The n e w e ng l a n d j o u r na l of m e dic i n e
images in clinical medicine
Patulous Eustachian Tube
and Eustachian-Tube Dysfunction
A
36-year-old woman presented with a 4-year history of intermit- Rodney C. Diaz, M.D.
ICM AUTHOR Diaz RETAKE 1st
tent bilateral aural fullness, subjective hearing loss, and 2nd popping and crack-
REG F FIGURE 1 University of California at Davis
ling tinnitus withCASE
autophony
TITLE
of the left ear. Aural symptoms 3rd were sometimes
Medical Center
Revised
relieved by positional changes,
EMail particularly Line
a change 4-Cto a supine position. The pa- Sacramento, CA 95817
tient had a long-standingEnonhistory of seasonal
ARTIST: mst allergicH/T
H/T rhinitisSIZE
and had had recurrent rcdiaz@ucdavis.edu
FILL Combo 28p
acute otitis media as a child. Examination of the left ear revealed an atrophic, mono-
AUTHOR, PLEASE NOTE:
meric posterior segment ofFigure
tympanic
has beenmembrane (arrow)
redrawn and type with
has been reset.adherence to the long
process of the incus (incudomyringopexy). The
Please check middle-ear cleft was well aerated.
carefully.
The atrophic segment of tympanic membrane was grossly mobile with the patient’s
JOB: 36021 ISSUE: 5-21-09
respirations, and this was amplified with deep respirations (see video). The right ear
showed similar mobility of the tympanic membrane on respiration but without the
associated chronic tympanic changes and atrophy. This case demonstrates simul-
taneous manifestations of disease from opposite ends of the spectrum of eustachian-
tube disorders: an atrophic, monomeric segment of tympanic membrane with associ-
ated incudomyringopexy, which is consistent with a history of eustachian-tube
dysfunction, and gross mobility of the tympanic membrane with respiration, which
is consistent with a patulous eustachian tube. Management options for patulous eu-
stachian tube were discussed, including placement of a tympanostomy tube, medi-
cal management with estrogen nasal drops, and surgical correction. After consider-
ing the options, the patient elected to defer active treatment and observe her symptoms,
which have been stable and tolerable without treatment for the past 2 years.
Copyright © 2009 Massachusetts Medical Society.
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The New England Journal of Medicine
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