What are the implications of a patulous Eustachian tube (ET) following an adenoidectomy?

From the Guidelines

Patulous Eustachian tube (PET) after adenoidectomy is best managed with conservative measures, such as adequate hydration, avoiding caffeine, and head positioning during symptoms, as most cases improve spontaneously within 3-6 months. Management of PET includes both conservative and medical approaches [@\1@]. Initially, try conservative measures such as adequate hydration, avoiding caffeine, and head positioning during symptoms. Medical treatments include nasal saline irrigation, nasal steroids like fluticasone (2 sprays per nostril daily), and oral antihistamines if allergies are present. For persistent symptoms, consider estrogen-containing nasal drops (estradiol 0.1% solution, 2-3 drops three times daily for 2-4 weeks) or diluted 0.25% phenylephrine nasal drops (2-3 drops three times daily for short-term use). Severe cases may benefit from autologous fat or cartilage injection to the Eustachian tube, or surgical patching procedures.

Key Considerations

• PET typically occurs because adenoid removal alters the nasopharyngeal anatomy, potentially affecting Eustachian tube function by removing tissue that normally provides structural support and partial occlusion of the tube's pharyngeal orifice [@\1@].
• Most cases improve spontaneously within 3-6 months as tissues adapt to the new anatomical configuration, so reassurance and symptomatic management are often sufficient.
• The risks of adenoidectomy, including velopharyngeal insufficiency, refractory bleeding, and Grisel’s syndrome, should be discussed with caregivers [@\1@].

Treatment Options

• Conservative measures: adequate hydration, avoiding caffeine, and head positioning during symptoms.
• Medical treatments: nasal saline irrigation, nasal steroids, oral antihistamines, estrogen-containing nasal drops, and diluted phenylephrine nasal drops.
• Severe cases: autologous fat or cartilage injection to the Eustachian tube, or surgical patching procedures. It is essential to note that the decision to perform adenoidectomy should be based on the individual patient's needs and symptoms, and should be discussed with the patient and their family [@\2@].

From the Research

Patulous Eustachian Tube after Adenoidectomy

• The patulous Eustachian tube is a condition where the Eustachian tube remains open, causing symptoms such as autophony and breathing sounds 1.
• Adenoidectomy is a surgical procedure that can affect the Eustachian tube function, and patulous Eustachian tube can occur as a complication after adenoidectomy.
• The treatment options for patulous Eustachian tube include:
  • Conservative measures:
    • Nasal instillation of saline 2
    • Estrogen-nasal ointment 3
    • Craniocervical manual therapy 3
  • Surgical interventions:
    • Submucosal graft implantation to restore the normal convexity to the valve wall 1
    • Other surgical options that avoid elevating a tympanomeatal flap, are reversible, and are effective 4

Efficacy of Treatment Options

• The efficacy of treatment options for patulous Eustachian tube varies, with recovery rates ranging from 50% to 100% 5.
• Conservative treatments can be considered as a primary therapeutic option for patulous Eustachian tube, while surgical interventions seem to be a safe and valuable solution in patients with refractory disease 5.
• The assessment of efficacy is often based on subjective improvement of patient symptoms, as there is no validated outcome tool available 5.

Diagnosis and Management

• The diagnosis of patulous Eustachian tube can be made using various methods, including the Eustachian tube score (ETS-5) and ETS-7 score 3.
• The management of patulous Eustachian tube requires a comprehensive approach, including diagnosis, treatment, and follow-up 3, 1, 5, 4.