Seasonal variation of patulous Eustachian tube diagnoses using climatic and national health insurance data

Objectives This study aimed to analyse if there were any associations between patulous Eustachian tube occurrence and climatic factors and seasonality. Methods The correlation between the monthly average number of patients diagnosed with patulous Eustachian tube and climatic factors in Seoul, Korea, from January 2010 to December 2016, was statistically analysed using national data sets. Results The relative risk for patulous Eustachian tube occurrence according to season was significantly higher in summer and autumn, and lower in winter than in spring (relative risk (95 per cent confidence interval): 1.334 (1.267–1.404), 1.219 (1.157–1.285) and 0.889 (0.840–0.941) for summer, autumn and winter, respectively). Temperature, atmospheric pressure and relative humidity had a moderate positive (r = 0.648), negative (r = –0.601) and positive (r = 0.492) correlation with the number of patulous Eustachian tube cases, respectively. Conclusion The number of patulous Eustachian tube cases was highest in summer and increased in proportion to changes in temperature and humidity, which could be due to physiological changes caused by climatic factors or diet trends.

Hearing Loss and Teprotumumab

Thyroid eye disease (TED) is an unpredictable autoimmune inflammatory disease which can be sight-threatening, debilitating, and disfiguring. Teprotumumab (IV infusion every 3 weeks x 8 doses) was recently approved as the first and only FDA-approved drug for TED in 2020. Phase 2 and 3 studies showed significant improvement in proptosis, double vision, soft tissue inflammation and quality of life for patients with active moderate to severe TED. Side effects were experienced by 85% of patients on teprotumumab. Hearing loss symptoms were reported in 10% of patients and were reported to be reversible upon stopping the drug. Objective: To explore the incidence of hearing loss symptoms and sensorineural hearing loss in patients treated with teprotumumab. Methods: All patients, followed at one institution, treated with at least 4 infusions of teprotumumab were evaluated. Charts were evaluated for baseline hearing symptoms and hearing symptoms during or after therapy with teprotumumab. Those patients with hearing symptoms were referred for audiogram testing and patulous eustachian tube (PET) testing. Results: Twenty-eight patients were included in this analysis. Thirteen patients (46%) complained of hearing symptoms. The most common symptoms were autophony or an ear plugging sensation and hearing loss or muffled hearing. Hearing symptoms developed after a mean of 3.6 infusions. Of the patients with hearing symptoms, three patients (23%) had sensorineural hearing loss documented on audiogram (n=2) or patulous eustachian tube (n=1) documented on PET testing. To date, the patient with PET has experienced some improvement, but not resolution, of her symptoms. The two patients with documented sensorineural hearing loss have not experienced a significant improvement in hearing, on audiogram, on average 3 months after stopping teprotumumab. Conclusion: Teprotumumab is a promising new therapy for active moderate to severe thyroid eye disease. Providers should consider performing a baseline audiogram with PET testing and performing audiograms with PET testing for patients that develop hearing symptoms during or after therapy. Hearing loss is a concerning adverse event and its mechanism and reversibility should be further studied.

Salvage Eustachian Tube Cartilage Chip Insertion After Multiple Transnasal Shim Operations in Intractable Patulous Eustachian Tube

This article presents 2 cases of extremely intractable patulous Eustachian tube following multiple transnasal shim insertion. These cases highlight the disadvantages of repeat transnasal shim operations, including enlargement of the Eustachian tube lumen, frequent dislocation, repeat surgery, recurrent middle ear infection, and shim misswallowing. The patients in these cases were successfully treated with Eustachian tube cartilage chip insertion through a postauricular approach. We describe the surgical technique and advantages of this promising management method.

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

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.