Patulous Eustachian tube is a benign but notoriously difficult condition to treat successfully. Symptoms include autophony of voice and breathing, and aural fullness.

This paper presents a series of 8 patients (12 ears) for whom a novel computed tomography guided injection of silicone elastomer suspension implant (Vox) was used to treat patulous Eustachian tube. This is the largest and only series in the current literature using this technique.

The combined complete and partial symptom resolution rate was 91 per cent. Complications related to the procedure are described. The pros and cons of this novel approach are also discussed in relation to traditional endoscopic transnasal techniques.

Computed tomography guided injection of Vox for the treatment of patulous Eustachian tube is suggested to be a feasible alternative to endoscopic transnasal approaches, particularly for refractory cases.

Patulous Eustachian tube is a distressing condition characterised by chronic patency of the Eustachian tube and its failure to close. Patients typically present with symptoms of autophony and aural fullness. In patients requiring surgical intervention, a variety of different procedures have been demonstrated (both transtympanic and endonasal), with limited success. Evidence of the effectiveness of a number of surgical interventions is limited to small case series only.

This paper describes a novel treatment for patulous Eustachian tube using a 3 mm VortX Diamond endovascular coil.

A transnasal endoscopic approach was adopted, with cannulation of the Eustachian tube orifice using a Relieva sinus guide suction tube from a balloon sinuplasty set. The coil was deployed 1.5 cm deep into the Eustachian tube. Post-operative imaging was used to confirm correct positioning. Regular follow up was arranged. The patient reported complete resolution of her symptoms.

The technique has so far proved highly effective and minimally invasive. It will be employed in more patients to fully establish its effectiveness in treating patulous Eustachian tube.