Overview

What are the Eustachian Tubes?

You have a Eustachian tube on each side of your head. These small tubes run from the very back of your nose to the middle part of your ear. Usually, they remain closed and only open briefly when you swallow, yawn, or chew. Their main job is to equalise the air pressure on either side of your eardrum (which is why your ears "pop" on an aeroplane) and to drain any normal mucus from the middle ear.

What is Patulous Eustachian Tube Dysfunction (PETD)?
"Patulous" is a medical term that simply means "abnormally open." In PETD, the Eustachian tube stays open too much or all of the time, rather than staying naturally closed. Because the tube is constantly open, sounds from your mouth and throat—as well as your breathing—can travel directly up the tube and strike the eardrum from the inside.

While it is a benign (harmless) condition, it can be quite bothersome and distressing for those who experience it.

Symptoms and Causes

Symptoms

Symptoms can range from very mild to highly distracting, and they often come and go. You might experience:

• Autophonia: Hearing your own voice abnormally loudly or as if it is echoing inside your head.
• Internal Body Noises: Hearing your own breathing, chewing, or heartbeat very loudly.
• Hyperacusis: Hearing general sounds (like other people's voices) as painfully or uncomfortably loud.
• Aural Fullness: A sense of pressure, fullness, or "plugging" in the ears.
• Mild Hearing Loss or Tinnitus: A slight reduction in hearing or a ringing/roaring sound in the ears.

Note: Interestingly, symptoms often temporarily improve when you lie down, put your head between your knees, or when you have a common cold (because a cold causes the tissues in the nose to swell, which naturally forces the tube shut).

Causes

Doctors cannot always find an exact reason why PETD develops. However, it is strongly associated with several factors that cause the tissues around the tube to shrink or change:

• Significant Weight Loss: Losing weight rapidly can cause a loss of the natural fatty tissue that helps keep the Eustachian tube closed.
• Hormonal Changes: Pregnancy, the menopause, or taking hormone therapy (such as oral contraceptives).
• Medical Treatments: Previous radiotherapy or chemotherapy.
• Other Health Conditions: Fatigue, stress, allergies, or Gastro-oesophageal reflux disease (acid reflux/heartburn).
• Exercise: Symptoms may get temporarily worse during heavy aerobic exercise due to dehydration and increased breathing.

Diagnosis and Investigations

Because the symptoms of PETD (like a blocked feeling or ringing ears) can mimic other common ear problems, it is often misdiagnosed at first. If your GP suspects PETD, they will likely refer you to an Ear, Nose, and Throat (ENT) specialist.

Investigations may include:

• Ear Examination: The specialist will look inside your ear with a light. They may be able to see your eardrum physically moving inwards and outwards in time with your breathing.
• Nasal Endoscopy: A small, flexible camera is passed just inside the back of your nose to assess the opening of the Eustachian tube and see if it is staying open.
• Tympanometry / Pressure Tests: A special test that uses a small probe in the ear to gently change air pressure and check how well your eardrum moves.
• Hearing Evaluation: A standard hearing test to rule out any underlying hearing loss.

Management and Treatment

For many people, PETD is not a worrying condition and no treatment is strictly required, as the symptoms will often come and go. However, if symptoms are debilitating, treatment aims to either relieve the symptoms or partially re-block the open tube.

1. Lifestyle Adjustments

• Stay Hydrated: Drink plenty of water. Dehydration causes tissues to shrink, opening the tube further.
• Reduce Caffeine: Caffeine acts as a mild diuretic (makes you pass more urine) and can dry out your tissues.
• Positional Changes: Lying down or lowering your head between your knees can offer temporary symptom relief during a bad flare-up.

2. Specific Medications (OTC & Prescription)

Rather than "curing" the tube, medications usually focus on treating underlying causes or intentionally plumping up the nasal lining.

• Hypertonic Saline Nasal Rinses (Available Over-The-Counter)
• • What it is: A very salty water rinse that intentionally causes mild irritation in the nose, helping the tissues swell slightly and close the Eustachian tube. Around half of all patients find this significantly reduces symptoms.
  • How to get it: You can buy a proprietary rinse kit like the NeilMed Sinus Rinse from most UK pharmacies without a prescription.
  • When to take it: Use as often as you find useful. To make a "hypertonic" (extra salty) solution, use two sachets of the NeilMed salt mixture in a single wash bottle of sterile/cooled boiled water. Alternatively, you can use half a teaspoon of iodinated table salt in the bottle.
• Acid Reflux Medications (OTC and Prescription)
• • What it is: If acid reflux is causing inflammation that contributes to your symptoms, reducing stomach acid can help.
  • Examples: Antacids like Gaviscon (OTC, take after meals and before bed), or Proton Pump Inhibitors like Omeprazole or Lansoprazole (available OTC in lower doses, or on prescription for stronger doses. Usually taken once daily in the morning).
• Allergy Medications (OTC and Prescription)
• • What it is: To treat underlying hayfever or dust allergies.
  • Examples: Antihistamine tablets like Cetirizine or Loratadine (OTC, taken once daily).
• MEDICATIONS TO AVOID:
• • Do NOT use nasal decongestants (such as Sudafed / pseudoephedrine tablets or Otrivine / xylometazoline nasal sprays). These are designed to open blocked nasal passages and will make a patulous (open) Eustachian tube much worse.

3. Surgical Treatments

If conservative management and nasal rinses fail, an ENT surgeon may discuss minor surgical options:

• Grommet Insertion: A tiny plastic tube is placed into the eardrum under local anaesthetic to alter middle ear pressure and relieve the echoing sensation.
• Eustachian Tube Injection: Under general anaesthetic, a small amount of medical filler (like a gel) is injected into the opening of the tube in the nose to plump it up and partially plug it.
• Cartilage Tympanoplasty: An operation to thicken or stiffen a highly mobile eardrum so it vibrates less when you breathe or speak.

Prevention

Because the exact cause is often idiopathic (unknown), PETD cannot always be prevented. However, you can minimise your risk of developing it or triggering flare-ups by:

• Avoiding rapid, extreme weight loss: Aim for slow, steady weight management to preserve the natural fatty tissues around the ear canal.
• Managing nasal health: Keep allergies and acid reflux well-controlled.
• Staying well-hydrated: Especially during endurance sports, heavy exercise, or in humid weather.

Outlook / Prognosis

The long-term outlook for Patulous Eustachian Tube Dysfunction is generally very positive. It is a completely benign condition, meaning there is nothing to suggest it will progress into a more serious or dangerous disease over time.

For many patients, the condition is temporary. For example, if it is brought on by pregnancy, it almost always resolves shortly after childbirth. If it is caused by weight loss, regaining a little weight can often completely cure the issue. For those with chronic symptoms, using hypertonic saline rinses and making minor lifestyle modifications provides enough relief to stop the condition from interfering with daily life.