title: Management of patulous eustachian tube with habitual sniffing.
abstract: OBJECTIVE
  Evaluation of the effect of conservative and surgical treatment in patients with patulous Eustachian tube (PET) associated with habitual sniffing.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  University hospital otolaryngology department.
  
  
  METHODS
  Ninety-seven (23.4%) of 414 PET patients were found to have habitual sniffing to alleviate uncomfortable aural symptoms. Of these, 38 PET patients with sniffing habit were selected.
  
  
  METHODS
  Conservative intervention included instructions to stop sniffing and nasal instillation of saline. Surgical interventions used ventilation tube (VT) insertion to the eardrum and/or transmyringeal insertion of the PET plug (PEP).
  
  
  METHODS
  Relief of uncomfortable symptoms and stopping sniffing.
  
  
  RESULTS
  In 52 (53.6%) of the 97 sniff-positive cases, retraction-type eardrum abnormalities or operated ear due to cholesteatoma were identified, whereas normal bilateral eardrums were observed in 34 (87.2%) of 39 sniff (-) cases. Abnormal findings in the eardrum were significantly more common in the sniff-positive group than in the sniff-negative group (p < 0.0001). Twenty-three patients (65.7%) stopped sniffing with conservative treatment. VT insertion was performed in 8 ears. Subsequent PEP was necessary in 2 of the 8 ears because of PET symptoms. PEP was successful in the other 11 ears, including one ear which needed additional VT insertion because of middle ear effusion.
  
  
  CONCLUSIONS
  The management of habitual sniffing is difficult, but blocking the Eustachian tube by nasal instillation of saline and/or PEP could help PET patients to stop sniffing.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, Sendai, Japan. ryoukich@hotmail.com
authors.forename: Ryoukichi
authors.initials: R
authors.lastname: Ikeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oshima
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Oshima
authors.forename: Makiko
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Tetsuaki
authors.initials: T
authors.lastname: Kawase
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004427:Ear Diseases / Q000601:surgery / Q000628:therapy*; D005064:Eustachian Tube / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000627:therapeutic use; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000002:abnormalities* / Q000601:surgery
chemical_list: D012965:Sodium Chloride