Abstract
We encountered two cases of refractory sniff-type patulous Eustachian tubes. Case 1, a 14-year-old girl visited our hospital with the chief complaint of “aural fullness”. The diagnosis of patulous Eustachian tube was made according to the diagnostic criteria for this condition. Conservative treatments, such as oral medicines, instillation of physiological saline, and application of adhesive tape on the tympanic membrane proved ineffective, and we performed ventilation tube insertion. Immediately after placement of the ventilation tube, the patient developed “auditory hyperacusis” (hypersensitivity to surrounding sounds), but this improved from the 16th day after insertion. Wearing earplugs was effective during this period when environmental noise was particularly noticeable. With the improvement of the auditory hyperacusis, the aural fullness also improved. It is important to explain to the patients about the possible development of auditory hyperacusis before the ventilation tube insertion. Case 2 was a 31-year-old woman with the chief complaint of “autophonia”. She also had anorexia nervosa. The diagnosis of patulous Eustachian tube was made according to the diagnostic criteria for this condition. We considered that the “sound invasion into the middle ear” had a greater effect on the pathology than the “pressure change in the middle ear” in this case, and inserted Kobayashi plugs into the Eustachian tube. We also inserted a ventilation tube in anticipation of continued sniffing and worsening of the tympanic membrane retraction due to negative pressure. Thereafter, the patient exhibited the behavior of sniffing while inserting a finger into the external auditory meatus, but we considered that there was no direct effect on the tympanic membrane. The Kobayashi plugs were replaced (sized up) during follow-up, and the ear symptoms, mainly autophonia, resolved.
