Repeated insufflation to the eustachian tube orifice with a mixture of boric acid and salicylic acid powder (4:1 ration) (from Pulec 1970 - Bezold 1908).Procedures (without or without local anesthesia).Mucus thickening agent: SSKI 1 g/cc of saturated potassium iodide oral solution in a 30-mL dropper bottle with 7 to 10 drops in 8 ounces of juice or water taken orally three times a day has been advocated by others (Dyer 1991).Premarin nasal solution as nasal drops (Poe 2007).Discontinue decongestants and nasal steroids.Weight gain (recommended only if underweight).Observation, reassurance and address underlying process (Pulec et al 1970 and many others). Video of eustachian tube opening with a swallow maneuver Flexible transnasal endoscope for view of nasopharyx.Trans-nasal anatomy of eustachian tube (click on video to active).CT to rule out superior semicircular canal dehiscence syndrome.Impedance tympanometry may document successful fluctuations in tracings synchronous with breathing and breath-holding (Bluestone 1999).Nasopharyngeal endoscopy may show concave longitudinal defect in superior anterolateral wall of tubal valve (Poe 2007, Rotenberg 2013 and others) where it is normally convex.May improve symptoms with ipsilateral internal jugular vein compression.Best done with patient sitting (lying down may cause venous congestion to close the tube).Observe movement of TM (otoscopy) during rapid nasal breathing.May occur spontaneously or activated by exercise, use of nasal decongestants.Often relieved during period of a head cold.Often relieved with reclining or lowering the head between the knees (increase venous/lymphatic congestion about E.T.).As per Pulec et al (1970): they identified one fifth of patients with the condition had been labeled as neurotic or psychotic.Associated with low thresholds on Vestibular-Evoked Myogenic Potential testing (Poe 2007).Associated with identifiable dehiscence in the superior or posterior semicircular canal on CT.Autophony of voice but not breathing sounds more common in patients with superior semicircular canal dehiscence syndrome.Superior semicircular canal dehiscence syndrome (Poe 2007 and Crane 2009).1/3 with patulous eustachian tube have no identifiable cause (Doherty 20003).Other disorders associated: pregnancy / use of high dose oral contraceptives / scarring in nasopharynx (adenoidectomy, irradiation).Neuromuscular disorders (strokes, polio, multiple sclerosis, and Parkinsons) (Perlman 1939).Significant weight loss with depletion of soft tissue around eustachian tube (Munoz 2010).Associated disorders (Pulec et al 1970).When the ET is patulous, the middle ear pressure is nearly continually atmospheric and perceived as abnormal.Perceived sensation of normal pressure in the middle ear cavity is due to a slight relative negative pressure.High absorption rate of nitrogen from middle ear cleft explains passive movement of air into middle ear with ET opening.Normal pressure in middle ear is slightly negative relative to atmospheric (O'Connor 1981).Longitudinal concave defect in the mucosal valve of the anterolateral wall of the eustachian tube (Poe 2007).Credited by Poe (2007), O'Connor (1981) and others as first being described by Jago in 1858 (Jago subsequently published his own personal experience with the process).Fluctuating sensation of the tympanic membrane with respiration.Aural fullness (sensation of fullness in the ear).Abnormal sound of one's own voice (voice sounds abnormally loud and low-pitched).Definition - Abnormally patent eustachian tube.
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