{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.patulous-eustachian-tube","code":"thing-q1361850","url":"https://ver.cy/models/thing/q1361850/","name":"patulous eustachian tube","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Cross-cutting context","entryKind":"thing","plane":"XCT","domain":["XCT.STA"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Patulous eustachian tube is a disorder in which the eustachian tube fails to remain adequately closed at rest, permitting abnormal transmission of sound and pressure between the nasopharynx and middle ear.","purpose":"Enable an agent to recognise suspected patulous eustachian tube, record evidence of abnormal resting patency, assess its impact and support clinician-led decisions.","scope":{"in":["Abnormal resting patency, including intermittent presentations","Voice autophony, breathing autophony and aural fullness","Ear-specific examination and functional testing","Distinction between suspected patency and clinically supported symptomatic dysfunction","Symptom burden, management decisions and follow-up"],"out":["General eustachian tube anatomy and normal swallowing-related opening","Obstructive and baro-challenge-induced eustachian tube dysfunction as independent conditions","Superior semicircular canal dehiscence and other alternative diagnoses","General hearing-loss classification and rehabilitation","Independent models of diagnostic devices, medicines and surgical procedures"],"boundaries":[]},"distinguishingFeatures":["The defining abnormality concerns failure of resting closure; normal transient opening during swallowing does not establish this condition.","Separate hearing one's own breathing from hearing one's own voice: voice autophony alone does not establish patulous eustachian tube.","Symptoms accompanied by breathing-synchronous tympanic membrane movement support patulous dysfunction. [ETD diagnostic consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC4600223/)","Record whether posture change or clinician-performed temporary tubal obstruction alters symptoms; these responses are components of the JOS diagnostic approach. [JOS criteria cohort](https://pmc.ncbi.nlm.nih.gov/articles/PMC6934284/)","Record evidence for obstructive dysfunction or another cause of autophony separately rather than treating ear fullness as proof of patency."],"structure":{"bundles":[{"id":"resting-patency-and-case-boundary","name":"Resting patency and case boundary","description":"Establish what abnormal openness means for this ear and how confidently it explains the presentation.","layers":[{"id":"abnormal-resting-closure","name":"Abnormal resting closure","description":"Describe the proposed failure of closure outside normal opening events.","findings":[{"id":"patency-outside-swallowing","name":"Patency outside swallowing","description":"Record the circumstances in which inappropriate openness is suspected or demonstrated.","questions":[{"text":"What evidence indicates openness at rest rather than a normal opening during swallowing?","id":"patency-outside-swallowing-q01","kind":"definition"},{"text":"Which ear was observed, over what interval, and was the patient symptomatic?","id":"patency-outside-swallowing-q02","kind":"measurement"}]}]},{"id":"diagnostic-classification","name":"Diagnostic classification","description":"Attach diagnostic confidence to an identifiable assessment framework.","findings":[{"id":"criteria-and-evidence","name":"Criteria and evidence","description":"Record the criteria used, their required observations and any unmet elements.","questions":[{"text":"Which published criteria and version did the assessing clinician apply?","id":"criteria-and-evidence-q01","kind":"provenance"},{"text":"Which required elements are demonstrated, missing or contradictory?","id":"criteria-and-evidence-q02","kind":"boundary"},{"text":"Is this a symptomatic disorder, an incidental observation or an unresolved hypothesis?","id":"criteria-and-evidence-q03","kind":"definition"}]}]}]},{"id":"autophony-and-episode-pattern","name":"Autophony and episode pattern","description":"Capture what the person hears and when the experience occurs.","layers":[{"id":"self-generated-sound","name":"Self-generated sound","description":"Separate voice resonance, breathing sounds and other reported internal sounds.","findings":[{"id":"voice-versus-breathing","name":"Voice versus breathing","description":"Preserve the patient's description without treating all autophony as equivalent.","questions":[{"text":"Does the affected ear amplify the person's voice, nasal breathing or both?","id":"voice-versus-breathing-q01","kind":"measurement"},{"text":"Are other sounds being described as autophony, and do they require a different diagnostic explanation?","id":"voice-versus-breathing-q02","kind":"boundary"}]}]},{"id":"symptom-modulation","name":"Symptom modulation","description":"Record episode timing and reproducible changes under specified conditions.","findings":[{"id":"posture-and-activity-pattern","name":"Posture and activity pattern","description":"Document observed associations with posture, activity and time of day without assuming causation.","questions":[{"text":"How do symptoms change between upright and recumbent positions?","id":"posture-and-activity-pattern-q01","kind":"measurement"},{"text":"What activities precede episodes, and how consistently does the association recur?","id":"posture-and-activity-pattern-q02","kind":"measurement"},{"text":"Which reported conditions could help a clinician assess the ear during a typical episode?","id":"posture-and-activity-pattern-q03","kind":"action"}]}]}]},{"id":"objective-patency-evidence","name":"Objective patency evidence","description":"Connect clinical observations and functional recordings to symptoms in the same ear.","layers":[{"id":"respiratory-transmission","name":"Respiratory transmission","description":"Record examination or functional evidence of breathing-related transmission.","findings":[{"id":"breathing-synchronous-observation","name":"Breathing-synchronous observation","description":"Capture the observed sign, method and contemporaneous respiratory activity.","questions":[{"text":"Was tympanic membrane movement synchronous with breathing observed in the symptomatic ear?","id":"breathing-synchronous-observation-q01","kind":"measurement"},{"text":"If prolonged tympanometry or another functional test was used, what trace and protocol support the interpretation?","id":"breathing-synchronous-observation-q02","kind":"provenance"},{"text":"Could swallowing, patient movement or recording artefact explain the apparent synchrony?","id":"breathing-synchronous-observation-q03","kind":"boundary"}]}]},{"id":"test-context-and-discordance","name":"Test context and discordance","description":"Preserve conditions that constrain positive and negative results.","findings":[{"id":"representative-examination","name":"Representative examination","description":"Distinguish failure to demonstrate patency from a sufficiently supported exclusion.","questions":[{"text":"Were posture, breathing manoeuvre and symptom presence documented at testing?","id":"representative-examination-q01","kind":"provenance"},{"text":"If symptoms were absent during a negative test, what uncertainty remains about intermittent patency?","id":"representative-examination-q02","kind":"boundary"},{"text":"Would repeat assessment during a typical episode resolve a material diagnostic uncertainty?","id":"representative-examination-q03","kind":"action"}]}]}]},{"id":"mimics-and-contributing-context","name":"Mimics and contributing context","description":"Evaluate competing explanations and potential contributors without merging neighbouring conditions.","layers":[{"id":"alternative-ear-mechanisms","name":"Alternative ear mechanisms","description":"Maintain a differential tied to the actual symptom and examination pattern.","findings":[{"id":"autophony-differential","name":"Autophony differential","description":"Record assessment of obstructive dysfunction, canal occlusion, superior canal dehiscence and other relevant explanations.","questions":[{"text":"What findings support excessive patency rather than impaired tube opening?","id":"autophony-differential-q01","kind":"boundary"},{"text":"What evidence supports or weakens alternative explanations for this person's autophony?","id":"autophony-differential-q02","kind":"boundary"},{"text":"Which unresolved alternative would materially change the next clinical decision?","id":"autophony-differential-q03","kind":"action"}]}]},{"id":"onset-and-associated-events","name":"Onset and associated events","description":"Link symptom onset to relevant history with explicit attribution limits.","findings":[{"id":"contributor-timeline","name":"Contributor timeline","description":"Record candidate contributors as hypotheses supported by a timeline and source.","questions":[{"text":"Did onset follow weight change, pregnancy, medication change, irradiation or an ear-related procedure?","id":"contributor-timeline-q01","kind":"provenance"},{"text":"What evidence supports a causal contribution beyond temporal coincidence?","id":"contributor-timeline-q02","kind":"boundary"},{"text":"Which potentially modifiable contributor warrants clinician review?","id":"contributor-timeline-q03","kind":"action"}]}]}]},{"id":"management-and-functional-outcome","name":"Management and functional outcome","description":"Relate clinician-led management to autophony burden, objective evidence and subsequent ear function.","layers":[{"id":"decision-and-target","name":"Decision and target","description":"Document why observation, conservative management or an intervention was selected.","findings":[{"id":"management-rationale","name":"Management rationale","description":"Connect a proposed action to diagnostic confidence, the suspected mechanism and the person's priorities.","questions":[{"text":"Which specific problem is the proposed management intended to improve: breathing autophony, voice autophony, fullness or functional interference?","id":"management-rationale-q01","kind":"action"},{"text":"What evidence and patient-specific reasoning support this option?","id":"management-rationale-q02","kind":"provenance"},{"text":"Has the clinician reconciled the proposed action with evidence for patency versus obstruction?","id":"management-rationale-q03","kind":"boundary"}]}]},{"id":"benefit-durability-and-ear-function","name":"Benefit, durability and ear function","description":"Compare outcomes against an ear-specific baseline and identify recurrence or adverse effects.","findings":[{"id":"paired-follow-up","name":"Paired follow-up","description":"Record symptom change, daily functioning and examination findings over a stated follow-up interval.","questions":[{"text":"How did voice autophony, breathing autophony and daily interference change using the same baseline measures?","id":"paired-follow-up-q01","kind":"measurement"},{"text":"Were new hearing complaints, effusion or signs of impaired ventilation observed after intervention?","id":"paired-follow-up-q02","kind":"measurement"},{"text":"What recurrence, insufficient benefit or adverse effect would prompt reassessment?","id":"paired-follow-up-q03","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these typical measurements hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of patulous eustachian tube this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain the condition and its typical symptoms in general terms.","Suggest that a person with a persistent echo of their own voice or breathing see an ear specialist."],"mustNot":["Diagnose the condition or tell a person their symptoms are harmless.","Recommend home remedies, devices or procedures to close the tube.","Dismiss the symptoms as anxiety or imagination.","Recommend weight loss or other changes to a specific person as a treatment."],"requiresHuman":["Any surgical or interventional treatment."]},"ethics":{"considerations":["Symptoms are often dismissed, leaving people distressed for years.","The condition affects speech and concentration at work."],"affectedParties":["Patients","Their families","Workers who rely on their voice"]},"owners":{"steward":"Nobody owns the condition; patients and their clinicians answer for care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q1644260","type":"parent","note":"registry parent class"},{"target":"Q18558207","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.patulous-eustachian-tube","Wikidata: Q1361850 (https://www.wikidata.org/wiki/Q1361850)"]},"properties":{"applicability":"not-applicable","items":["Affected ear: left | right | bilateral | uncertain","Diagnostic status: suspected | supported under named criteria | unresolved | alternative explanation favoured","Resting patency pattern: intermittent | persistent during observation | not demonstrated | unknown","Autophony phenotype: own voice | own breathing | both | neither | unclear","Respiratory synchrony: demonstrated | absent during test | equivocal | not tested","Posture-related response: improved | unchanged | worsened | inconsistent | untested; with posture specified","Episode duration and frequency: minutes per episode and episodes per day, with observation period","Autophony burden: named questionnaire score or explicitly anchored patient rating","Potential contributing exposure: linked event, physiological change, medication or procedure; timing and attribution confidence"]},"recognition":{"applicability":"optional","items":["On examination the eardrum may move in and out with breathing."]},"capabilities":{"applicability":"required","items":["Assemble an ear-specific evidence summary for specialist assessment.","Identify missing observations when symptoms and examination disagree.","Compare symptomatic and asymptomatic testing conditions.","Track voice and breathing autophony independently through management.","Flag treatment decisions that depend on distinguishing excessive patency from obstruction.","Maintain an explicit account of unresolved diagnosis, benefit and adverse effects."]},"hazards":{"applicability":"required","items":["Hearing one's own voice and breath loudly causes distress and fatigue.","Often mistaken for a blocked ear and treated wrongly."]},"interfaces":{"applicability":"required","items":["International Classification of Diseases (ICD-11), World Health Organization."]},"context":{"applicability":"required","items":["Patulous eustachian tube is encountered in ear and hearing assessments when people report unusually loud perception of their own voice or breathing.","The concept helps clinicians distinguish abnormal resting openness of the tube from other causes of ear fullness and altered hearing."]}},"sources":[{"title":"Wikidata item Q1361850: patulous eustachian tube","url":"https://www.wikidata.org/wiki/Q1361850","note":"identity and sense of the item"},{"title":"Wikipedia: Patulous Eustachian tube","url":"https://en.wikipedia.org/wiki/Patulous_Eustachian_tube","note":"general description of the item"}],"openQuestions":["Should this registry entry include asymptomatic demonstrated patency, or only symptomatic patulous eustachian tube dysfunction?","Which diagnostic framework should govern classification, and how should disagreement between frameworks be represented?","What testing sequence best resolves typical intermittent symptoms when initial examination does not demonstrate patency?","Which outcome instrument and meaningful-change threshold are sufficiently validated for the intended population?","Which management options have sufficiently reliable comparative and long-term evidence for particular symptom and test patterns?"],"resources":{"spec":"/models/things/publications/thing-q1361850/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q1361850/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T11:57:16Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:26+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane XCT: no invented physical properties."},"score":1.0}}