Keep repeating what I’ve said;
Autophony. Sounds strangely intriguing…unless you’re the
one suffering from it. It’s uncommon,
but once in a while someone presents with bothersome autophony: a
perception of hearing things internally, inside the head, that is abnormally
loud and distracting. Autophony is often
described as hearing one’s own voice in one or both ears, like an echo, or
hearing one’s own breathing or chewing. Some
described it as hearing things “in a barrel” when talking.
Some folks think they’re going crazy. Most times (there are exceptions) it’s not a problem
that’s “just in your head,” and although literally true, there is a bona fide dysfunction
with one’s anatomy.
One cause of autophony is a patulous
eustachian tube (PaET). With normal eustachian tube function, the collapsible eustachian tube
(ET) naturally closes shut. It opens itself
when swallowing or when intentionally performing maneuvers to force the ET open.
However, with PaET, the ET remains persistently
open. Sounds arising from normal
breathing and talking naturally resonate up into the nose and nasopharynx, the
location of the ETs. A closed ET
prevents these sounds from transmitting through the ET and into the middle
ear. However, with a PaET, these sounds waves
travel through the open ET into the middle ear and onto the eardrum (tympanic
membrane, TM). The TM then vibrates
and transmits that unwanted sound to from
TM to the tiny ear bones (ossicles) to the inner ear (cochlea).
One common cause of PaET is significant
weight loss. Weight loss reduces the
bulk of soft tissue everywhere in the body, including the nasopharynx and
throat (which is the reason snoring and sleep apnea improve with weight loss). This includes tissue around the ETs. Significant loss of soft tissue around the ET
then leads to PaET.
Staying well hydrated, drinking plenty of
water or electrolyte drinks often helps, which keeps soft tissue properly
hydrated and saturated. Another method—though
contrary to good health and not advocated here—is regaining the weight. Again, this is not advisable, unless a person
is significantly under-weight.
Mass-loading or stiffening the TM to
reduce unwanted vibrations can reduce sound input to the TM with little to no
effect to normal hearing. A simple method is a paper patch over the TM. This is not an unusual practice: ENT docs have used patches to cover fresh TM
perforations in order to enhance healing and closure—the patch acts as a
scaffold for the TM epithelial cells to migrate, which can hasten closure of
the perforation. In the case of PaET,
the patch reduces TM vibrations and can help quell or eliminate autophony.
What do we use for a paper patch? Cigarette paper, of course. Yep, good ole Zig-Zags. Don’t be shocked, but this is a common ear-patch
material, used by ENT docs far and wide.
It’s clean, it’s cheap, and it has the desired properties--thin and
light, tolerated well by human tissue (ie, it doesn’t get rejected) and readily
available from your supermarket or grocery store (actually, the last time I had
to request this at the tobacco and liquor counter, and the sales gal looked puzzled
when I explained it’s purpose, responding, “O.K., whatever makes you happy,” or
something to that effect).
 |
| Paper patch over ear drum |
We create circular paper patches and store them in isopropyl alcohol. The patch is placed using an operating microscope in the office, and usually is a relatively quick procedure, barring any anatomic anomalies or a squirming patient. The few patients I’ve used this technique were quite pleased with the result.
References:
Bance M, Tysome JR, Smith ME. Patulous Eustachian tube (PET), a practical overview. World J Otorhinolaryngol Head Neck Surg. 2019 Oct 11;5(3):137-142. doi: 10.1016/j.wjorl.2019.08.003. PMID: 31750425; PMCID: PMC6849362.
©Randall
S. Fong, M.D.
For more topics on
medicine, health and the weirdness of life in general, check out the rest of
the blog site at randallfong.blogspot.com
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