Clinical characteristics and diagnostic value of symptoms and objective findings in patulous eustachian tube: A large-scale study based on the Japan Otological Society criteria.

OBJECTIVE

To clarify the clinical characteristics of patulous Eustachian tube (PET) based on the Japan Otological Society (JOS) diagnostic criteria and to assess the diagnostic contribution of individual symptoms and objective findings.

METHODS

We retrospectively analyzed patients diagnosed with definite PET or non-PET at a subspecialty Eustachian tube clinic between June 2019 and July 2025, excluding possible PET to minimize diagnostic uncertainty. Demographics, background factors, symptoms, and objective test results-including tympanic membrane (TM) flutter, tubo-tympano-aerodynamic graphy, and sonotubometry-were examined. Logistic regression identified independent factors, and receiver operating characteristic (ROC) curves were generated to evaluate diagnostic performance.

RESULTS

Among 1009 patients (1613 ears), definite PET was associated with habitual sniffing (OR = 8.18), history of weight loss (OR = 1.78), and, in females, low-dose estrogen-progestin use (OR = 7.31). Lower body mass index and younger age also showed significant associations. Voice autophony (OR = 4.09) and breathing autophony (OR = 9.98) were the most predictive symptoms. Objective findings demonstrated high diagnostic accuracy, with TM flutter showing the highest odds ratio (OR = 42.17). The seven-symptom model achieved an area under the ROC curve (AUC) of 0.862.

CONCLUSION

This large-scale study identified key background factors and symptoms valuable for PET diagnosis and confirmed that objective tests have strong discriminatory ability, supporting earlier and more accurate clinical decision-making.