title: Tympanic membrane manipulation to treat symptoms of patulous eustachian tube.
abstract: OBJECTIVE
  Patulous eustachian tube (PET) can have a significant negative impact on a patient's quality of life. Previous work has demonstrated that temporarily mass loading and stiffening the tympanic membrane significantly reduces these symptoms. This study examined KTP laser myringoplasty (LM) and cartilage tympanoplasty (CT) as a means to manipulate the tympanic membrane to alleviate PET symptoms.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Academic tertiary care referral hospital.
  
  
  METHODS
  Patients (n = 20) were identified from the senior authors' (M.B.) specialty eustachian tube disorders clinic. Patients met previously established diagnostic criteria for PET. All patients had a clinically apparent flaccid segment of the eardrum and had symptom improvement after simple mass loading of their eardrum in the clinic.
  
  
  METHODS
  Patients in this study received either KTP LM (10 patients, 15 ears) or CT (10 patients, 11 ears) to treat their flaccid eardrum segment in an attempt to alleviate PET symptoms.
  
  
  METHODS
  Preoperative and postoperative questionnaire scores and tympanometry measurements were compared.
  
  
  RESULTS
  Patients undergoing CT for PET had a significant reduction in their symptoms of autophony (p ≤ 0.001), conducted breath sounds (p = 0.001), and aural fullness (p = 0.009). KTP LM did not significantly reduce symptoms.
  
  
  CONCLUSIONS
  Cartilage tympanoplasty provides a safe and accessible surgical option for the treatment of PET and significantly reduces the symptoms of autophony, conducted breath sounds, and aural fullness. Further studies are needed to investigate whether addressing PET symptoms simultaneously from both the tympanic membrane and the eustachian tube orifice can improve patient symptoms even further.
authors.affiliation: *Division of Otolaryngology - Head and Neck Surgery and †Faculty of Medicine - Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Brace
authors.forename: Peter
authors.initials: P
authors.lastname: Horwich
authors.forename: David
authors.initials: D
authors.lastname: Kirkpatrick
authors.forename: Manohar
authors.initials: M
authors.lastname: Bance
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods; D000328:Adult; D004427:Ear Diseases / Q000473:pathology / Q000601:surgery*; D005064:Eustachian Tube / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State; D008297:Male; D008875:Middle Aged; D009225:Myringoplasty / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*