First report on a case series of Patulous Eustachian tube following GLP-1 receptor agonist-induced weight loss.

Abstract

Objective: To describe seven cases of patulous Eustachian tube (PET, "Tuba aperta") arising in adult patients undergoing significant weight loss with GLP-1 receptor agonists (semaglutide [Ozempic^®] or tirzepatide [Mounjaro^®]).

Methods: Retrospective descriptive case series of patients presenting to our otolaryngology clinic between June 2024 and June 2025 with symptoms of autophony, aural fullness, and audible breathing. All had initiated GLP-1 agonist therapy ≥ 3 months prior and achieved ≥ 8% body-weight reduction. Diagnosis of PET was confirmed by patient symptoms, otoscopy, digital volume tomography, reflex decay tympanometry and tubomanometry.

Results: Seven patients (5 female, 2 male; age 28-56 years) developed bilateral (n = 5) or unilateral (n = 2) PET after 4-10 months of GLP-1 therapy. Weight loss ranged from 8.2 to 18.7% of baseline. Common symptoms were autophony (7/7), intermittent aural fullness (6/7), and hearing one's own breathing (5/7). Conservative management led to symptom improvement in one patient; six required injections of VOX-Implants^® into the affected Eustachian tubes with resolution of symptoms.

Conclusion: Significant weight loss from GLP-1 receptor agonists may predispose susceptible individuals to PET. Clinicians should be aware of this potential otologic side effect and consider early conservative measures.