Presentation and eustachian tube function test results in children evaluated at a specialty clinic

Abstract

Objectives/Hypothesis Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET‐specific or sinus balloons around the world and off‐label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children. Study Design Retrospective cross‐sectional study. Methods This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable. Results Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%). Conclusions ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing. Level of Evidence 4 Laryngoscope, 129:1218–1228, 2019

The Eustachian Tube Dysfunction in Children: Anatomical Considerations and Current Trends in Invasive Therapeutic Approaches

“…The bibliography that concerns children is not as rich as that of adults, primarily due to the lack of FDA approval for dilation in children. However, some well-organized original studies and meta-analyses have already been published [26,32,34,55,[61][62][63][64][65]. Most pediatric series use the SPIGGLE and THEIS dilation system (TubaVent; Overath, Germany: SPIGGLE & THEIS Medizintechnik GmbH), but some publications use the Acclarent AERA 6x16 mm and Acclarent 3.5x10 mm, even if they are not FDA approved yet.…”

Impact of Surgery for Velopharyngeal Insufficiency on Eustachian Tube Function in Children: Pharyngeal Flap Versus Sphincter Pharyngoplasty

“…While analysis of tympanometry is a reasonable outcome to measure in studies of ETD, we felt that analyzing the frequency of ETD sequelae and surgical management of these sequelae was a better patient-oriented outcome in our population given these challenges. Unfortunately, there is no widely accepted direct measure of ETF, although many are under investigation (Alper et al, 2018;Smith et al, 2018), which may shed additional light on the relationship between ETF and nasal obstruction, both in the context of VPD and in general.…”

Advances in Eustachian tube function testing

“…An interesting result of exploring objective tests of ET function has been the discovery that some patients appear to have a predominance of dysfunction in either passive or active ET opening 18 , 30 , 56 . The ability to characterise obstructive ETD patients in this way may provide a means to target medical or surgical therapies better to specific causes of ETD.…”