This translation aims to provide a clear and easy-to-understand guide for managing the symptoms of patulous Eustachian tube.
The main symptoms of patulous Eustachian tube improve or disappear temporarily when lying down or bending forward. This is because lying down increases the blood flow around the Eustachian tube, causing it to be compressed and close more easily. The fact that the symptoms change with posture is very helpful in diagnosis. In contrast, with other conditions such as sudden deafness, the symptoms typically do not change with posture.
01
A feeling of ear fullness (aural fullness)
This symptom is perceived in various ways by different people. Many describe it as feeling like being underwater. Some people refer to this symptom as “tinnitus.”
02
Hearing your own voice echoing (medically known as autophony) and hearing your own breathing
The mechanism behind these symptoms is simple. The Eustachian tube, which should normally be closed, functions as a valve to prevent unwanted sounds from flowing back from the nose and throat. When it loosens, it allows these unwanted sounds to enter.
03
Other Symptoms
According to a survey of our patients, the following symptoms were reported
“When did your symptoms start?” This question is very important to us.
“When did you first notice the symptoms? Did you experience any changes in your life around that time?” This question is crucial for improving this condition. However, it is often not asked by doctors. Patulous Eustachian tube typically develops due to a combination of various stress factors. In other words, there is often a specific cause. Therefore, identifying the cause is a vital step towards recovery.
In our clinic, we take a team approach to thoroughly investigate the causes of symptoms in collaboration with our patients. Like detectives, we examine why symptoms appear at certain times and worsen in specific situations, uncovering the underlying factors. During the initial consultation, we meticulously review the patient’s medical history, treatment progress, symptom changes, living conditions, and developmental history to identify any links to stress.
However, the relationship between stress and symptoms is not always clear. Some patients are aware of the connection between their symptoms and stress, making it easier to understand the impact of stress. On the other hand, the connection may be unclear, or the patient may not be aware of it. Therefore, when considering the root cause, it is essential to take the time to examine the details thoroughly.
While stress often plays a role, patulous Eustachian tube is not solely caused by stress. Sudden weight loss, dieting, surgery, illnesses, pregnancy, and breastfeeding can also trigger symptoms. Genetic factors may also be involved. Recently, symptoms of patulous Eustachian tube have been reported as a long-term effect of COVID-19 infection. This translation aims to clearly convey the original text’s meaning and importance.
Main Treatments at Our Clinic: Enhancing Disease Understanding and Resilience
Main Treatments at Our Clinic: Enhancing Disease Understanding and Resilience
At our clinic, we aim not only to alleviate the symptoms of patulous Eustachian tube but also to achieve true healing. Today, the main approach to treating patulous Eustachian tube involves methods we’ve previously discussed. Many patients benefit significantly from symptom relief through Eustachian tube pin insertion surgery (covered by insurance). However, from the perspective of treating ENT-related stress disorders using a psychosomatic approach, we believe another viewpoint is also important. Many patients with patulous Eustachian tube suffer from significant stress and feel stuck in their lives.
To illustrate the true cause of symptoms, we can compare it to a “fire.” The Eustachian tube pin surgery could be likened to “turning off the fire alarm.” While it may relieve the loud blaring noise, the actual “fire” causing the problem has not been extinguished. At our clinic, we focus on the accumulation of various causes such as mental and physical imbalances, resilience (the endurance to overcome stress), inherent physical weaknesses, autonomic nervous system imbalances, lack of exercise, and poor nutrition, which contribute to the development of patulous Eustachian tube
Our goal is to extinguish the fire by addressing the immediate symptoms and working towards a mental and physical transformation. This way, even if patients return to stressful environments, they will not suffer from the same symptoms again. We walk this path together with our patients.
Mechanism of Patulous Eustachian Tube: The Dam Collapse Hypothesis
Many patients develop symptoms under excessive stress. Over time, these symptoms tend to appear and improve intermittently, similar to a dam breaking under pressure. For instance, during heavy rainfall, a dam’s water level rises sharply. The excessive pressure causes the dam to break, flooding the downstream area. A similar phenomenon can be observed in various human systems.
Take brain hemorrhages, for example. Excessive increases in overall blood pressure raise the pressure within cerebral blood vessels. When the pressure becomes too high, it can cause a rupture in weakened areas of the blood vessel walls, leading to a brain hemorrhage. Initially, symptoms such as headaches, stiff neck, and shoulder tension might occur. Nosebleeds may also happen as a safety mechanism to release excessive pressure and prevent a fatal brain hemorrhage. In hindsight, there are often multiple warning signs before a fatal condition like a brain hemorrhage occurs.
In human stress states, similar multi-stage safety mechanisms exist. Patulous Eustachian tube also operates within these mechanisms. The human life system is incredibly intricate. By explaining these mechanisms, I aim to help patients understand the inevitability of their conditions. Many illnesses are painful and challenging, but from the perspective of the life system, they are often necessary and optimal choices.
The best treatment for patulous Eustachian tube involves understanding these inevitabilities and considering the overall integrity of the life system.
Medication
For those who prefer medication, we prescribe herbal medicine based on the individual’s constitution. In mild cases, this alone may lead to improvement.
Herbal Medicine (We also consider abdominal examination findings when determining the appropriate herbal treatment) This translation aims to clearly convey the original text’s meaning and complexity while making it understandable for English speakers
Main Examinations at Our Clinic
Standard Pure Tone Audiometry
A test to evaluate hearing ability.
Eustachian Tube Function Test
A test to examine the movement of the tube connecting the ear and nose (Eustachian tube)
Tympanometry
A test to assess eardrum movement.
Autonomic Nervous Function Test
Measures pulse from the finger for 2 minutes and 30 seconds. The analysis provides information on autonomic nervous activity, physical fatigue, blood flow quality, and vascular elasticity.
Psychological Tests:
SDS (Self-rating Depression Scale) to assess tendencies toward depression.
STAI (State-Trait Anxiety Inventory) to assess levels of anxiety.
Symptom Checklist to confirm the presence of specific symptoms.
Symptom Distress Scale to gauge the severity of the symptoms.
Sleep Habit Evaluation to assess the implementation of healthy sleep habits.
Other Tests:
o For tinnitus, a tinnitus test is conducted.
o If anemia is suspected, blood tests for serum iron and ferritin (stored iron) are performed
o Review of previous examination results. Most blood test results are only considered abnormal when high, but low levels of AST, ALT, γ-GTP, cholesterol, BUN, etc., might indicate protein or vitamin deficiencies.
General Treatments
01
Lifestyle Guidance
•Improvement and prevention of weight loss •Symptoms often worsen after intense exercise, in cold weather, or in dry conditions
Caution: Sniffing the nose might temporarily improve symptoms, but it can lead to conditions requiring surgery, such as cholesteatomatous otitis media or adhesive otitis media. Therefore, refrain from sniffing your nose.
02
Nasal Drop Therapy
03
Herbal Medicine
04
Eustachian Tube Treatment (Not Performed at Hori Clinic)
05
Eustachian Tube Pin Insertion Surgery (Not Performed at Hori Clinic)
The Eustachian tube, as shown in the diagram, is a tubular organ that connects the back of the nose and the throat to the cavity behind the eardrum (the middle ear). In healthy individuals, the Eustachian tube remains tightly closed and occasionally opens during swallowing to keep the pressure in the middle ear (the space behind the eardrum, called the tympanic cavity) constant. When sound enters from the outside, it causes the eardrum to vibrate. These vibrations are transmitted through tiny bones called ossicles and then to the snail-shaped cochlea. Within the cochlea, the vibrations become fluid waves, which are sorted as sound and transmitted via nerves to the brain, where the sound is recognized
Causes of Patulous Eustachian Tube
In individuals with normal Eustachian tube function, the pressure within the middle ear (middle ear pressure) remains constant. This consistency allows proper regulation of sound transmission from the eardrum to the ossicles. When a loud sound is received, the eardrum, ossicles, and associated muscles act to limit transmission, preventing excessive vibrations from reaching the cochlea.
Conversely, for sounds that are too soft, the system amplifies the vibrations to ensure the sound is effectively transmitted to the cochlea. When the internal pressure of the middle ear is constant, this space seamlessly integrates with the body and goes unnoticed. However, when the Eustachian tube is open, it causes discomfort and a sense of awareness in the ear and related areas. Similarly, due to the relaxation of the Eustachian tube, individuals may experience the following symptoms:
Under the guidance of experienced counselors, individualized sessions allow for efficient learning. Current stress responses are often the inevitable result of maladaptive coping habits developed during one’s upbringing. From this perspective, illnesses are not random events. Reflecting on the journey to illness and discovering and nurturing a new self is a significant life experience.
Acupuncture Treatment
Acupuncture is often effective for those who suffer from severe neck and shoulder tension or ear pain.
Lifestyle to Alleviate Symptoms of Patulous Eustachian Tube
To alleviate the symptoms of patulous Eustachian tube, it is important to “reduce factors that worsen the condition and increase factors that improve it.” Here’s how you can do that
01
Meditation and Relaxation
Relaxation training (to move from a tense constitution to a more efficient mind and body), mindfulness meditation, autogenic training, and progressive relaxation techniques are all effective
02
Exercise
Moderate exercise during the day improves metabolism and prepares many neurotransmitters from muscles necessary for deep sleep. However, excessive exercise can worsen symptoms in patulous Eustachian tube patients. It is also known that excessive exercise can weaken the immune system
03
Mind-Body Relaxation
Exercises that gently relax muscles, such as stretching, yoga, and qigong, activate the parasympathetic nervous system
04
Breathing Techniques
Breathing techniques are effective for activating the autonomic nervous system and stabilizing the mind and body
05
Dietary Improvements
Eighty percent of patients are slender women, who may have latent digestive function decline. Iron-deficiency anemia is also common, necessitating attention to protein, B vitamins, and iron intake.
Reducing food additives, replacing refined foods (white sugar, refined salt) with alternatives like brown sugar and natural salt, improving cooking methods (reducing frying and sautéing), and using cooking techniques that avoid glycation are also important.
06
Nutritional Supplements
Personalized complementary therapies are important, including the measurement of ferritin in the blood to detect potential anemia (beyond just serum iron and hemoglobin) and addressing potential vitamin deficiencies.
07
Avoiding Excessive Habits
Excessive alcohol consumption and smoking promote arteriosclerosis and suffocate cells
08
Bathing
Finish bathing 1.5 to 2 hours before bedtime or take a bath in the morning
09
Sleep
Deep sleep is crucial, and attention to daytime lifestyle is essential. Adequate sleep can be achieved through daily habits
10
Television, Mobile Phones, and Computers
• Limit screen time to avoid overstimulation and excessive excitement of brain activity
Why Can’t ENT Specialists Cure Patulous Eustachian Tube?
Many modern doctors, including ENT specialists, lack interest or basic knowledge about the close connection between the mind and body. This perspective is often not emphasized even in many university hospital ENT departments. What about psychiatry or psychosomatic medicine? The focus of their treatment is currently on medication. However, medication alone does not restore the deeper mechanisms of the mind and body. While I do refer patients in severe depressive states to specialists, there are few doctors who value and foster the patient’s intrinsic ability to heal. There is a need for ENT specialists to improve their diagnostic abilities and deepen their understanding of the relationship between the mind and body.
