Neuroendocrine tumors (NETs) are usually found in the gastrointestinal tract and pancreas; however, they are rare in the middle ear. The presentation of vague symptoms, such as tinnitus and conductive hearing loss, complicates the diagnosis. We present a 46-year-old male with a history of right ear discharge and a previous canal wall-down mastoidectomy, suspected to have cholesteatoma recurrence. Imaging and surgery demonstrated a well-differentiated G1 NET in the middle ear. Postoperative metastatic workup revealed few pulmonary nodules needing ongoing observation. Middle-ear NETs are difficult to diagnose due to their rarity. This case underscores the importance of histological and immunohistochemical evaluation and the need for systemic assessment to rule out metastasis due to pulmonary nodules. We contribute to the limited literature highlighting the need to include NETs in the differential of middle ear masses and the usefulness of interdisciplinary teamwork.

Introduction: Tympanic membrane perforations are typically repaired using surgical tympanoplasty techniques, which involve various grafting materials and approaches. While effective, traditional tympanoplasty methods can require significant operative time and technical skill. This study evaluates a novel sutured patching (SP) tympanoplasty technique, comparing its efficacy and outcomes to conventional tympanoplasty (CT). Patients: This prospective study included 44 patients with small, central, dry tympanic membrane perforations. Intervention: SP utilized tragal cartilage sutured to a silastic sheet, applied via a transcanal approach. Patients were monitored postoperatively for pain, subjective hearing improvement, and audiological outcomes. Follow-up occurred at 6 days, 4 weeks, and 6 months post-surgery. Data were analyzed using t-tests , χ ² tests, and linear regression. Results: Both SP and CT achieved 100% graft integrity at 6 months. Preoperative ABG was lower in the SP group (16.0 ± 10.4 dB) compared with the CT group (22.2±7.66 dB, P = 0.032), with comparable postoperative ABG values (SP: 6.90±5.80 dB; CT: 9.57±6.01 dB, P = 0.143). SP demonstrated significantly shorter operative times (27.9±8.27 vs. 87.1±25.9 min, P < 0.001) and reduced postoperative pain (VAS: 2.00 vs. 5.00, P < 0.001). Patients in the SP group reported quicker subjective hearing improvement (median: 1 vs. 24.5 d, P < 0.001). Conclusion: Sutured patching tympanoplasty offers comparable audiological outcomes to conventional tympanoplasty, with the added benefits of reduced operative time, less postoperative pain, and faster perceived recovery. This technique is a promising alternative for suitable patients, particularly in resource-limited settings or high-risk surgical candidates. Further research is warranted to evaluate long-term outcomes and broader applicability.

Patulous Eustachian Tube (PET) is a rare otologic disorder, which is caused by abnormal patency of the Eustachian tube. Rapid weight loss is a recognized predisposing factor for PET potentially because of the reduction in peritubal adipose tissue that contributes to normal tubal closure. Although there is increasing awareness of this association, the best treatment of PET is still debated with several conservative, medical and surgical operations reported in the literature. This narrative review summarizes the available evidence regarding conservative, medical, minimally invasive, and surgical management of PET, with particular consideration of PET associated with rapid weight loss. Relevant literature was identified through searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library, with attention to studies using standardized diagnostic criteria and outcome measures. Conservative approaches, including hydration, nasal saline instillation, and behavioral modifications such as cessation of habitual sniffing, have been associated with symptomatic improvement and considered as initial options because of their accessibility and low procedural burden. Medical therapies, such as topical irritants, estrogen-based preparations, and mucosal-thickening agents, may provide temporary symptom relief, although their long-term effects require further evaluation. Among interventional strategies, silicone (Kobayashi) plug insertion has demonstrated encouraging symptom improvement and reductions in symptom scores in selected patients with refractory PET. Minimally invasive techniques, including autologous fat injection, cartilage augmentation, and soft tissue bulking procedures, have also demonstrated encouraging outcomes. Trans-tympanic interventions, including ventilation-tube insertion and catheter-based techniques, provided additional options with variable reported outcomes. Management of PET remains heterogeneous and largely individualized. Conservative and medical therapies are considered reasonable first-line options, while surgical and minimally invasive approaches may be considered for selected patients with persistent symptoms.