Author(s)
Sebastian Guadarrama-Sistos Vazquez, MD
Akshay Prabhakar, Mr
Alejandro Pardo-Antunez
Justina Varghese, B.A.don Bounds
Francisco Piqueras
Manuel Burgos-Olmos, PhD
Omar G Ahmed, MD, FARS
Masayoshi Takashima, MD, FARS
Jeffrey Vrabec, Professor
Affiliation(s)
Houston Methodist Hospital
Abstract:
*I: Patulous eustachian tube (PET) is a challenging disorder producing disturbing symptoms of autophony for voice and breathing. Treatments are typically aimed at altering the Eustachian tube (ET) lumen. However, the benefit is limited as many patients experience recurrent or persisting symptoms. We utilized computational fluid dynamics (CFD) to analyze nasal airflow and its potential role in symptom pathogenesis.
*M: Flowgy® (PUC, Spain) was used to perform CFD analysis on CT scans from 4 PET patients and 4 controls (HC) without PET or nasal symptoms. Airflow (AF) velocity (V), pressure (P), and turbulence (T) patterns were analyzed in the ET pharyngeal opening (ETO) and nasopharynx (NP).
*R: The pattern of AF in the NP differs in PET patients and HC. HC have no trend in the laterality of V, P or T; contrary to PET patients, who have a pattern of lower P, and higher V and T ipsilateral to symptoms.
NP P remained homogeneous in HC, compared to significant pressure differentials on the affected vs the unaffected ETO on PET patients, which all have the lowest NP P area surrounding the symptomatic ETO.
Patient symptoms often improve by closing the ipsilateral nostril. Virtual surgery simulating nostril obstruction was performed on one PET patient to replicate in-clinic maneuvers that temporarily resolve symptoms. The resulting CFD images show NP AF patterns comparable to HC when the ipsilateral nostril is obstructed.
*C: While PET manifests as an otologic condition, our CFD analysis suggests a rhinologic etiology. This represents a paradigm shift in understanding PET pathophysiology and suggests that therapeutic interventions targeting nasal AF characteristics may offer novel treatment approaches for this challenging condition.