Elsevier

Auris Nasus Larynx

Volume 45, Issue 1, February 2018, Pages 1-5
Auris Nasus Larynx

Diagnostic criteria for Patulous Eustachian Tube: A proposal by the Japan Otological Society

https://doi.org/10.1016/j.anl.2017.09.017Get rights and content

Abstract

Patulous Eustachian Tube (PET) is of increasing importance in otology. However, despite the abundance of diseases requiring a differential diagnosis from PET, such as superior semicircular canal dehiscence syndrome, perilymphatic fistula, acute low-tone sensorineural hearing loss, etc., there are currently no established diagnostic criteria for PET.

In view of these circumstances, the Japan Otological Society (JOS) Eustachian Tube Committee proposed the diagnostic criteria for Patulous Eustachian Tube in 2012, in order to promote clinical research on PET. A revision was made in 2016, maintaining the original concept that the criteria should be very simple, avoid any contamination of “Definite PET” with uncertain cases. Moreover, it was also intended to minimize the number of cases that could be accidentally excluded even in the presence of some suspected findings (“Possible PET”).

The criteria can be used by all otolaryngologists even without using the Eustachian tube function test apparatus. However, the use of such an apparatus may increase the chances of detecting “Definite PET”. The algorithm for the diagnosis of PET using the criteria has also been described.

The JOS diagnostic criteria for Patulous Eustachian Tube will further promote international scientific communication on PET.

Section snippets

Background

The Patulous Eustachian Tube (PET) has long been considered a unique but relatively rare disorder [1], [2], [3], [4], [5]. In recent years, however, there has been a remarkable increase in the number of clinical reports and studies on PET [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49],

Concept of the JOS diagnostic criteria for Patulous Eustachian Tube 2016

The JOS diagnostic criteria for Patulous Eustachian Tube 2016 was formulated to avoid any contamination of “Definite PET” with uncertain cases, so that “Definite PET” accurately reflects PET cases. Moreover, it was also intended to minimize the number of cases that could be accidentally excluded even in the presence of some suspected findings (“Possible PET”).

The criteria can be used by all otolaryngologists even without using the Eustachian tube function test apparatus. However, the use of

JOS diagnostic criteria for Patulous Eustachian Tube 2016

The JOS diagnostic criteria for Patulous Eustachian Tube 2016 (Fig. 1), the notes for the criteria (Table 1, Fig. 2, Fig. 3) and the algorithm for diagnosis of PET using the criteria (Fig. 4) are shown.

Conclusion

The JOS diagnostic criteria for Patulous Eustachian Tube will further promote international scientific communication on PET.

References (76)

  • J.L. Pulec et al.

    Abnormal patency of the eustachian tube: report on 41 cases

    Laryngoscope

    (1964)
  • K. Flisberg et al.

    Middle-ear mechanics in patulous tube cases

    Acta Otolaryngol

    (1969)
  • M.H. Stroud et al.

    Patulous eustachian tube syndrome: preliminary report of the use of the tensor veli palatini transposition procedure

    Arch Otolaryngol

    (1974)
  • S. Ogawa et al.

    Patulous eustachian tube. A new treatment with infusion of absorbable gelatin sponge solution

    Arch Otolaryngol

    (1976)
  • T. Kumazawa et al.

    Aerodynamic pattern of eustachian tube dysfunction

    Arch Oto Rhino Laryngol

    (1977)
  • H. Virtanen

    Patulous eustachian tube. Diagnostic evaluation by sonotubometry

    Acta Oto Laryngol

    (1978)
  • A.F. O'Connor et al.

    Autophony and the patulous eustachian tube

    Laryngoscope

    (1981)
  • C.D. Bluestone et al.

    “How i do it” — otology and neurotology. A specific issue and its solution. Management of the patulous eustachian tube

    Laryngoscope

    (1981)
  • H. Virtanen et al.

    Surgical treatment of patulous eustachian tube

    Arch Otolaryngol

    (1982)
  • M. Morita et al.

    Effects of an anti-cholinergic on the function of patulous eustachian tube

    Acta Otolaryngol

    (1988)
  • C.S. Derkay

    Eustachian tube and nasal function during pregnancy: a prospective study

    Otolaryngol Head Neck Surg

    (1988)
  • H. Sato et al.

    Treatment of patulous eustachian tube with injectable collagen

    Pract Otol (Kyoto)

    (1989)
  • P.J. Robinson et al.

    Patulous eustachian tube syndrome: the relationship with sensorineural hearing loss. Treatment by eustachian tube diathermy

    J Laryngol Otol

    (1989)
  • D.A. Chen et al.

    Myringotomy and tube for relief of patulous eustachian tube symptoms

    Am J Otol

    (1990)
  • T. Kobayashi et al.

    Voluntarily retractable tympanic membranes: case report

    Am J Otol

    (1991)
  • R.K. Dyer et al.

    The patulous eustachian tube: management options

    Otolaryngol Head Neck Surg

    (1991)
  • N. Yamaguchi et al.

    Histologic study of eustachian tube cartilage with and without congenital anomalies: a preliminary study

    Ann Otol Rhinol Laryngol

    (1990)
  • A. Mink

    Manometric determinations of pressure changes in the external auditory meatus caused by a patulous eustachian tube

    Eur Arch Oto Rhino Laryngol

    (1992)
  • J. Sakakihara et al.

    Compliance of the patulous eustachian tube

    Ann Otol Rhinol Laryngol

    (1993)
  • J. Sakakihara et al.

    Eustachian tube compliance in sniff-induced otitis media with effusion

    Acta Otolaryngol (Stockh)

    (1993)
  • S. Ishikawa

    Patulous eustachian tube treated with Chinese medicine, Kamikihito

    Pract Otol

    (1994)
  • N. Yamaguchi et al.

    Patulous eustachian tube: endoscopic observation of the tympanic membrane and the pharyngeal orifice of the eustachian tube and the impedance method

  • N. Yamaguchi et al.

    Patulous eustachian tube: the types of pharyngeal orifice and etiology

  • N. Yamaguchi et al.

    Endoscopic video-monitor examination of patulous eustachian tube — Patulous eustachian tube associated with sequellae of otitis media and atelectatic ear

  • N. Yamaguchi

    Therapeutic diagnosis of patulous eustachian tube

    Otol Jpn

    (2000)
  • A. Oshima et al.

    Tympanic membrane and nasopharyngeal orifice of eustachian tube of former leprosy patients

    Otol Jpn

    (2000)
  • H. Yoshida et al.

    Imaging of the patulous eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique

    Acta Otolaryngol

    (2004)
  • S. Kano et al.

    Possible new assessment of patulous eustachian tube function: audiometry for tones presented in the nasal cavity

    Acta Otolaryngol

    (2004)
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    1

    All authors belong to the Eustachian Tube Committee of the Japan Otological Society (JOS).

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