Patulous tube syndrome (PTS), is a form of Eustachian tube dysfunction. Whereas the normal dysfunction of failure of the tube to open normally, in PTS the tube remains abnormally open allowing transmission of nasopharyngeal pressure to the middle ear.
During strong inspiration (i.e 'sniff') transmits negative pressure to the middle ear and tympanic membrane retraction of the tympanic membrane and even acquired cholesteatomas secondary to retraction pockets.
Although commonly idiopathic, PTS is more frequently seen with:
On imaging, the diagnosis can be suggested by wide patency of the Eustachian tube, often associated with failure to visualize Ostmann's fat pad (inferolateral the the eustachian tube and thought to contribute to tubal occlusion).
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