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. 2022 Jul 4;7(4):1143-1149.
doi: 10.1002/lio2.846. eCollection 2022 Aug.

Transient patulous eustachian tube in severe anorexia nervosa: A prospective observational study

Scott E Mann  1   2 , Jeff Hollis  3   4   5 , Trudy Frederics  6 , Ashlie Watters  4   5 , Judy Oakes  3   5 , Stephen P Cass  1 , Philip S Mehler  4   5   7
Affiliations

Transient patulous eustachian tube in severe anorexia nervosa: A prospective observational study

Scott E Mann et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: To understand the presence of transient autophony symptoms in patients being treated for severe anorexia nervosa (AN), and whether those symptoms were due to patulous eustachian tube (PET).

Methods: A prospective observational study was performed in patients requiring admission for treatment of severe AN. All enrolled patients completed The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and were screened for symptoms of autophony. If patients reported autophony and had a score of ≥14.5 on the ETDQ-7 they were asked to undergo comprehensive audiological testing and an evaluation with an otolaryngologist.

Results: Of the 73 patients enrolled in the study, 35 patients (44%) reported autophony and 36 (49%) scored 14.5 or higher on the ETDQ-7. Of the 16 (22%) patients who had both autophony and an ETDQ-7 score of 14.5 or higher, 7 patient s (representing 11 symptomatic ears) underwent evaluations by audiology and otolaryngology. Every evaluation of a symptomatic ear revealed objective evidence of PET. Nine of 11 (81.8%) symptomatic ears had subjectively resolved within 12 days of admission after nutritional rehabilitation and weight gain.

Conclusion: Transient autophony in severe AN patients is due to PET, and was present in at least 8% of patients within our cohort. Further study is warranted to understand the quality of life impact and pathophysiology of transient PET in this patient population.

Keywords: Eustachian tube dysfunction; anorexia nervosa; autophony; patulous eustachian tube.

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Conflict of interest statement

No conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Objective evidence of patulous eustachian tube. Objective evidence of PET during testing of single subject is shown. Respiratory oscillations observed during reflex decay testing observed during (A) slow ipsilateral nasal breathing, and (B) fast ipsilateral nasal breathing. Tympanic membrane excursions visualized during video otoscopy: (C) inhalation, and (D) exhalation. Note the change in tympanic membrane bulges and the light reflex changes during exhalation.
FIGURE 2
FIGURE 2
Study overview. Demonstration of overall cohort results is shown. This observational study revealed that at least six patients (8.2%) of the enrolled patients had patulous eustachian tube.
FIGURE 3
FIGURE 3
Resolution of autophony symptoms. Patients within the testing group were followed until autophony resolution. One patient still had symptoms on hospital day #11 when they transferred to another facility. In the remaining six patients, all improved their BMI prior to resolution of symptoms (A). Shown in the dotted line is the mean improvement from 12.4 to 13.4 kg/m2. (B) The cessation of autophony occurred rapidly. Number of days in the hospital prior to symptom resolution ranged from 3 days to 12 days (mean 6.5 ± 3.6).
See this image and copyright information in PMC

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