{"id":1678,"date":"2021-09-15T08:00:00","date_gmt":"2021-09-15T08:00:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=1678"},"modified":"2021-09-16T06:10:21","modified_gmt":"2021-09-16T06:10:21","slug":"talking-through-a-fog-the-impact-of-patulous-eustachian-tube-on-patients-with-advanced-cancer","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2021\/09\/15\/talking-through-a-fog-the-impact-of-patulous-eustachian-tube-on-patients-with-advanced-cancer\/","title":{"rendered":"\u201cTalking Through a Fog\u201d: The Impact of Patulous Eustachian Tube on Patients with Advanced Cancer"},"content":{"rendered":"

By Dr Holly McGuigan (Specialty Doctor in Palliative Medicine, Strathcarron Hospice) and Dr Ruth Isherwood (Consultant in Palliative Medicine, Cornhill Macmillan Centre, Perth)<\/em>
\nTwitter: @cloudy_lemonade<\/em><\/p>\n

\"Dr<\/a><\/p>\n

 <\/p>\n

\u201cI\u2019m sorry, what?\u201d<\/p>\n

\u201cPatulous Eustachian Tube\u201d, came the reply from my prospective Masters supervisor.<\/p>\n

\u201cI\u2019m sorry but I have no idea what you\u2019re talking about\u2026\u201d<\/p>\n

And so began an obsession with a part of the body I hadn\u2019t thought about since medical school.<\/p>\n

 <\/p>\n

What\u2019s a Eustachian tube and how does it become Patulous?<\/strong><\/p>\n

Thanks for asking!<\/p>\n

The Eustachian tube is\u00a0the small passageway that connects your throat to your middle ear. Under normal resting conditions it is held closed by the pressure of surrounding tissues and opens when you sneeze, swallow, or yawn.<\/p>\n

A Patulous Eustachian Tube (PET) is one that stays open all the time. This causes external sounds to seem muffled and causes an abnormal awareness of \u2018internal sounds\u2019 such as your own breathing and speech [1].<\/p>\n

 <\/p>\n

How common is it?<\/strong><\/p>\n

More common than you\u2019d think!<\/p>\n

Rapid weight loss causes the fatty tissues holding the Eustachian tube closed to shrink leading to PET. Because of this association we thought that PET would be more common in patients with advanced cancer so we did a study to find out.<\/p>\n

We recruited 36 participants with cancer (24 women and 12 men). Participants were aged between 52 and 92 years (mean=70.7). The participants had a range of primary cancers and most (25 of the 36) had metastatic disease.<\/p>\n

Patients with PET were identified using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), otoscopy and tympanometry.<\/p>\n

A diagnosis of PET was made in seven (19.4%) of the 36 participants in the study. This is much higher than the general population prevalence of 0.3-6.6% [2,3,4]<\/p>\n

What did the patients have to say about it?<\/strong><\/p>\n

We conducted interviews with five participants and identified several themes.<\/p>\n

Theme 1: Patient Experience of Symptoms<\/u><\/p>\n

Participants described hearing loss as the initial symptom.<\/p>\n

\u201cSometimes it\u2019s like talking through a fog, ken. Just like it\u2019s like a vacuum. It\u2019s weird I can\u2019t explain it.\u201d (Participant 5)<\/p>\n

Two participants described feeling as though their ears were closed or blocked.<\/p>\n

\u201cI feel as though somebody\u2019s stuck a bit of cotton wool in there and not taken it out. It\u2019s just dulled your hearing a bit.\u201d<\/em> (Participant 4)<\/p>\n

Theme 2: Communication<\/u><\/p>\n

All participants spoke about adaptations that their families or friends made to aid communication.<\/p>\n

\u201cI\u2019ve got to try to be face to face\u2026 I\u2019m picking up the wrong thing that they are saying if they are not directly beside me\u201d<\/em> (Participant 1)<\/p>\n

Participants described the emotional impact of their communication difficulties. The majority of participants expressed a fear of missing parts of conversations and spoke of this making them feel dissociated from their loved ones.<\/p>\n

Theme 3: Understanding<\/u><\/p>\n

Most participants spoke about wanting to understand the cause of their symptoms rather than simply being offered aids to manage hearing loss.<\/p>\n

Two participants expressed concern that the underlying cause of hearing impairment was brain metastases.<\/p>\n

Theme 4: Acceptance and Stigma<\/u><\/p>\n

Significant stigma was identified regarding hearing loss.<\/p>\n

\u201cI wouldn\u2019t like to be deaf, I really wouldn\u2019t like to be deaf. Honestly, I wouldn\u2019t like to be deaf\u2026.\u201d <\/em>(Participant 3)<\/p>\n

Theme 5: Hearing Aid Experiences and Perceived Futility<\/u><\/p>\n

There were several comments related to body image and stigma associated with hearing aids. Participants who had tried hearing aids didn\u2019t find them useful.<\/p>\n

\u00a0\u201cWell I did get a hearing aid but it doesn\u2019t work properly so I don\u2019t bother with it\u201d<\/em> (Participant 5)<\/p>\n

\u00a0<\/strong><\/p>\n

Why should it matter to me?<\/strong><\/p>\n

In palliative medicine we spend a lot of time paying careful attention to the words we say but it\u2019s equally important that patients can hear our carefully chosen words!<\/p>\n

Patients with PET may struggle in discussions held in a large group e.g. discharge planning meetings. Patients may also struggle to understand what is being said to them in noisy ward environments. It is important that these issues are considered, and that adaptations are made to allow effective communication.<\/p>\n

Now that I know what you\u2019re talking about what changes can I make to my practice?<\/strong><\/p>\n