Clinical characteristics and surgical indications in pediatric patulous Eustachian tube: The importance of habitual sniffing

Objective: To investigate the clinical characteristics of pediatric patulous Eustachian tube (PET), with a particular focus on the presence or absence of habitual sniffing, and to assess the role of this behavior in disease severity and management. Methods: A retrospective review was conducted of 52 patients under 18 years of age who were diagnosed with PET (definite or possible) based on the Japan Otological Society Diagnostic Criteria for PET between December 2014 and November 2024. Clinical data, including symptoms, otoscopic findings, tympanometry, and Eustachian tube function tests (TTAG and sonotubometry), were analyzed. Patients were divided into two groups based on the presence (Group A) or absence (Group B) of habitual sniffing. Surgical outcomes, including those from ventilation tube placement and Kobayashi Plug Surgery (KPS), were also evaluated. Results: Among 1633 PET patients, 52 (3.2 %) were under 18 years of age. Voice autophony (78.9 %), breath autophony (75.0 %), and aural fullness (71.1 %) were the most common symptoms. Habitual sniffing was identified in 32 cases (61.5 %). Tympanic membrane retraction was significantly more frequent in Group A (p < 0.001). Tympanometry showed abnormal (type B or C) patterns in 42.6 % of Group A ears, while all tested ears in Group B showed type A (p < 0.0001). Eustachian tube function test results did not differ significantly between groups. Surgical intervention was required in 11 cases, of which 10 were in Group A. Post-KPS, PHI-10 scores significantly improved, although sonotubometry probe tone levels did not show statistically significant changes. Conclusion: Pediatric PET is often associated with habitual sniffing, which correlates with abnormal tympanic findings and may necessitate surgical treatment. Assessing for habitual sniffing is essential in pediatric PET, and otoscopic and tympanometric findings are more reliable indicators of this behavior than Eustachian tube function tests. Early detection and intervention may prevent progression to retraction-type middle ear disease.