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10 Articles in Volume 7, Issue #7
Burning Mouth Syndrome
Chronic Pain Program in a Primary Care Setting
Chronic Persistent Pain Can Kill
Education and Exercise Program for Chronic Pain Patients
Managing Pain in Intensive Care Units
Oxycodone to Oxymorphone Metabolism
Patulous Eustachian Tube: Part 1
Rational, Emotive, Ethical Approaches to Bio-psychosocial Pain Care
Smoking and Aberrant Behavior in Chronic Pain Patients
Structuring Opioid Therapy

Patulous Eustachian Tube: Part 1

Often unrecognized, the symptoms of patulous eustachian tube may, and often do, mimic other ear conditions.
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Discussion

Speculations about etiology include events such as pregnancy, gaining too much weight, losing too much weight, being in a noisy environment, sinus or nasal infection, loss of luminal fat ring at the tube opening, exercise, caffeine from coffee (dehydrating effects). Efforts to provide treatment ranges from tubes in the ears, more aggressive forms of surgery, Asian herbal drops, and a variety of other therapies. More strenuous efforts to mitigate this condition can include weight gain (assuming weight loss may have been associated with onset), lying down 4 times a day with legs raised about two feet (while discontinuing exercise), or stopping coffee use.4-5

Other admonitions include: no use of decongestants (makes tissues drier in tube), don’t swim in lakes, rivers or non-chlorinated waters, and don’t forget that predisposing factors may include medications that acts as diruetics. Certain results of procedures such as nasopharyngeal adhesions from adenoidectomy and radiation therapy may trigger this condition in susceptible individuals.

The act of putting the head down between the knees temporarily adds mucous congestion in the lumen of the 2-3 mm wide tube and may provide temporary relief. Some believe that there may be neurologic diseases such as stroke, multiple sclerosis, and motor neuron disease that can contribute to muscle atrophy. Temporomandibular joint syndrome, fatigue, stress, anxiety, among other issues, have been implicated as possible contributing factors.

There is the potential for a cascade of increasingly severe symptoms that can occur with a patient having this condition. The sufferer may be unable to continue normal activities because of the real risk of neurosis due to lack of relief. For many, the symptoms are unrelenting and exceedingly distracting.

“The nerve supply to the eustachian tube is complex, and thus any discomfort may contribute to referred pain to other areas of the head and neck.”

Conclusion

Perhaps the most frustrating issue for ENT doctors and patients is the lack of understanding and the lack of insight regarding etiology. This is not a rare condition as is thought by some, it is simply not recognized and diagnosed adequately for those unfortunate patients with this condition and so the need for research and discovery cannot be over-emphasized.

This condition has prompted me to add another unusual disorder to my mental “checklist.” An anesthesiologist friend wisely encourages those in pain management to think “outside the checklist.” In other words, if we look only for what we know, we will usually not see or recognize anything else. n

Last updated on: February 26, 2013
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