The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

Autoři: Yoshinobu Kawamura aff001;  Ryoukichi Ikeda aff001;  Toshiaki Kikuchi aff001;  Hiromitsu Miyazaki aff001;  Tetsuaki Kawase aff001;  Yukio Katori aff001;  Toshimitsu Kobayashi aff001
Působiště autorů: Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan aff001;  Sen-En Rifu Otologic Surgery Center, Rifu, Miyagi, Japan aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



The objective is to describe characteristics of patients diagnosed with patulous Eustachian tube (PET) using the Diagnostic Criteria proposed by Japan Otological Society, and to evaluate the efficiency of objective tests to determine patent Eustachian tube.

Study design



Tertiary referral center.


A retrospective survey of medical records in Sen-En Rifu Hospital identified 78 ears of 56 patients with “Definite PET” diagnosed by the JOS Diagnostic Criteria between January 2017 and December 2017.


Initial diagnosis, aural symptoms (voice autophony, aural fullness and breathing autophony), tubal obstruction procedures (posture change and pharyngeal orifice obstruction) and objective findings (tympanic membrane movement, Tubo-Tympano-Aerodynamic Graphy (TTAG) and sonotubometry) were evaluated. In addition, sonotubometry with postural change (Ohta’s method), sitting CT and a newly devised PHI-10 score were also examined.


Voice autophony, aural fullness, and breathing autophony were observed in 93.6%, 87.2%, 78.2%, respectively. In 91% of the ears, PET symptoms improved by postural change from sitting to the lying / forward-bending position. Synchronous movement of the TM upon respiration was observed in 69.1% of the ears. Positive findings of TTAG were observed in 75.6% of ears. Positive findings of sonotubometry were found in 55.1% of ears. Sonotubometry with postural change (Ohta’s method), when the cut-off value of over 10dB was used, was positive in 45.2% of ears. Newly devised PHI-10 score representing severity of subjective symptoms classifying patients into no handicap, mild handicap, moderate handicap and severe handicap were observed in 12.2%, 10.8%, 18.9% and 58.1% of ears, respectively. The evaluation of the extent of patency of the ET by sitting CT indicated completely open, closed-short, and closed-long, in 68.6%, 11.4% and 21.4% of ears, respectively. Compared to the closed group, the completely open group had a significantly higher frequency of positive breathing autophony, positive sonotubometry, and positive Ohta’s method.


The characteristics of main symptoms and the efficiency of various tests in PET diagnosis were analyzed based on data obtained from “Definite PET” patients diagnosed by the JOS Diagnostic Criteria. The greater the availability of tests to evaluate PET, the greater the opportunities to diagnose “Definite PET”. In particular, tests measuring pressure transmission between the nasopharynx and middle ear, such as TM observation and TTAG, are more sensitive than sonotubometry measuring sound transmission.

Klíčová slova:

Breathing – Diagnostic medicine – Ears – Musculoskeletal system – Nasopharynx – Otology – Positron emission tomography – Sound pressure


1. Sudhoff HH, Mueller S. Treatment of pharyngotympanic tube dysfunction. Auris Nasus Larynx. 2018;45(2):207–14. doi: 10.1016/j.anl.2017.07.001 28734727

2. O'Connor AF, Shea JJ. Autophony and the patulous eustachian tube. Laryngoscope. 1981;91(9 Pt 1):1427–35.

3. Pulec JL, Simonton KM. Abnormal Patency of the Eustachian Tube: Report on 41 Cases. Laryngoscope. 1964;74:267–71. doi: 10.1002/lary.5540740211 14117259

4. Kawase T, Hori Y, Kikuchi T, Sato T, Oshima T, Takahashi H, et al. Patulous Eustachian tube associated with hemodialysis. Eur Arch Otorhinolaryngol. 2007;264(6):601- doi: 10.1007/s00405-007-0243-y 17256122

5. Ikeda R, Kobayashi T, Yoshida M, Yoshida N, Kikuchi T, Oshima T, et al. Patulous Eustachian Tube and Otitis Media With Effusion as Complications After Trigeminal Nerve Injury. Otol Neurotol. 2017;38(8):1125–8. doi: 10.1097/MAO.0000000000001492 28708793

6. Poe DS. Diagnosis and management of the patulous eustachian tube. Otol Neurotol. 2007;28(5):668–77. doi: 10.1097/mao.0b013e31804d4998 17534202

7. Kobayashi T, Morita M, Yoshioka S, Mizuta K, Ohta S, Kikuchi T, et al. Diagnostic criteria for Patulous Eustachian Tube: A proposal by the Japan Otological Society. Auris Nasus Larynx. 2018;45(1):1–5. doi: 10.1016/j.anl.2017.09.017 29153260

8. Kumazawa T, Honjo I, Honda K. Aerodynamic pattern of Eustachian tube dysfunction. Arch Otorhinolaryngol. 1977;215(3–4):317–23. doi: 10.1007/bf00463069 577699

9. Ikeda R, Kawase T, Takata I, Suzuki Y, Sato T, Katori Y, et al. Width of Patulous Eustachian Tube: Comparison of Assessment by Sonotubometry and Tubo-tympano-aerography. Otol Neurotol. 2019.

10. Virtanen H. Sonotubometry. An acoustical method for objective measurement of auditory tubal opening. Acta Otolaryngol. 1978;86(1–2):93–103. doi: 10.3109/00016487809124724 696300

11. Takata I, Ikeda R, Kawase T, Suzuki Y, Sato T, Katori Y, et al. Sonotubometric Assessment for Severity of Patulous Eustachian Tube. Otol Neurotol. 2017;38(6):846–52. doi: 10.1097/MAO.0000000000001413 28437362

12. Ikeda R, Kikuchi T, Oshima H, Miyazaki H, Hidaka H, Kawase T, et al. New Scoring System for Evaluating Patulous Eustachian Tube Patients. Otol Neurotol. 2017.

13. Ohta S, Katsura H, Ikehata M, Akazawa K, Mishiro Y, Sakagami M. The postural change eustachian tube function test using a sonotubometry [in Japanese]. Otol Jpn. 2015;25:800–4.

14. Ikeda R, Kikuchi T, Oshima H, Miyazaki H, Hidaka H, Kawase T, et al. Relationship Between Clinical Test Results and Morphologic Severity Demonstrated by Sitting 3-D CT in Patients With Patulous Eustachian Tube. Otol Neurotol. 2016;37(7):908–13. doi: 10.1097/MAO.0000000000001102 27273397

15. Kikuchi T, Oshima T, Ogura M, Hori Y, Kawase T, Kobayashi T. Three-dimensional computed tomography imaging in the sitting position for the diagnosis of patulous eustachian tube. Otol Neurotol. 2007;28(2):199–203. doi: 10.1097/01.mao.0000253280.10501.72 17255887

16. Kikuchi T, Oshima T, Hori Y, Kawase T, Kobayashi T. Three-dimensional computed tomography imaging of the eustachian tube lumen in patients with patulous eustachian tube. ORL J Otorhinolaryngol Relat Spec. 2009;71(6):312–6. doi: 10.1159/000265939 20016242

17. Smith ME, Tysome JR. Tests of Eustachian tube function: a review. Clin Otolaryngol. 2015;40(4):300–11. doi: 10.1111/coa.12428 25851074

18. Ward BK, Ashry Y, Poe DS. Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities. Otol Neurotol. 2017;38(9):1362–9. doi: 10.1097/MAO.0000000000001543 28796094

19. Pyne JM, Amoako-Tuffour Y, Earle G, McIntyre G, Butler MB, Bance M. Transmission of a novel sonotubometry acoustic click stimulus in healthy and patulous eustachian tube subjects: a retrospective case -control study. Journal of otolaryngology—head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2017;46(1):47.

20. Kikuchi T, Kobayashi T, Oshima T, Takata I, Oshima H, Ikeda R, et al. High false-positive rate of the sonotubometry in the diagnosis of the patulous eustachian tube [in Japanese]. Otol Jpn. 2013;23:193–7.

21. Smith ME, Takwoingi Y, Deeks J, Alper C, Bance ML, Bhutta MF, et al. Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway. PLoS One. 2018;13(11):e0206946. doi: 10.1371/journal.pone.0206946 30408100

22. Yoshida H, Kobayashi T, Takasaki K, Takahashi H, Ishimaru H, Morikawa M, et al. Imaging of the patulous Eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique. Acta Otolaryngol. 2004;124(8):918–23. doi: 10.1080/00016480410017422 15513527

23. Smith ME, Scoffings DJ, Tysome JR. Imaging of the Eustachian tube and its function: a systematic review. Neuroradiology. 2016;58(6):543–56. doi: 10.1007/s00234-016-1663-4 26922743

24. Ward BK, Carey JP, Minor LB. Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years. Frontiers in neurology. 2017;8:177. doi: 10.3389/fneur.2017.00177 28503164

25. Ikeda R, Miyazaki H, Morita M, Yamauchi D, Kawase T, Katori Y, et al. Surgical treatments for a case of superior canal dehiscence syndrome associated with patulous Eustachian tube. Auris Nasus Larynx. 2018.

26. Kikuchi T, Ikeda R, Oshima H, Takata I, Kawase T, Oshima T, et al. Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube. Acta Otolaryngol. 2017;137(3):253–8. doi: 10.1080/00016489.2016.1231420 27666086

27. Ikeda R, Kikuchi T, Kobayashi T. Endoscope-assisted silicone plug insertion for patulous Eustachian tube patients. Laryngoscope. 2017.

28. Schroder S, Lehmann M, Sudhoff HH, Ebmeyer J. Treatment of the patulous Eustachian tube with soft-tissue bulking agent injections. Otol Neurotol. 2015;36(3):448–52. doi: 10.1097/MAO.0000000000000646 25356764

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden