Utility of evaluating symptom changes in the patient with patulous Eustachian tube through acoustic assessment: A case report

Rationale: Patulous Eustachian tube (PET) refers to condition where the Eustachian tube remains abnormally open or fails to close adequately, leading to autophony, aural fullness, breathing autophony, tinnitus, and hypernasality. This case study reports the acoustic characteristics of a PET patient with hypernasality evaluate the changes in symptoms before and after conservative therapy, and demonstrate the utility of objective assessment through speech evaluation in addition to subjective symptom assessment. Patient concerns: The 40-year-old female presented to the otolaryngology outpatient clinic with complaints of aural fullness and autophony, tinnitus, hypernasality. Otoscopic examination revealed bilateral adhesive tympanic membranes. Despite bilateral ventilation tube insertion performed to address the persistent aural fullness, the patient continued to experience the same symptoms postoperatively. Diagnoses and Interventions: The patient began evaluation and treatment including speech, physical, and drug therapy were performed, for hypernasality, dyspnea, and swallowing problem with the Department of Rehabilitation Medicine. We assessed nasalance, vocal quality, and questionnaire both before and after the treatment. The acoustic data related to PET and the questionnaire results were then obtained. Outcomes: Significant improvements were observed in nasalance and vocal quality, questionnaire. Nasalance and jitter, shimmer metrics, questionnaire results gradually decreased. Notably, jitter and shimmer, questionnaire score, which were outside the normal range in the pretreatment assessment, returned to within normal limits following the conservative treatment. Lessons: Studies focused on PET with hypernasality changes in acoustic data and questionnaire are extremely rare. This case is significant in that not only was PET with hypernasality improved after conservative therapy, but also changes in nasalance, voice quality, and questionnaire were observed.