Endoscopic Evaluation of the Eustachian Tube: assessment of a novel tool for grading Eustachian tube inflammation

Abstract

Background: Signs of inflammation are commonly encountered during endoscopic examination of the Eustachian tube (ET) region. The clinical applicability of these findings may be enhanced by use of a standardized assessment score.Methods: Digital video recordings were obtained of 50 nasal endoscopy examinations of the nasopharyngeal portion of the ET. Four fellowship-trained rhinologists independently reviewed the videos with regard to specific physical findings: edema of the ET torus, erythema of the ET torus, exudate at the ET orifice, and presence of tubal tonsil. Scoring of this Endoscopic Evaluation of the Eustachian Tube (3ET) was reported using both 2-point and 3-point scales. Each reviewer repeated the scoring at a 10-day interval. Interrater and intrarater agreement were calculated for each item and the total scores. Results:Interrater and intrarater agreement were greater for the 3-point scale than the 2-point scale. Interrater agreement for overall instrument using the 3-point scale was in the "acceptable" range for Krippendorff's alpha on both the first trial (0.6922) and second trial (0.7238). Intrarater agreement was generally "excellent" for individual items as well as the overall instrument. Conclusion:The 3ET comprising these 4 physical findings has acceptable interrater and intrarater reliability, and may be applied to future clinical studies of ET function and disease. C 2018 ARS-AAOA, LLC.

The Effect of Endoscopic Sinus Surgery on Eustachian Tube Dysfunction Symptoms

“…Recently proposed standardization of endoscopic grading of eustachian tube inflammation may help to validate proposed diagnostic and treatment algorithms. 20…”

Association of a standardized measure of nasopharyngeal inflammation with Eustachian tube dysfunction questionnaire score

“…Example photographs of various 3ET scores are demonstrated in Figure S1. The 3ET scoring system has been proposed to assess the severity of inflammation at the ET orifice and has demonstrated good interrater and intrarater reliability, though the diagnostic performance has not been established 22 …”

“…The 3ET has been previously described and consists of evaluation of 4 components of the nasopharyngeal ET orifice: edema of the ET torus, erythema of the ET torus, exudate at the ET orifice, and presence of tubal tonsil. 22 Each component is scored from 0 to 2 and the individual component scores are summed for a maximum total score of 8. Left and right sides are scored separately.…”

The Infratemporal Fossa Sign: Pilot Study of a Potential Clue to Eustachian Salpingitis

“…Nasal endoscopy findings of inflammation at the proximal (medial) ET were reported via the Endoscopic Evaluation of the Eustachian Tube (3ET), an 8-point scale with established inter- and intrarater reliability, in which higher scores indicate more severe findings. 3 All patients completed the ETDQ-7 (7-item Eustachian Tube Dysfunction Questionnaire), which is scored on a scale of 1.0 to 7.0, with a higher score indicating more severe symptoms. 4 This study was approved by the institutional review board of Ochsner Clinic.…”