Hearing voices and strange noises after sleeve gastrectomy

Abstract

Patulous eustachian tube (PET) dysfunction is a rare complication of weight loss, which can be easily misdiagnosed. We present a case of PET dysfunction after laparoscopic sleeve gastrectomy. A 36-year-old Caucasian female with Class III morbid obesity (131 kg, BMI 46.6 kg/m²) successfully underwent laparoscopic sleeve gastrectomy. At her postoperative follow-up appointment six months later, her weight dropped to 96 kg and she complained of severe autophony (hearing of self-generated sounds), leading to anxiety and insomnia. She was initially misdiagnosed with a sinus infection by her primary care provider and was started on antibiotics. She was subsequently seen by an otolaryngologist who diagnosed her with PET. Weight loss can be a predisposing factor for PET. Our patient did not notice onset of symptoms of PET until significant weight loss (35 kg, 59.5% EWL).

Keywords

Sleeve gastrectomy / bariatric surgery / patulous eustachian tube dysfunction / otolaryngology / the Ostmann fat pads / autophony

References

[1] Hussein AA,Turner JH.Surgical management of Patulous Eustachian tube: a systematic review..Laryngoscope2015;125:2193-8 PMCID:PMC4725712

[2] Bance M,Smith ME.Patulous eustachian tube (PET), a practical overview..World J Otorhinolaryngol Head Neck Surg2019;5:137-42 PMCID:PMC6849362

[3] Alhammadi M,Olbers T.Patulous eustachian tube complicating gastric bypass surgery..J Laryngol Otol2009;123:1058-60

[4] Pascoto G,Silva ML,Pignatari SS.The impact of acute loss of weight on eustachian tube function..Int Arch Otorhinolaryngol2014;18:376-9 PMCID:PMC4296987

[5] SAGES. Autophony after laparoscopic sleeve gastrectomy: a case report. Available from: https://www.sages.org/meetings/annual-meeting/abstracts-archive/autophony-after-laparoscopic-sleeve-gastrectomy-a-case-report/. [Last accessed on 13 Jul 2020]

[6] Schilder AG,Butler CC,Levine LH.Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis..Clin Otolaryngol2015;40:407-11 PMCID:PMC4600223

[7] Ward BK,Poe DS.Patulous eustachian tube dysfunction: patient demographics and comorbidities..Otol Neurotol2017;38:1362-9

[8] McCarthy-Jones S.Auditory verbal hallucinations in schizophrenia and post-traumatic stress disorder: common phenomenology, common cause, common interventions?.Front Psychol2015;6:1071 PMCID:PMC4517448

[9] Luu K,Fandino M,Westerberg BD.Treatment effectiveness for symptoms of patulous eustachian tube: a systematic review..Otol Neurotol2015;36:1593-600

[10] Ikeda R,Oshima H.Diagnosis of the patulous eustachian tube..Ear Nose Throat J2020;145561320925938