Concordance Analysis of the Pressure Chamber and Tubomanometer According to Estève for the Determination of Eustachian Tube Opening Pressure

Abstract

Introduction For the diagnosis of Eustachian tube dysfunction (ETD), clinical procedures such as tympanometry, micro-otoscopy, and maneuvers according to Toynbee and Valsalva only allow an indirect assessment for the moment. With a prevalence of up to 5%, the selection of patients with ETD and its subtypes is clinically relevant. Dynamic methods of Eustachian tube function assessment include a hypo/hyperbaric pressure chamber and Estève’s tubomanometer (TMM). One method of assessing ETD is the evaluation of Eustachian tube opening pressure (ETOP). Material and Methods We performed a concordance analysis between pressure chamber and TMM to determine ETOP. For this purpose, we analyzed the measurements of both methods from 28 healthy subjects using Bland–Altman plots, regression according to Passing–Bablok and Lin’s concordance correlations coefficient. The maximum tolerated clinical deviation of measured values was set at 10%. Results A maximum of 53 measurements of ETOP between pressure chamber and TMM were compared. Mean ETOP for TMM was 28.7 hPa, passive opening was 32 hPa, Toynbee maneuver was 28.4 hPa, and Valsalva maneuver was 54.6 hPa. Concordance analysis revealed following results: passive opening versus TMM: Bland–Altman mean difference 3.3 hPa, limits of agreement ±31.8 hPa; Passing–Bablok regression y = 0.67x + 9.36; Lin’s r ccc = 0.18. Toynbee versus TMM: Bland–Altman mean difference 0.7 hPa, limits of agreement ±35.8 hPa; Passing–Bablok regression y = 0.47x + 14.03; Lin’s r ccc = 0.14. Valsalva versus TMM: Bland–Altman mean difference 24.2 hPa, limits of agreement ±117.5 hPa; Passing–Bablok regression y = 0.17x + 25.12; Lin’s r ccc = 0.18. Conclusion Estève‘s tubomanometer and pressure chamber measurements of ETOP are not concordant. The two methods cannot be interchanged without reservation.