title: Treatment of the patulous Eustachian tube with soft-tissue bulking agent injections.
abstract: OBJECTIVE
  A patulous Eustachian tube ([ET] tuba aperta) may cause symptoms as autophony, breath synchronous tinnitus, pressure sensation, and conductive hearing loss and thus lead to an enormous cutback in quality of life. In combination with "sniffing," it can trigger the development of cholesteatoma. Because of the ambiguous symptoms, the diagnosis can be challenging. A patulous ET can only be diagnosed through a well-structured examination, including patient history, physical examination with thorough observation of the movements of the tympanic membrane, and tympanometry with reflex-decay.
  
  
  METHODS
  Transnasal endoscopic injection of injectable soft-tissue bulking agent into the torus tubarius was performed in 20 patients as a new treatment option for patulous ET. All patients were followed up 6 weeks and 6 and 12 months after treatment. For each intervention, 0.8 to 2 mL of injectable soft-tissue bulking agent was used.
  
  
  RESULTS
  In nine patients, more than one procedure was necessary. On follow-up, 10 out of 15 patients were satisfied with the result. Only three out of 15 patients reported no improvement of their symptoms. The procedure was minimally invasive, fast, and easy to perform.
  
  
  CONCLUSIONS
  There is no gold standard for the therapy of patulous ET. The injection of soft-tissue bulking agent in the torus tubarius is a new minimally invasive therapeutic approach, but much more clinical experience is needed.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital of Münster University, Bielefeld, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schröder
authors.forename: Martin
authors.initials: M
authors.lastname: Lehmann
authors.forename: Holger H
authors.initials: HH
authors.lastname: Sudhoff
authors.forename: Jörg
authors.initials: J
authors.lastname: Ebmeyer
mesh_terms: D000158:Acoustic Impedance Tests; D000293:Adolescent; D000328:Adult; D000368:Aged; D004427:Ear Diseases / Q000601:surgery*; D004724:Endoscopy; D005064:Eustachian Tube / Q000601:surgery*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014012:Tinnitus / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult