaging ) are not yet satisfactory.

Treatment methods

In view of the frequent lack of symptoms no therapy is often required. In asthenic patients, a weight gain may eliminate the symptoms in women discontinuation or change of ovulation inhibitor can be successful. Occasionally shows the use of a nasal ointment improvement. Decongestant nose drops or sprays are to be avoided, as is the frequent performing the Valsalva test.

Various surgical methods for narrowing the tube entrance, as the injection of silicone, collagen, or the implantation of Gelatineschwämmchen or cartilage in the Eustachian prominence, show no regular success.