What are the treatment options for autophony?

From the Guidelines

Treatment of autophony should prioritize addressing the underlying cause, with a focus on non-invasive management strategies, such as speech and language therapy, to improve quality of life and reduce morbidity. The most recent and highest quality study, 1, provides consensus recommendations for speech and language therapy in the management of functional communication disorders, including autophony. According to this study, treatment options for autophony may include:

• Education and explanatory strategies, such as clear explanation of the nature of the disorder and the rationale for the diagnosis
• Symptomatic strategies, such as natural, reflexive, or instinctive behaviors, like coughing and clearing the throat, or using playful pre-linguistic vocal sounds
• Psychological strategies, such as communication counseling, identifying and addressing patterns of avoidance, and supporting patients to increase exposure to feared situations
• Redirection of attentional focus, such as bubble blowing into water with vocalization, or using large body movements to facilitate redirection and release
• Use of amplification or headphones to alter or enhance auditory feedback
• Use of electroglottography (EGG) and electromyography as forms of laryngeal biofeedback It is essential to note that the treatment of autophony should be individualized, and the most effective approach may involve a combination of these strategies. Additionally, the study 1 provides recommendations for the management of hoarseness (dysphonia), which may be relevant to the treatment of autophony, and highlights the importance of identifying the underlying cause of dysphonia and assessing the patient's history and physical examination to guide management. Furthermore, the study 1 provides consensus recommendations for the management of functional communication, swallowing, cough, and related disorders, including functional articulation disorders, which may be relevant to the treatment of autophony. Overall, a comprehensive treatment approach that addresses the underlying cause of autophony and incorporates non-invasive management strategies can help improve quality of life and reduce morbidity.

From the Research

Treatment Options for Autophony

The treatment options for autophony, a symptom often associated with patulous Eustachian tube, include various surgical and minimally invasive methods. Some of the treatment options are:

• Autologous fat grafting for the refractory patulous Eustachian tube, which involves cauterization with autologous fat graft plugging of the ET at its nasopharyngeal orifice, in conjunction with myringotomy and ventilation tube placement 2
• Computed tomography guided, transcutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube, using silicone elastomer suspension implant (Vox) 3, 4
• Endoluminal patulous Eustachian tube reconstruction, which involves submucosal graft implantation to fill in the concavity within the patulous tubal valve, using a combined endoscopic transnasal and transoral approach under general anesthesia 5
• Endoscopic ligation of the patulous Eustachian tube, using a combination of fat plugging, endoluminal cauterization, and suture ligation 6

Efficacy of Treatment Options

The efficacy of these treatment options varies, with some studies reporting significant improvement or complete relief of autophony symptoms. For example:

• The study by 2 reported successful treatment of refractory patulous Eustachian tube in 2 patients with at least 1-year follow-up
• The study by 3 reported a combined complete and partial symptom resolution rate of 91% in 8 patients (12 ears) treated with computed tomography guided injection of Vox
• The study by 5 reported immediate complete relief of autophony in all 14 cases, with significant improvement or complete relief of symptoms at an average follow-up of 15.8 months
• The study by 6 reported sustained satisfactory subjective improvement in autophony in 12 of the 14 ears (85.7%) at primary surgery, with nine of these 12 ears (75%) demonstrating full autophony cessation

Complications and Considerations

While these treatment options show promise, there are also potential complications and considerations to be aware of, such as:

• Correlation between patulous Eustachian tube and other conditions, such as superior semicircular canal dehiscence syndrome, which can cause similar autophony symptoms 5
• Importance of differentiating between the autophony of semicircular canal dehiscence syndrome and patulous Eustachian tube 5
• Potential for complications related to the procedure, such as those described in the study by 3