Patulous Eustachian Tube (PET): When Your Ear Is "Stuck Open" 

Imagine hearing your own voice echo loudly in your head every time you speak, or being able to hear the rush of your own breathing like a wind tunnel. You might constantly feel a strange sense of fullness in your ear, yet your hearing tests are completely normal. Many patients suffer from this deeply frustrating condition for years, often being misdiagnosed with standard ear congestion and wrongly prescribed decongestants—which actually make the problem much worse.

Patulous Eustachian Tube (PET) is one of the most misunderstood conditions in ENT. The Eustachian tube connects the back of your nose to your middle ear. In a healthy person, the tube is normally closed. It acts like a one-way valve, springing open for just a fraction of a second when you swallow or yawn to equalize ear pressure, and then immediately snapping shut. This closed resting state protects your ear from hearing the internal sounds of your own body.

In a patient with PET, the tube becomes "patulous," meaning it remains chronically stuck wide open. This abnormal patency strips away the acoustic barrier between your airway and your ear. Every word you speak travels directly up the open tube and strikes the back of your eardrum. PET is frequently triggered by rapid weight loss (which depletes the protective fat pad surrounding the tube), hormonal changes, or neuromuscular conditions.

Because the tube is already too open, standard treatments for a "blocked ear"—like decongestant nasal sprays, allergy pills, or placing surgical ventilation tubes in the eardrum—will only widen the airway further and exacerbate the misery. We must instead focus on structurally narrowing or plumping the valve.

The treatment strategy for PET is carefully stepped:

• Conservative Medical Management: The first step is reversing any underlying causes. We stop all decongestants. We instruct patients to significantly increase their daily hydration, which naturally plumps the mucosal lining. In some cases, we use specialized hypertonic saline drops to deliberately induce mild swelling in the nasal opening of the tube.

• Targeted Soft-Tissue Augmentation: For patients who do not respond to conservative measures, we now utilize minimally invasive, endoscopic injection techniques. Working entirely through the nose, we inject specialized biocompatible fillers (such as hyaluronate filler or autologous fat) directly into the torus tubarius—the tissue surrounding the tube's opening. This safely "bulks up" the defective valve, providing enough tissue volume for the tube to finally close at rest. This comes with potential complications, eventhought quite rare, which the patient should aware of.

• Surgical Reconstruction: For the most severe, refractory cases, advanced endoscopic surgical reconstruction can be performed. This involves raising a delicate submucosal flap inside the tube and placing a permanent graft to restore the normal convexity and competence of the valve.

Living with the relentless echo of your own body can be debilitating, but it is not untreatable. By accurately diagnosing the open state of the tube and applying targeted bulking therapies, we can quiet the noise and restore your quality of life.

Asst Prof Wirach Chitsuthipakorn, MD
Rhinologist

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