Objective Determine if Eustachian Tube (ET) function (ETF) tests can identify ears with physician-diagnosed ET dysfunction (ETD) in a mixed population at high sensitivity and specificity and define the inter-relatedness of ETF test parameters. Methods ETF was evaluated using the Forced-Response, Inflation-Deflation, Valsalva and Sniffing tests in 15 control ears of adult subjects after unilateral myringotomy (Group I) and in 23 ears of 19 adult subjects with ventilation tubes inserted for ETD (Group II). Data were analyzed using logistic regression including each parameter independently and then a step-down Discriminant Analysis including all ETF test parameters to predict group assignment. Factor Analysis operating over all parameters was used to explore relatedness. Results The Discriminant Analysis identified 4 ETF test parameters (Valsalva, ET opening pressure, dilatory efficiency and % positive pressure equilibrated) that together correctly assigned ears to Group II at a sensitivity of 95% and a specificity of 83%. Individual parameters representing the efficiency of ET opening during swallowing showed moderately accurate assignments of ears to their respective groups. Three factors captured approximately 98% of the variance among parameters, the first had negative loadings of the ETF structural parameters, the second had positive loadings of the muscle-assisted ET opening parameters and the third had negative loadings of the muscle-assisted ET opening parameters and positive loadings of the structural parameters. Discussion These results show that ETF tests can correctly assign individual ears to physician-diagnosed ETD with high sensitivity and specificity and that ETF test parameters can be grouped into structural-functional categories.

A primary etiological factor underlying chronic middle ear disease is an inability to open the collapsible Eustachian tube (ET). However, the structure-function relationships responsible for ET dysfunction in patient populations at risk for developing otitis media (OM) are not known. In this study, three-dimensional (3D) finite element (FE) modeling techniques were used to investigate how changes in biomechanical and anatomical properties influence opening phenomena in three populations: normal adults, young children and infants with cleft palate. Histological data was used to create anatomically accurate models and FE techniques were used to simulate tissue deformation and ET opening. Lumen dilation was quantified using a computational fluid dynamic (CFD) technique and a sensitivity analysis was performed to ascertain the relative importance of the different anatomical and tissue mechanical properties. Results for adults suggest that ET function is highly sensitive to tensor veli palatini muscle (TVPM) forces and to periluminal mucosal tissue (PMT) elasticity. Young children and cleft palate subjects exhibited reduced sensitivity to TVPM forces while changes in PMT stiffness continued to have a significant impact on ET function. These results suggest that reducing PMT stiffness might be an effective way to restore ET function in these populations. Varying TVPM force vector relationships via changes in hamulus location had no effect on ET opening in young children and cleft palate subjects but did alter force transmission to the ET lumen during conditions of elevated adhesion. These models have therefore provided important new insights into the biomechanical mechanisms responsible for ET dysfunction.

Objective Compare the accuracy of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) in identifying people with Eustachian tube (ET) dysfunction based on symptoms and based on an objective ET function test. Study Design Cross-sectional study. Setting Tertiary referral center. Subjects and Methods 55 subjects with and without symptoms suggestive of ET dysfunction completed the ETDQ-7 questionnaire and had their ET function evaluated by the percentage of middle ear pressure equilibrated after 5 swallows (PEq5) either during a Pressure Chamber test (intact tympanic membranes) or by the Inflation-Deflation test (non-intact tympanic membranes). The ETDQ-7 score ≥ 14.5 and PEq5<60% were used to define ET dysfunction and sensitivity, specificity and Receiver Operating Characteristic curves were used to assess the level of association between ETDQ-7 scores and PEq5. Results 25 asymptomatic (Group 1= 15 females, 15 whites, mean age 32±12.8 years) and 30 subjects with ET dysfunction symptoms (Group 2= 17 females, 25 whites, mean age 27±16.3 years) were included in the analysis. ETDQ-7 sensitivity and specificity regarding correct group assignment were 70% and 100% and with respect to predicting PEq5<60%, 54% and 78% respectively. An area under the curve (AUC) of 0.68 (95% CI 0.53–0.83) at the participant level and of 0.64 (95% CI 0.50–0.77) at ear level indicated a moderate level of association which was lower, although not statistically significant, for non-intact tympanic membranes (AUC=0.63 at participant and AUC=0.49 at ear level). Conclusion The ETDQ-7 score had higher correlation with ET dysfunction symptoms than with an objective measure of ET function.

Conclusions-The middle ear (ME) surface area/volume ratio (SA/V) is greater than that of the tympanum. The rate of ME pressure decrease between Eustachian tube openings is proportional to the ME SA/V. This analysis showed that the MACS will not function as a ME gas reserve under the assumed conditions, but could, if the blood perfusion/surface area is much greater for the tympanum than the MACS and is lesser for greater MACS volumes.Objective-Measure the surface and volumes for the MACS and tympanum and evaluate if the MACS could function as a ME gas reserve.Methods-Twenty adult subjects with a wide range of MACS volumes had a CT scan of their MEs. Using Image J software, the left and right surface areas and volumes of the tympanum and MACS were reconstructed. These data were entered into a simple perfusion-limited model of transmucosal gas exchange between ME and mucosal blood. The model predicted that the MACS would function as a ME gas reserve if the SA/V for the ME is less that that for the tympanum, or equivalently, if the tympanum SA/V divided by the ME SA/V is less than a critical value of 1.Results-Both MACS and tympanum surface areas were linearly related to their volumes. MACS surface area and volume and the ME SA/V were significantly greater than those for the tympanum. Solving the model equation using the measured values yielded a critical value of 1.4 which was significantly greater than 1.