Background

Patulous eustachian tube dysfunction (PET) is a physical disorder where the eustachian tube, which is normally closed, instead stays intermittently open. Patients experience autophony, the hearing of self-generated sounds. Weight loss is a predisposing factor. We present a case of PET dysfunction after laparoscopic sleeve gastrectomy. Aims. This is the first reported case of PET dysfunction after a laparoscopic sleeve gastrectomy for morbid obesity.

Methods

A 36-year-old Caucasian female with class III morbid obesity (289 lbs, BMI 46.6 kg/m2) presented to our multidisciplinary accredited bariatric program in April 2018. She successfully underwent laparoscopic sleeve gastrectomy surgery. At her post-operative follow-up appointment 6 months later, her weight was 212 pounds. She complained of severe autophony. She started to hear her own voice leading to anxiety and insomnia. Since she had intermittent sensation of ear fullness and blockage in her right ear, she was initially misdiagnosed with a sinus infection by her primary care provider and inappropriately started on antibiotics. She was subsequently seen by an otolaryngologist and diagnosed by tympanometry with PET.

Results

PET may be caused by rapid weight loss and the consequent loss of adipose tissue that surrounds the cartilaginous part of the eustachian tubes, the Ostmann fat pads. History of intermittent sensation of ear fullness and blockage in the ear may be present.

Conclusions

We report the first case of PET dysfunction after sleeve gastrectomy. Since PET is a rare complication of weight loss, it can be easily misdiagnosed. Our patient did not notice onset of symptoms of PET until significant weight loss [77 lbs, %59.5 EWL].