A novel computed tomography guided, transcutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube – a case series

AbstractBackgroundPatulous Eustachian tube is a benign but notoriously difficult condition to treat successfully. Symptoms include autophony of voice and breathing, and aural fullness.MethodsThis paper presents a series of 8 patients (12 ears) for whom a novel computed tomography guided injection of silicone elastomer suspension implant (Vox) was used to treat patulous Eustachian tube. This is the largest and only series in the current literature using this technique.ResultsThe combined complete and partial symptom resolution rate was 91 per cent. Complications related to the procedure are described. The pros and cons of this novel approach are also discussed in relation to traditional endoscopic transnasal techniques.ConclusionComputed tomography guided injection of Vox for the treatment of patulous Eustachian tube is suggested to be a feasible alternative to endoscopic transnasal approaches, particularly for refractory cases.

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Valsalva computed tomography in visualization of Eustachian tube in patients with patulous Eustachian tube

10.22541/au.161212162.29219261/v1 ◽

2021 ◽

Author(s):

Suleyman Aksoy ◽

Yavuz Selim Yıldırım ◽

Işıl Yurdaışık

Keyword(s):

Computed Tomography ◽

Eustachian Tube ◽

Volume Rendering ◽

Supine Position ◽

Valsalva Maneuver ◽

Case Series ◽

Air Volume ◽

Design Case ◽

First Time ◽

Patulous Eustachian Tube

Abstract Objectives: There is no study in the literature that patients with clinically-proven PET were evaluated by Valsalva CT. We aimed to evaluate the merit of Valsalva computed tomography (CT) in patients who had clinically-proven patulous Eustachian tube (PET). Design: Case-series Setting and participants: We recruited patients with clinically-proven PET. Participants: Main outcome measures: All participants underwent temporal bone CTs while they were performing the Valsalva maneuver in the supine position. Standard axial plane CT images, along with multiplanar reconstruction and 3D Air volume rendering, were used to visualize the ET in its entirety. Results: Three patients (2 females, one male) with a total of 6 ears were included in the study. All patients had suggestive symptoms of PET, including aural fullness, aerophony, and autophony and underwent clinical examination and audiologic tests. In all ears, the whole Eustachian tube could be visualized with Valsalva CT. Conclusion: For the first time, we demonstrated the merit of Valsalva CT in visualization of the Eustachian tube in its entirety in patients with clinically diagnosed PET.

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A novel computed tomography guided, trans-cutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube – a case series

10.26226/morressier.5adde3c4d462b80290b596cc ◽

2018 ◽

Author(s):

Bayo Alli

Keyword(s):

Computed Tomography ◽

Eustachian Tube ◽

Case Series ◽

Patulous Eustachian Tube

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Classification System for Results in Eustachian Tube Surgery

Otolaryngology ◽

10.1016/j.otohns.2008.05.238 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P74-P74 ◽

Cited By ~ 4

Author(s):

Carlos Yanez ◽

Nallely Mora

Keyword(s):

Computed Tomography ◽

Eustachian Tube ◽

Classification System ◽

Lateral Wall ◽

New Classification ◽

Severity Of Disease ◽

Starting Point ◽

Tube Dysfunction ◽

Cartilage Grafting ◽

Patulous Eustachian Tube

Objective To present a new classification system for reporting results and severity of disease state preoperatively of Eustachian tube (ET) obstructive (ETOD) and non-obstructive dysfunction (ETNOD) based in numerical scores, and to report the results obtained in 40 patients intervened by the author following this criteria. Methods A retrospective review of 25 patients was carried out. 20 patients presented obstructive and 5 patients presented non-obstructive (patulous) Eustachian tube dysfunction. These patients were diagnosed and treated between May 2002 and Dec 2007. Patients with ETNOD received laser endoscopic tuboplasty (LEPT) and in patients with ETOD, a cartilage grafting reconstruction of the antero-lateral wall of the ET (ETR) was carried out endonasally. Results Scores from patients were tabulated accordingly. 18 patients (90%) were symptom free, 1 patient (5%) had partial recurrence of symptoms and 1 patient (5%) had a full recurrence of symptoms at the end of the study in the obstructive dysfunction patients. 3 patients (60%) were symptom free, 2 patients (40%) had partial recurrence of symptoms after Eustachian tube reconstruction. Endoscopy, computed tomography, and audiologic results revealed the efficacy or failure of the interventions. Conclusions 1) This suggested system could serve as a starting point for Eustachian tube surgeons to develop criteria. It could be adopted if eventually accepted in the field. 2) Results obtained indicate that LEPT is effective in relieving symptoms in selected patients. 3) EPTR for patulous disease may be not effective in some cases. New experiences are further needed.

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Current Treatment Options for Patulous Eustachian Tube: A Review of the Literature

Ear Nose & Throat Journal ◽

10.1177/0145561320932807 ◽

2020 ◽

pp. 014556132093280

Author(s):

Petros Koltsidopoulos ◽

Charalampos Skoulakis

Keyword(s):

Eustachian Tube ◽

Therapeutic Option ◽

Treatment Options ◽

Case Series ◽

Current Treatment ◽

Case Control Studies ◽

Retrospective Case ◽

Level Of Evidence ◽

Surgical Interventions ◽

Patulous Eustachian Tube

Objective: Patulous Eustachian tube (PET) is a clinical condition that is associated with troublesome aural symptoms and is difficult to be treated successfully. The purpose of this review is to examine the published literature regarding the therapeutic value of the current treatment options for PET. Methods: We searched Web of Science, PubMed and Medline from 1999 to 2019. The search focused on papers concerning the clinical evaluation of treatment methods in PET patients. Statistical techniques were not used. Results: Prospective and retrospective case series were the types of trials available for review. We included 28 articles that evaluated the efficacy of various conservative and surgical therapeutic options. The recovery rates ranged from 50% to 100%. In most studies the assessment of efficacy was based on the subjective improvement of patient symptoms as there is no validated outcome tool available. No severe adverse events were observed in any study. Conclusion: On the basis of the available literature, it seems that conservative treatments can be considered as a primary therapeutic option for PET. Concerning the surgical interventions they seem to be a safe and valuable solution in patients with refractory disease. Finally, given the low level of evidence, prospective case–control studies with long follow-up and robust setting looking into the therapeutic approach of PET are required. The need for establishment of standard criteria of PET recovery should be underlined.

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A novel, computed tomography guided, trans-cutaneous approach to treat refractory autophony in a patient with a patulous eustachian tube

The Journal of Laryngology & Otology ◽

10.1017/s0022215113003599 ◽

2014 ◽

Vol 128 (2) ◽

pp. 182-184 ◽

Cited By ~ 10

Author(s):

J C L Rodrigues ◽

A Waddell ◽

J-L Cook

Keyword(s):

Computed Tomography ◽

Eustachian Tube ◽

Symptomatic Relief ◽

Therapeutic Benefit ◽

Silicone Elastomer ◽

Endoscopic Management ◽

Superior Semicircular Canal Dehiscence ◽

Implant Placement ◽

Endoscopic Placement ◽

Patulous Eustachian Tube

AbstractObjective:We report a novel, computed tomography guided treatment for autophony associated with a patulous eustachian tube.Methods:Case report and literature review of the management of patulous eustachian tube.Results:A 36-year-old woman presented with disabling autophony. Otoscopic examination revealed a poorly mobile right tympanic membrane. High resolution temporal bone computed tomography excluded superior semicircular canal dehiscence. The patient was diagnosed with patulous eustachian tube but failed to achieve therapeutic benefit from conventional endoscopic placement of a silicone elastomer suspension implant adjacent to the eustachian tube. Subsequently, she underwent further silicone elastomer suspension implant placement via a trans-cutaneous, computed tomography guided approach. The patient achieved prompt symptomatic relief and remained symptom-free at six-month follow up.Conclusion:This is the first published description of treatment of patulous eustachian tube using a computed tomography guided, trans-cutaneous approach. It serves to highlight to otolaryngologists the fact that computed tomography guided treatment of patulous eustachian tube may control disabling symptoms in patients who have failed to respond to convention endoscopic management.

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Three-Dimensional Computed Tomography Imaging of the Eustachian Tube Lumen in Patients with Patulous Eustachian Tube

ORL ◽

10.1159/000265939 ◽

2009 ◽

Vol 71 (6) ◽

pp. 312-316 ◽

Cited By ~ 19

Author(s):

Toshiaki Kikuchi ◽

Takeshi Oshima ◽

Yoko Hori ◽

Tetsuaki Kawase ◽

Toshimitsu Kobayashi

Keyword(s):

Computed Tomography ◽

Eustachian Tube ◽

Three Dimensional ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Tube Lumen ◽

Patulous Eustachian Tube

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Diagnosis of the Patulous Eustachian Tube

Ear Nose & Throat Journal ◽

10.1177/0145561320925938 ◽

2020 ◽

pp. 014556132092593

Author(s):

Ryoukichi Ikeda ◽

Toshiaki Kikuchi ◽

Hidetoshi Oshima ◽

Toshimitsu Kobayashi

Keyword(s):

Computed Tomography ◽

Tympanic Membrane ◽

Diagnostic Criteria ◽

Eustachian Tube ◽

Accurate Diagnosis ◽

Postural Change ◽

Precise Evaluation ◽

Function Tests ◽

Patulous Eustachian Tube

Objectives: To review the diagnosis of patulous Eustachian tube (PET) based on the diagnostic criteria for the PET proposed by Japan Otological Society (JOS). Methods: We reviewed typical aural symptoms of PET, Eustachian tube (ET) obstruction procedure to confirm diagnosis of PET, objective findings of a patent ET obtainable from observation of the movement of the tympanic membrane, and by ET function tests (tubo-tympano-aerodynamic graphy, sonotubometry). In addition, usefulness of other tests such as patulous Eustachian tube handicap inventory-10 (PHI-10), sonotubometry with postural change (Ohta method), and sitting computed tomography (CT) to diagnose PET is described. Results and Conclusions: We have described the diagnosis of PET based on the diagnostic criteria for PET proposed by JOS; PHI-10, Ohta method, and sitting CT are also useful for the diagnosis of PET. Further investigation is needed for an accurate diagnosis and precise evaluation of the pathophysiology of this challenging disease.

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Incidental Pancreatic Lipomas: A Case Series on 64 Slice MDCT done for Different Pathologies

Nepalese Journal of Radiology ◽

10.3126/njr.v1i1.6318 ◽

2012 ◽

Vol 1 (1) ◽

pp. 23-26

Author(s):

AD Dwivedi ◽

A Srivastava ◽

R Shukla ◽

S Patwari

Keyword(s):

Computed Tomography ◽

Adipose Tissue ◽

Current Literature ◽

Case Series ◽

Benign Lesions ◽

Single Institution ◽

Multi Detector Computed Tomography ◽

Density Coefficient

Pancreatic lipomas are rare benign lesions, with only 50 cases being documented in the current literature to the best of our knowledge. We describe four cases of intrapancreatic lipomas from a single institution, all incidentally found using multi detector computed tomography within a 6-month period. Computed tomography depicted lipomas as homogeneous, nonenhancing, well-marginated lesions with a density coefficient consistent with adipose tissue. DOI: http://dx.doi.org/10.3126/njr.v1i1.6318 Nepalese Journal of Radiology Vol.1(1): 23-26

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Patulous Eustachian tube obliteration using endovascular coils: a novel technique

The Journal of Laryngology & Otology ◽

10.1017/s0022215118000725 ◽

2018 ◽

Vol 132 (06) ◽

pp. 564-566 ◽

Cited By ~ 1

Author(s):

K Jolly ◽

A Darr ◽

S V Chavda ◽

S K Ahmed

Keyword(s):

Eustachian Tube ◽

Case Series ◽

Surgical Interventions ◽

Novel Treatment ◽

Patient Reported ◽

Transnasal Endoscopic Approach ◽

Endovascular Coils ◽

Patulous Eustachian Tube ◽

Distressing Condition

AbstractBackgroundPatulous Eustachian tube is a distressing condition characterised by chronic patency of the Eustachian tube and its failure to close. Patients typically present with symptoms of autophony and aural fullness. In patients requiring surgical intervention, a variety of different procedures have been demonstrated (both transtympanic and endonasal), with limited success. Evidence of the effectiveness of a number of surgical interventions is limited to small case series only.ObjectiveThis paper describes a novel treatment for patulous Eustachian tube using a 3 mm VortX Diamond endovascular coil.Case reportA transnasal endoscopic approach was adopted, with cannulation of the Eustachian tube orifice using a Relieva sinus guide suction tube from a balloon sinuplasty set. The coil was deployed 1.5 cm deep into the Eustachian tube. Post-operative imaging was used to confirm correct positioning. Regular follow up was arranged. The patient reported complete resolution of her symptoms.ConclusionThe technique has so far proved highly effective and minimally invasive. It will be employed in more patients to fully establish its effectiveness in treating patulous Eustachian tube.

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