![]() ![]() When the patient lies down or bends over, more venous blood gathers around the Eustachian tube, and the resultant pressure causes the Eustachian tube to close. The weight loss causes the fat pad around the Eustachian tube to shrink, leading to a loss of support for tube closure.Īs a result, the abnormally open Eustachian tube will allow sound to get through the nasopharynx, into the Eustachian tube, and into the middle ear, causing patients to feel like they are talking in a barrel. Patients with a patulous Eustachian tube generally present after a significant weight loss. An abnormally open Eustachian tube, termed a patulous Eustachian tube, can cause a variety of symptoms, including autophony and pulsatile tinnitus. Normally, the Eustachian tube is closed, only opening upon swallowing or yawning. In our patient, the problem is vascular and mechanical. The fact that the change in position of the head affects symptomatology indicates a mechanical or vascular phenomenon. The finding of an improvement when the patient lies down is significant. Like people with otosclerosis, these patients often have pulsatile tinnitus, and internal sounds seem louder to them. Superior and posterior canal dehiscence also cause conductive hearing loss and increased ability to hear via bone conduction, leading patients to hear their own voice through the vibrations of the skull. (When patients have sensorineural hearing loss, on the other hand, they speak more loudly.) This phenomenon is counterintuitive to their family members, who notice that the patient has hearing loss but speaks quietly. For people with otosclerosis, their own voice sounds much louder in the affected ear, leading patients to speak more softly. Patients also hear their own voice in their ear when they have conductive hearing loss from a middle ear disorder. As a result, patients hear their own voice in the ear affected by unilateral cerumen impaction. The decrease in air-conduction sound causes an increased sensation of bone-conduction sound relative to the unaffected side. Any dysfunction of either mechanism leads to patients feeling like they hear their own voice in their ear.įor example, cerumen impaction on one side can cause conductive hearing loss. ![]() In the second, vibrations of sound in the larynx and mouth vibrate the skull, leading to bone-conduction sound. In the first, sound exits the mouth and enters the ear canals via air conduction. People hear their own voice via two different mechanisms. These images of the patient's nasopharynx show the abnormally open Eustachian tube orifice (top) and the scar band behind the posterior lip (bottom). ![]()
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