A novel, computed tomography guided, trans-cutaneous approach to treat refractory autophony in a patient with a patulous eustachian tube.

OBJECTIVE: We report a novel, computed tomography guided treatment for autophony associated with a patulous eustachian tube.

METHODS: Case report and literature review of the management of patulous eustachian tube.

RESULTS: A 36-year-old woman presented with disabling autophony. Otoscopic examination revealed a poorly mobile right tympanic membrane. High resolution temporal bone computed tomography excluded superior semicircular canal dehiscence. The patient was diagnosed with patulous eustachian tube but failed to achieve therapeutic benefit from conventional endoscopic placement of a silicone elastomer suspension implant adjacent to the eustachian tube. Subsequently, she underwent further silicone elastomer suspension implant placement via a trans-cutaneous, computed tomography guided approach. The patient achieved prompt symptomatic relief and remained symptom-free at six-month follow up.

CONCLUSION: This is the first published description of treatment of patulous eustachian tube using a computed tomography guided, trans-cutaneous approach. It serves to highlight to otolaryngologists the fact that computed tomography guided treatment of patulous eustachian tube may control disabling symptoms in patients who have failed to respond to convention endoscopic management.