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Larionova et al. Mini-invasive Surg 2020;4:59 I http://dx.doi.org/10.20517/2574-1225.2020.49 Page 3 of 4

Figure 1. Our patient’s audiogram. SF: sound field; SAT: speech awareness threshold; SRT: speech reception threshold; MCL: most
comfortable level; UCL: uncomfortable level; SIN: speech-in-noise; SNR: signal-to-noise ratio; SFA: sound-field audiometry; Alr: auditory
late response; NR: no response

options and minimally invasive options include topical estrogen or insufflation with salicylic or boric
acid into the ET pharyngeal orifice. Adequate hydration, nasal saline drops, and saline irrigations can be
effective options for symptom management. Decongestants or nasal steroids can, on the contrary, worsen
the symptoms. Surgical options are reserved for patients with severe symptoms and include tympanostomy
tube insertion, ligation of the orifice, intraluminal catheter placement, cartilage grafting, complete occlusion
[1,9]
of the ET, and hamulotomy . It remains unclear whether weight gain can contribute to symptom
improvement. Further research is needed to explore the advantages of current treatment options.

[10]
Intensity of PET symptoms might vary . Our patient’s symptoms are currently intermittent and tolerable.
She did find saline nasal irrigations to be helpful to relieve her symptoms. Our patient continues to
lose weight and denies any worsening of her symptoms. It would be helpful to continue to evaluate the
severity of symptoms in regards to her weight. PET may be triggered by significant weight loss after sleeve
gastrectomy. Raising awareness of the possibility to develop PET after bariatric surgeries would facilitate
the right diagnosis and allow appropriate referral and disease management.

DECLARATIONS
Authors’ contributions
Manuscript writing: Larionova E
Final approval of manuscript: Jalisi SM, Jones DB