Endoscopic transnasal shim technique for treatment of patulous eustachian tube

INTRODUCTION An abnormally patent Eustachian tube, known as a patulous Eustachian tube (pET), can cause disabling autophony as well as annoying transmitted sounds of breathing and swallowing. The elegant work of Poe’s group has shown that the anatomical defect is found in the anterolateral tubal valve of the nasopharyngeal end of the Eustachian tube (ET). To the frustration of both patients and their caregivers, current medical and surgical treatments are relatively inconsistent in their ability to eliminate the symptoms of pET. Numerous treatments have been proposed, including silicone plugs, rolled catheters, mass loading material on the tympanic membrane, silver nitrate cautery, conjugated estrogen drops, electrocauterization, Teflon/fat injection, and cartilaginous luminal reconstruction. In 2012, our group from Western University published the results of suture ligation of the torus tubaris for treatment of pET. Over time, however, we found that the sutures eventually worked themselves out of place in several cases, presumably due to the strong muscular forces acting on the ET during swallow. In these cases, revision surgery via placement of a suturefixated shim filled with bone wax to block the ET lumen in the resting position, thereby restoring the competency of the closing mechanism, immediately improved the pET symptoms—and did so both consistently and for the long term. Herein we describe our shim technique and its effectiveness in eliminating autophony.