Grommets for patulous eustachian tube?

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My ENT surgeon has suggested grommets for eustachian tube disfunction which i have in both ears, although i'm not convinced this is the correct thing to have. The reason being is that at the very end of our recent discussion, he said grommets will help unblock the ears and equalise the pressure. However, my ears are not blocked, quite the opposite in fact. After doing a lot of research myself, i suspect that the symptoms indicate patulous eustachian tube, which is where the eustachian tube spends too much time open for what ever reason, resulting in autophony symptoms and generally everything being too loud, as if my ears are constantling "popped". I dont see how grommets will help. Should i get a second opinion before going through with the operation?

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  • Posted

    Absolutely, Rory. 

    If you are uncomfortable with this diagnosis, you should get a second opinion and even a third. 

    I have eustachian tube problems myself and my ears pop and crackle when I'm exercising, especially on a treadmill. The eustachian tube does have a tendency to malfunction and yes, you would hear sounds loudly, or even hear your own voice in the affected ear. Typically, grommets or tubes are used in children with ear problems and help drain the fluid that causes the ear to become infected. 

    I hope you get by this problem and although the surgey is deemed simple, yes, get a good 2nd opinion.

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    • Posted

      Thanks, i certainly shall. Depending on the severity of it, it's a highly inconvenient condition. As mine has gotten worse it's really affected my ability to communicate as i have to constantly pinch my nose and suck in to regulate the pressure, although a lot of the time this is ineffective. I've noticed that alcohol, lying on my back and cold weather makes it worse. Although turning my head upside down provides some temporary relief for some reason, i assume it exerts pressure on the tubes to close.

       

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  • Posted

    Hi Rory, grommets are used for both PET and ETD. For ETD to aerate the ear for PET to decrease the sound pressure experienced in the middle ear system when you speak/eat/breath. I would send your ENT clinic an email asking if you have ETD or PET and why the ENT thinks this. Do you have negative pressure in your middle ears? Does your hearing test show a conductive hearing loss (which is a sign of ETD)? Does your voice echo very loudly in your ears/head or does it sound muffled and blocked up? If you put your head between your knees does the echoing improve? If you put pressure on your jugular veins, does the echoing improve? If it is yes for either of these, it is PET. When you say everything is too loud do you mean external sound (like other people's speech, noise, cars etc) or internal sound (your voice, chewing and breathing?)

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    • Posted

      Hi Olizzieo,

      I have a pre-surgery assessment before the scheduled operation so will ask these questions. 

      With regard to the hearing tests, i had 2 tests on separate occassions and there is no hearing loss, the tests were fine. In fact, because everything is often too loud when my ears pop, i can hear a lot more (both internal and external) than perhaps i would do. When my ears pop, my voice sounds echoed and loud, rather than muffled and blocked. Putting my head between my legs helps temporarily, yes. Whilst everyone's ears pop from time to time, the fundamental symptom for me is that they pop too often, hundreds of times a day, every time i swallow and turn my head or talk to people. Also, whereas most people would just sniff to unpop them, i have to pinch my nose and sniff several times before they unpop. 

       

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    • Posted

      Olizzieo - thank you for your post!

      You described my ETD perfectly.  In all my years struggling with ENT Docs, I have never visited one that made me feel any better about my condition. I suffer terribly with tinnitus and have lost 80% of my high range hearing in my left ear. The same ear that has ETD.

      Take care -

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    • Posted

      Frequent sniffing is a sign of PET (unless you have a runny nose.) It gives temporary relief. What were your tympanograms like?
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    • Posted

      I have the initial tympanogram read out here, although i'm not sure what readings i should be looking at, there appears to be readings for Ear Volume, Compliance and Pressure.

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    • Posted

      Hi Glenn have you found an ENT that will balloon your eustachian tubes. It seems to be quite successful but I don't think it is available in Australia anywhere except in clinical research. In America and England it is available. Is the loss of high range hearing conductive (meaning your cochlear hearing is still normal) or is it sensorineural? Did you know that wearing a hearing aid can often help mask tinnitus, if it is something that bothers you?

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    • Posted

      Hi Again Olizzieo - ballooning my eustachian tubes has never been mentioned. I'm here in the U.S.  

      Yes, a hearing aid was recommended on my last visit to my ENT. The audiologist agreed with what you are saying. The hearing aid can assist in masking that high pitch hissing sound that I have lived with for many years. It's annoying and grates on my nerves at times. I do believe my hearing has deteriorated. The older I get, the more hearing I seem to lose. It seems if I didn't have the tinnitus, I would be able to hear better? The left ear has more hearing loss than the right ear and the left ear is one that plugged up for 10 days and that finally resolved itself. Althought the ear was plugged and I couldnt hear much out of it, everything like the TV seemed loud and annoying. Does that make sense? 

      What kind of procedure is invoved with ballooning the ET's? 

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    • Posted

      Hi Glenn, have a look on Youtube. They have several videos of 'eustachian tube balloon dilation'. Lucky you living in America. You will be able to find someone that performs this procedure!!

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    • Posted

      Wow, that is definitely eustachian tube dysfunction as both ears have very negative pressure and almost no movement of the ear drums. As with Glenn, ask your ENT about eustachian tube balloon dilation if you live in the US or England. 
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    • Posted

      Yes, there was already a diagnosis of ETD, it was on a different file though. What it doesnt say is whether it's PET though, which seems more consistent with my symptoms. Can you tell from that read out  if it is?

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    • Posted

      It does sound confusing and yet if you have such negative pressure in your ears then there is no way you can have PET because if the ear canals were open as they are in PET, then you couldn't have negative pressure.

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    • Posted

      Is the pressure more negative when the ears are unpopped compared to popped? The tests were done when my ears were unpopped, as this seemed like the correct state to be in for the tests. However, i could have very easily just popped them by swallowing. 

      I suppose what i'm getting at is can PET be a temporary state? I.e. once i pinch my nose and suck in, the tubes cease to be in a patulous state and negative pressure returns, albeit for a bit.

      My original concern with grommets is that they will allow the pressure to become constantly too positive and i'd suffer the symptoms ALL the time which would just be unbearable, rather than currently which is just 70% of the time. 

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    • Posted

      When the ears pop they return back to normal ie 0daPa which means the pressure behind your ear drums is the same as the pressure in your ear canals, but sometimes the pressure becomes positive because you have forced so much ear up into your middle ear. I don't think it is possible for your ears to be patulous even for a second, if they are so closed that they are causing negative pressure to build up. If a grommet is inserted the air pressure in the middle ear and canal would be equal. With an open grommet, it is impossible for the pressure to become negative or positive. It will always stay at 0daPa. Also if you did have PET, a grommet can help relieve the very loud sound of echoing. In your case though, I think that the echoing may be what we all experience after having a cold, where we pop our ears, the pressure returns to 0daPa and everything sounds loud and echoey (even though we are really hearing normally again.) It is just that we haven't heard like that while we have had negative middle ear pressure.

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