Understanding “comorbidity”
A comorbidity is another health condition present in the same person. Some items discussed in pETD research—such as significant weight loss—are better described as clinical associations or risk factors rather than separate diseases.
These distinctions matter. They keep patients from being blamed for their symptoms and prevent a statistical connection from being presented as medical certainty.
Common comorbidities and clinical associations
The figures below come from a retrospective study of 190 patients whose pETD was confirmed through objective findings at a tertiary referral center.1
How to read these numbers: They describe one specialty-clinic patient group, not everyone living with pETD. Referral-center populations may have more complex or persistent symptoms than the broader community.
Possible complications and broader effects
pETD is not generally considered life-threatening, but its effects can be disruptive and, for some people, disabling. The most important concerns involve symptom burden, quality of life, compensating behaviors, and treatment-related changes.
Symptoms may become persistent or bilateral
In the 190-patient study, 65% reported symptoms increasing in frequency and duration over time, and 52% had involvement in both ears.1 This does not predict what will happen to every patient.
Communication and daily functioning can suffer
Voice or breathing autophony, fullness, tinnitus, and sound sensitivity may make conversation, concentration, work, exercise, and social situations difficult.3
Mental health deserves attention
A 2024 study found that greater pETD-related handicap correlated with higher anxiety and depression scores.4 Emotional support should accompany—not replace—medical evaluation.
Treatment may create new middle-ear problems
Risks vary by procedure. In one prospective Kobayashi plug study, middle-ear fluid—including temporary fluid—occurred in 17.2% and eardrum perforation in 13.8%; one persistent effusion required a ventilation tube. These figures apply to that procedure and study, not to every pETD treatment.6
Habitual sniffing: an uncommon but important concern
Some patients repeatedly sniff because the temporary negative pressure can reduce autophony. Over time, forceful habitual sniffing may contribute to eardrum retraction and, in uncommon cases, cholesteatoma—a destructive skin growth in the middle ear.5
If sniffing has become an automatic way of controlling symptoms, tell your otologist or ENT. This is a symptom-management behavior, not a personal failing, and it deserves a thoughtful treatment plan.
Conditions that can overlap with or resemble pETD
Similar symptoms do not always have the same cause. Clinical history should be combined with examination and, when available, objective testing during symptoms.23
When to seek prompt medical care
The following symptoms are not automatically caused by pETD. They deserve timely evaluation so another ear, vascular, or neurologic condition is not missed.
- Sudden hearing loss or a rapid, unexplained change in hearing—seek same-day medical care.
- New or persistent one-sided pulsatile tinnitus.
- Severe or worsening vertigo, fainting, facial weakness, severe headache, or other neurologic symptoms.
- Persistent ear pain, fever, bleeding, or drainage.
- New symptoms following an ear or Eustachian tube procedure.
If the emotional burden feels unbearable: You deserve immediate support. In the United States, call or text 988 or visit the 988 Suicide & Crisis Lifeline . If there is immediate danger, call 911 or your local emergency service.
Preparing for an appointment
Because pETD can fluctuate, a normal examination on a symptom-free day may not tell the whole story. The Japan Otological Society diagnostic framework recommends combining symptoms, improvement when the tube is temporarily obstructed, and objective evidence of abnormal patency; repeat assessment may be helpful when findings are intermittent.3
- Record which ear is affected and whether symptoms are constant or intermittent.
- Note autophony of your voice, breathing, chewing, or other internal sounds.
- Track changes with posture, exercise, hydration, illness, weight change, and medications.
- Tell the clinician if you sniff repeatedly or change your breathing to obtain relief.
- Bring prior hearing tests, imaging, procedure records, and a current medication list.
A few important clarifications
Does anxiety cause pETD?
Research shows that anxiety commonly occurs alongside pETD, but this does not prove that anxiety causes the Eustachian tube to remain open. Anxiety can also develop because persistent autophony and uncertainty are genuinely distressing.
Will everyone with pETD develop complications?
No. Many patients do not develop structural ear disease. The eardrum-retraction and cholesteatoma concern is particularly associated with habitual sniffing and is considered uncommon.
Does weight loss always lead to pETD?
No. Weight loss is a recognized association, but most people who lose weight do not develop pETD. If symptoms began after significant or rapid weight change, share that timeline with your clinician.
Which specialist is most appropriate?
An otologist, neurotologist, or ENT clinician experienced in Eustachian tube disorders can evaluate pETD and important look-alike conditions. Experience matters because symptoms may fluctuate and objective testing is not available in every clinic.
You are not alone.
Living with the sound of your own voice or breathing can be exhausting—especially when others cannot hear what you are experiencing. The Collinson Foundation for Patulous Eustachian Tube is committed to education, connection, advocacy, and hope for every person affected by pETD.
Research sources
- Ward BK, Ashry Y, Poe DS. Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities . Otology & Neurotology. 2017;38(9):1362–1369. doi:10.1097/MAO.0000000000001543.
- Schilder AGM, Bhutta MF, Butler CC, et al. Eustachian Tube Dysfunction: Consensus Statement on Definition, Types, Clinical Presentation and Diagnosis . Clinical Otolaryngology. 2015;40(5):407–411. doi:10.1111/coa.12475.
- Ikeda R, Kikuchi T, Oshima H, Kobayashi T. Diagnosis of the Patulous Eustachian Tube . Ear, Nose & Throat Journal. 2020. doi:10.1177/0145561320925938.
- Koike N, Kono W, Yamada Y, Oshima T. Tendency Towards Anxiety and Depression in Patients with a Patulous Eustachian Tube . Practica Oto-Rhino-Laryngologica. 2024;117(1):63–69. doi:10.5631/jibirin.117.63.
- Choi SW, Lee DJ, Lee SH, Oh SJ, Kong SK. Management of Acquired Cholesteatoma Associated With Patulous Eustachian Tube and Habitual Sniffing . Clinical and Experimental Otorhinolaryngology. 2019;12(4):385–391. doi:10.21053/ceo.2018.01900.
- Ikeda R, Kikuchi T, Oshima H, Kobayashi T. Management of Patulous Eustachian Tube . JMA Journal. 2020;3(2):101–108. doi:10.31662/jmaj.2020-0007.
Medical disclaimer: This page is for education and support. It is not a diagnosis, medical advice, or a substitute for care from a qualified healthcare professional. Treatment decisions should be made with a clinician who understands your history, examination findings, and individual risks.