Patulous Eustachian tube obliteration using endovascular coils: a novel technique

Address for correspondence: Ms Karan Jolly, Department of Otolaryngology, Princess Royal Hospital, Telford TF1 6TF, UK E-mail: [email protected]

Mr K Jolly takes responsibility for the integrity of the content of the paper

Introduction

The Eustachian tube plays an important role in the pressure equalisation, drainage and overall health of the middle ear. Anatomically, it connects the mesotympanum and nasopharynx, and consists of a lateral bony and medial cartilaginous segment. In contrast to the bony segment, the cartilaginous segment is dynamic, opening and closing. Whilst at rest, the Eustachian tube orifice, which is made by the cartilaginous portion, remains closed. The Eustachian tube classically opens during swallowing and yawning because of tensor veli palatini and levator veli palatini actions. Eustachian tube dysfunction can result from failure of the tube to open or close appropriately. This article describes the patulous Eustachian tube, which is characterised by chronic patency and failure to close.

Patulous Eustachian tube affects 0.3–6 per cent of the population. This clinical diagnosis is based on history and examination with nasoendoscopy.¹ Patients typically present with symptoms of autophony, aural fullness and increased perception of physiological sounds, such as the heart beat and breathing.² Examination demonstrates movement of the tympanic membrane with respiration, and dilation of the Eustachian tube orifice.³ There are a number of theories behind the causality of patulous Eustachian tube, including tissue loss (weight loss, pregnancy, use of oestrogen therapy), and atrophy or scarring of the nasopharynx secondary to adenoidectomy, radiotherapy, poliomyelitis and trauma.^2,4,5

Treatment can be divided into medical or surgical modalities, although the effectiveness is limited. We present our first case of patulous Eustachian tube treated with transnasal endoscopic obliteration of the Eustachian tube with endovascular coils. To the best of our knowledge, this novel technique has not been described in literature previously.

Materials and methods

To date, we have successfully treated one patient with the following procedure. The patient consented to undergo Eustachian tube obliteration using a 3 mm VortX Diamond coil (Boston Scientific, Marlborough, Massachusetts, USA); the risks of bleeding, infection, pain, conductive hearing loss due to glue ear, treatment failure and coil migration were relayed. The procedure was undertaken alongside a neuroradiologist.

The procedure can be performed under local or...