GLP-1 and Patulous Eustachian Tube: When Weight Loss Becomes an ENT Complaint
June 2026
As GLP-1 receptor agonists continue to gain widespread use for obesity and diabetes management, ENT specialists may begin observing an increase in patients presenting with symptoms consistent with Patulous Eustachian Tube (PET) dysfunction following significant or rapid weight loss.
While PET is a well-recognized condition within otolaryngology, recent clinical discussion has focused on whether the accelerated weight loss associated with GLP-1 therapies may contribute to increased incidence in susceptible patients.
Understanding PET
The Eustachian tube normally remains closed at rest and opens transiently to equalize middle ear pressure. In PET, the tube remains abnormally open, allowing transmission of internal sounds to the middle ear.
Patients may report:
- Autophony
- Audible breathing sounds
- Aural fullness
- Echoing of their own voice
- Hyperawareness of internal bodily sounds
- Intermittent muffled hearing
GLP-1 Therapy and Rapid Weight Loss
ENT specialists have historically observed PET following bariatric surgery or other periods of rapid weight reduction. Similar observations are now being discussed in patients using GLP-1 medications such as:
- Semaglutide
- Tirzepatide
- Other incretin-based therapies
A recently published case series from a German ENT clinic described patients who developed PET symptoms after several months of GLP-1 therapy accompanied by substantial weight loss. Reported symptoms included autophony, breathing resonance, and persistent ear fullness.
Importantly, current literature does not suggest that GLP-1 medications directly cause PET. Rather, the proposed association appears related to the physiologic effects of rapid tissue and weight loss.
Clinical Considerations
Because PET symptoms may mimic more common otologic complaints, patients are sometimes initially treated for:
- Eustachian tube dysfunction
- Allergic disease
- Middle ear effusion
- Anxiety-related symptoms
As awareness increases, clinicians may consider PET in patients presenting with autophony or breathing resonance following significant weight reduction.
Management approaches vary depending on severity and may include:
- Hydration optimization
- Avoidance of nasal decongestants
- Weight stabilization
- Tympanic membrane patching
- Injectable fillers or surgical interventions in select cases
Some patients may experience symptom improvement over time as tissues adapt to weight stabilization.
Compounded Estradiol Nasal Spray
Massey Drugs compounds Estradiol Nasal Spray as a potential conservative treatment option for PET patients. Estradiol nasal therapy has been explored as a method to increase mucosal edema and support Eustachian tube closure in select patients.
References
- The New York Post. “Weight loss drugs are making people hear their own blood, eyes moving, ‘Darth Vader’ voice.” Based on interviews with ENT specialists discussing PET symptoms associated with rapid weight loss.
- Schrom T, et al. Patulous Eustachian Tube Dysfunction Associated With GLP-1 Receptor Agonist-Induced Weight Loss. PubMed PMID: 40721956.https://pubmed.ncbi.nlm.nih.gov/40721956/
- Poe DS, Hanna BM. Balloon dilation of the cartilaginous Eustachian tube. Otolaryngologic Clinics of North America.
- O’Connor AF, Shea JJ. Autophony and the patulous Eustachian tube. Laryngoscope.