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A 36-year-old woman presented with a 4-year history of intermittent bilateral aural fullness, subjective hearing loss, and popping and crackling tinnitus with autophony of the left ear. Aural symptoms were sometimes relieved by positional changes, particularly a change to a supine position. The patient had a long-standing history of seasonal allergic rhinitis and had had recurrent acute otitis media as a child. Examination of the left ear revealed an atrophic, monomeric posterior segment of tympanic membrane (arrow) with adherence to the long process of the incus (incudomyringopexy). The middle-ear cleft was well aerated. The atrophic segment of tympanic membrane was grossly mobile with the patient's respirations, and this was amplified with deep respirations (see video). The right ear showed similar mobility of the tympanic membrane on respiration but without the associated chronic tympanic changes and atrophy. This case demonstrates simultaneous manifestations of disease from opposite ends of the spectrum of eustachian-tube disorders: an atrophic, monomeric segment of tympanic membrane with associated incudomyringopexy, which is consistent with a history of eustachian-tube dysfunction, and gross mobility of the tympanic membrane with respiration, which is consistent with a patulous eustachian tube. Management options for patulous eustachian tube were discussed, including placement of a tympanostomy tube, medical management with estrogen nasal drops, and surgical correction. After considering the options, the patient elected to defer active treatment and observe her symptoms, which have been stable and tolerable without treatment for the past 2 years.
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