Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway

Abstract

Background and aimsEustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD.MethodsIndex tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results.ResultsThe expert panel diagnosis and PROMs results correlated with each other, but not with ET function measured by tests of ET opening. All index tests were found to be feasible in clinic, and acceptable to patients. PROMs had very poor specificity, and no diagnostic value. Combining the results of tests of ET function appeared beneficial. The latent class model suggested tympanometry, sonotubometry and tubomanometry have the best diagnostic performance for obstructive ETD, and these are included in a proposed diagnostic pathway.ConclusionsETD should be diagnosed on the basis of clinical assessment and tests of ET opening, as PROMs have no diagnostic value. Currently diagnostic uncertainty exists for some patients who appear to have intermittent ETD clinically, but have negative index test results.

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

“…Moreover, objective findings were also evaluated by TM movement, auscultation of voice sounds, TTAG, and sonotubometry. Multiple outcomes should be used because there is no single tubal function test or observation available at this time to evaluate ET function accurately . Postoperative objective findings were generally in good accord with the main outcome using the PHI‐10.…”

Eustachian Tube Function in Patients with Symptoms on Baro-Challenge

“…The test data were processed according to previously described diagnostic thresholds [Smith et al, 2018b]. To explore the diagnostic accuracy of tests of ET opening specifically for the baro-challenge-induced subtype of OETD, both diagnostic criteria (pain on baro-challenge and Item 6 index) were used to plot receiver operating characteristic curves for each test, and the AUC (area under the curve) was estimated.…”

“…Participants A single cohort of non-consecutive patients was recruited from ENT outpatient clinics at our tertiary care institution between November 2016 and May 2017. There is no standardised method by which to diagnose ETD, and the cohort in this study consisted of patients with symptoms or examination findings suggestive of OETD, with individuals selected from a larger cohort [Smith et al, 2018b]. It is well established that symptoms such as aural fullness are non-specific, and those recruited therefore were expected to be a heterogeneous group, including individuals with different forms of ETD, or even another otological cause for their symptoms and examination findings (hearing loss, Ménière's disease, etc.).…”

“…To date OETD has largely been defined by its symptoms, many of which are non-specific, such as aural fullness and discomfort. It is increasingly recognised, however, that symptoms may not correlate with more objective measures of ET function, namely tests that measure middle ear (ME) pressure equalisation or ET opening [Smith et al, 2018b]. DOI: 10.1159/000505655 Some individuals experience severe aural symptoms induced by rapid or significant pressure changes (barochallenge), such as those occurring during flight or scubadiving or when rapidly ascending a hill or passing at speed through a tunnel.…”

Advances in Eustachian tube function testing

“…Tympanometry remains the only widely-used objective measure of ET function, albeit acting as an indirect assessment based on a measurement of ME pressure, often at a single point in time. Tympanometry is simple to perform and is repeatable, with a ME pressure below −50daPa highly suggestive of obstructive ETD, and correlating with other more complex ET opening tests 30 . However, tympanometry is limited to use in patients with an intact tympanic membrane and aerated ME, and a measured normal ME pressure does not exclude obstructive or patulous ETD.…”