Introduction: Though Biliopancreatic Diversion with Duodenal Switch (BPD/DS) results in the most weight loss of any bariatric surgery, it is one of the least common procedures in the US as it is often associated with undesirable side effects1. We present a case of eustachian tube (ET) dysfunction resulting from significant weight loss following bariatric surgery.


Case presentation: 41 year-old male with a history of class III obesity, BMI of 50 kg/m2 presenting for care 6 months post BPD/DS. He had total weight loss of 155 lbs, 76% of excess weight. Patient complained of ongoing issues with ear pressure, nausea, and “underwater sensation' which initially manifested one month following bariatric surgery, but worsened over time. Sensation occurred while breathing in, and was exacerbated by cold weather. ENT evaluation concluded that the symptoms were related to patulous eustachian tube (PET) due to rapid weight loss. He was started on mucous-thickening nasal spray. PET surgical repair is planned, if treatment is ineffective.


Discussion: The ET is an osteocartilaginous canal communicating the middle ear with the nasopharynx2. It is responsible for functional balance, protection, aeration, and draining3. Tube dysfunction after bariatric surgery originates from the acute loss of adipocyte tissue surrounding the cartilage part of the ET (Ostmann's fat)4. It leads to a failure of tubal support resulting in abnormal patency of ET2. Objective diagnosis is difficult, as symptoms may not be present at tympanometry or audiometry. The diagnosis remains based on the history and clinical symptoms. Treatment has varied success and includes medical, peritubal injections, or surgical interventions2,5.


Conclusion: Acute weight loss from bariatric surgery can cause ET dysfunction. Physicians’ awareness of diagnosis criteria, treatment, and long-term follow-up can have a significant impact on outcomes and the quality of life of these patients.