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Gürtler N, Honegger F. Eustachian Tube Balloon Dilation in Children: Short- and Long-Term Outcome. Ann Otol Rhinol Laryngol 2024; 133:369-374. [PMID: 38197378 PMCID: PMC10898197 DOI: 10.1177/00034894231221888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Eustachian Tube Balloon Dilation (ETBD) represents an innovative therapeutic approach for chronic Eustachian tube dysfunction (CETD), a common disease in children. Some evidence of a benefit of ETBD in the adults exist in contrast to sparse reports in children. The objective was to analyze short- and long-term outcome of ETBD in children with CETD. METHODS A retrospective chart-review was performed in a cohort of 19 children (mean age 13 years, 7-17) who underwent ETBD. The following parameters were analyzed: tubomanometry (R-value), tympanogram, hearing (CPT-AMA, Air-bone gap [ABG]), Eustachian Tube Score (ETS and ETS-7), and Eustachian Tube Disease questionnaire (ETDQ). RESULTS Twenty-four ears were dilated (in 5 patients subsequently after successful first intervention) and grouped as A (17) without and B (7) with additional T-tube insertion. Most children suffered from either chronic otitis media with effusion or chronic perforation (12, 63%), the remainder comprising recurrent otitis media, adhesive otitis media and CETD with barotrauma. Mean duration of symptoms were 7/8.2 years and mean follow-up 13.7/11.1 months. Eighty percent of patients reported a subjective benefit. Accordingly, the R-value, ETS, and ETS-7 were significantly (P < .05) improved. Tympanometry, CPT-AMA and ABG showed a positive trend, but the result was not significant. Tympanic retraction remained largely the same; a spontaneous closure of a chronic tympanic perforation was seen in 1 of 3 cases. CONCLUSIONS The high subjective benefit and some significant objective improvement warrants further analysis of ETBD as part of the therapeutic management in pediatric CETD.
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Affiliation(s)
- Nicolas Gürtler
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University of Basel, Basel, Switzerland
- Hals-Nasen-Ohren-Klinik, University Children’s Hospital Basel, Basel, Switzerland
| | - Flurin Honegger
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University of Basel, Basel, Switzerland
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Ungar OJ, Demir Bajin M, Dahm V, Lin VYW, Chen JM, Le TN. Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review. Front Surg 2024; 11:1271248. [PMID: 38444902 PMCID: PMC10912332 DOI: 10.3389/fsurg.2024.1271248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
Objective To report a novel technique in Balloon Dilation of Eustachian Tube (BDET) using an endovascular balloon (EVB), in a prospective cohort. The results are compared with reported outcomes using standard balloons. Methods Demographic information and clinical parameters were collected prospectively fora series of patients with obstructive eustachian tube dysfunction (OETD). Balloon dilation Eustachian tuboplasty was performed under local anesthesia in a tertiary referral center, using the EVB. Systematic literature review was used for comparison, using Medline via "PubMed", "Embase", and "Web of Science". Results Eight OETD candidates (12 ears) were enrolled; 5 males and 3 females. Average age was 48 (range -23 to 63) years. The most common presenting symptom was aural fullness (9/12), followed by ear pressure (7/12), hearing loss (5/12) and tinnitus (4/12). Otoscopically, tympanic membrane retraction was evident in 10/12 ears, the majority of which was class II-Sade classification. Pre-operative tympanogram was type B and C in 7 and 5 ears, respectively. All BDETs were performed without complications. Post-operative tympanometry was A in 8/12 ears. Post-operatively, Eustachian Tube Dysfunction Questionnaire-7 results reduced to within normal limits (average score ≤3) in 11/12 ears (p = 0.0014). The systematic literature review included 6 papers (193 patients, 262 ETs) with comparable results, most also with little adverse effects. Conclusion BDET using an EVB is a safe and effective option for OETD. It is well tolerated under local anesthesia in properly selected individuals. The reduced procedural cost may be an important factor in certain healthcare jurisdictions.
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Affiliation(s)
- Omer J. Ungar
- Department of Otolaryngology, Head & Neck Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Muacevic A, Adler JR, Alhussaini OM, Alharbi RA, Almeshaly SS, Alraddadi AF, Zakareya BF, Alrehaili RD, Alkenani FA, Jorob SM. Prevalence of Eustachian Tube Dysfunction and Its Associated Factors Among the General Public in Al-Madinah, Saudi Arabia. Cureus 2023; 15:e33748. [PMID: 36788895 PMCID: PMC9922529 DOI: 10.7759/cureus.33748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
Objectives To determine the association between patient demographics including gender, age, family history of hearing loss, and eustachian tube dysfunction (ETD) in the Al-Madinah region. Methods This is a cross-sectional observational study that was conducted using an online survey in the Al-Madinah region of Saudi Arabia from March 2022 to August 2022. Data were collected using a self-administered questionnaire (ETDQ-7) that was designed based on previous studies and frameworks. It consists of seven items, each with a score ranging from 1 to 7, for a total score of between 7 and 49 points. A total score of 14.5 or above, or a mean domain score of 2.5 or above, is considered abnormal, with higher scores indicating greater severity of symptoms. The analysis was carried out using SPSS v23. Results About 380 participants were included in the current study. The mean age of the participants was 29.2 ± 8.7 years old. About 13 (3.4%) of the participants had a history of ETD. The prevalence of ETD among the study population was 41.3%. Gender was significantly associated with the prevalence of ETD (p-value=0.004), with females tending to have the condition more frequently than males. Moreover, the history of ETD was also significant (p=0.001) Conclusion A higher prevalence of ETD was found in the current study when compared to international studies, gender and history of ETD were found to be linked with increased prevalence of EDT.
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Clinical Analysis of Ear Congestion after Balloon Eustachian Tuboplasty (BET) with or without Tympanostomy Tube Insertion. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5929977. [PMID: 35911162 PMCID: PMC9337936 DOI: 10.1155/2022/5929977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the clinical analysis of ear congestion after balloon Eustachian tuboplasty (BET) with or without tympanostomy tube insertion. Methods A total of 35patients (49 affected ears) with ear congestion following BET with or without tympanostomy tube insertion were recruited from the hospitalized patients from January 2015 to December 2017. The score of Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) 15, visual analogue scale (VAS), and Valsalva scores were recorded before and after operation, and the influencing factors of prognosis were analyzed. The duration of follow-up was 1-4 years. Results All patients showed significantly decreased average preoperative ETDQ-7 score, VAS, and Valsalva score after operation (p < 0.05). The significance of the surgery types, course of disease, severity of tympanic membrane retraction, and tympanogram tracings classification as influencing factors of prognosis did not come up to the statistical standard (p > 0.05). Conclusion The patients showed relatively stable postoperative conditions after 3 years, and there were variations in the range of ETDQ-7 scores at 5 years postoperatively. Patients with levels I and II tympanic membrane retraction showed more favorable surgical effects. Surgical interventions are required for patients diagnosed with obstructive Eustachian tube dysfunction (ETD) after three months of conservative treatment without satisfactory results.
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Lu H, Su J, Chi W, Zou T, Yu M, Wang K. Clinical value of the Eustachian Tube Function Scoring System T-ETDQ: a prospective diagnostic study. Eur Arch Otorhinolaryngol 2021; 279:2223-2230. [PMID: 34590179 DOI: 10.1007/s00405-021-07108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Tubomanometry (TMM) and the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was integrated to establish the Tubomanometry Eustachian Tube Dysfunction Questionnaire (T-ETDQ), and its reliability, potential clinical application, and diagnostic value for Eustachian tube function were investigated. METHODS This prospective diagnostic study included patients visiting the ENT Department of our Hospital, between April and June 2021. Patients were grouped into Eustachian tube dysfunction (ETD) and control groups according to tympanometry diagnosis results. The diagnostic value of the T-ETDQ was evaluated using receiver-operating characteristic (ROC) curve analysis. RESULTS There were 48 patients with Obstructive ETD and 24 patients without. The area under the ROC curve (AUC) of T-ETDQ was 0.898 (95% confidence interval [CI] 0.826-0.969), and the highest sensitivity and specificity were 76.7% and 86.7% respectively when the positive cutoff value was 4.72. The AUC of Eustachian tube score (ETS) was 0.731 (95% CI 0.625-0.837) and the highest sensitivity and specificity were 48.3% and 90.0% respectively when the positive cut-off value was 4.5. The ETS and T-ETDQ had kappa values of 0.311 and 0.585, respectively (P < 0.001 for both), showing both methods were comparable to tympanometry; however, T-ETDQ had more consistent results than ETS. CONCLUSION T-ETDQ can effectively quantify and evaluate ETD severity in adults, has a higher diagnostic value than ETS, making it a suitable diagnostic tool.
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Affiliation(s)
- Hongyi Lu
- Zhejiang Chinese Medical University, Hangzhou, China.,Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jun Su
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Wanlei Chi
- Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Ting Zou
- Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Mingqiang Yu
- Department of Otolaryngology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Kang Wang
- Department of Otolaryngology, Zhejiang Hospital, Hangzhou, China.
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Andresen NS, Sharon JD, Nieman CL, Seal SM, Ward BK. Predictive value of the Eustachian Tube Dysfunction Questionnaire-7 for identifying obstructive Eustachian tube dysfunction: A systematic review. Laryngoscope Investig Otolaryngol 2021; 6:844-851. [PMID: 34401511 PMCID: PMC8356874 DOI: 10.1002/lio2.606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/26/2021] [Accepted: 06/10/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To perform a systematic review to determine if a total score of ≥14.5 (mean score ≥ 2.1) on the ETDQ-7 accurately identifies patients with obstructive Eustachian tube dysfunction (OETD) on impedance tympanometry (peak compliance <0.2 mL or middle ear pressure of -100 daPa) or other objective measures of OETD. METHODS A systematic review without a meta-analysis was performed of studies in four electronic databases (Pubmed, Embase, Web of Science, and Scopus) that used the ETDQ-7 and at least one objective measure of OETD. RESULTS Six-hundred and fifty-two studies were identified in the initial literature search. Abstracts from 337 studies were screened, followed by full-text review of 61 studies, and qualitative synthesis of 12 studies. Tympanometry was used as an objective measure in ten studies. Eight of the 12 included studies had patient cohort selection bias. Eight studies administered the ETDQ-7 in cohorts of patients with or without OETD, already confirmed on tympanometry, and found a sensitivity of 91%-100% and specificity of 67%-100%. Four studies administered the ETDQ-7 to patients who had not previously undergone objective testing and found a sensitivity of 49%-80% and specificity of 24%-78%. CONCLUSIONS The ETDQ-7 is an important patient-reported outcome measure. However, based upon existing literature, the ETDQ-7 appears limited as a diagnostic tool for OETD or as an objective measure of Eustachian tube function.
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Affiliation(s)
- Nicholas S. Andresen
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jeffrey D. Sharon
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California—San FranciscoSan FranciscoCaliforniaUSA
| | - Carrie L. Nieman
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Stella M. Seal
- Welch Medical LibraryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Bryan K. Ward
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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[Evaluation of standardized questionnaires for diagnosis and differentiation of obstructive and patulous Eustachian tube dysfunction]. HNO 2021; 69:198-205. [PMID: 32885310 PMCID: PMC8241754 DOI: 10.1007/s00106-020-00931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hintergrund Eine klaffende Tube kann insbesondere durch Autophonie, Druckgefühl und gestörten Höreindruck zu einer Einschränkung der Lebensqualität führen. Bei fehlenden spezifischen Symptomen kann die Diagnose der klaffenden Tube schwierig sein. Insbesondere die Abgrenzung zur chronisch obstruktiven Tubenfunktionsstörung stellt eine Herausforderung dar. Da derzeit kaum standardisierte Diagnostik- und Therapieoptionen zur Verfügung stehen, ist eine strukturierte Untersuchung zur sicheren Diagnostik und wissenschaftlichen Aufarbeitung dieser Erkrankung erforderlich. Für die Diagnostik der chronisch obstruktiven Tubenfunktionsstörung wurde 2012 bereits der „Eustachian Tube Dysfunction Questionnaire“ (ETDQ-7-Fragebogen) nach McCoul entwickelt. Für die klaffende Tube existiert seit 2017 der PHI-10-Fragebogen („patulous Eustachian tube handicap inventory“) nach Kobayashi. Material und Methoden Der PHI-10-Fragebogen wurde ins Deutsche übersetzt und an 41 Gesunden, 13 Patienten mit Tinnitus auris, 11 Patienten mit klaffender Tube und 18 Patienten mit chronisch obstruktiver Tubenventilationsstörung getestet. Zusätzlich erfolgte im Vergleich die Auswertung des ETDQ‑7 nach McCoul. Ergebnisse Es erfolgt die Präsentation der deutschen Übersetzung des PHI-10 und der Ergebnisse von PHI-10 und ETDQ‑7 in allen Patientengruppen. Der ETDQ‑7 hat das Risiko falsch-positiver Ergebnisse bei Patienten mit klaffender Tube und der PHI-10 bei Patienten mit obstruktiver Tubenfunktionsstörung. Beide untersuchten Fragebögen sind falsch-positiv bei Tinnituspatienten. Schlussfolgerung Der PHI-10 (deutsch) und ETDQ‑7 (deutsch) sind eine nützliche Unterstützung der Anamnese bezüglich Tubenfunktionsstörungen. Sie unterscheiden jedoch nur unzureichend zwischen klaffenden und obstruktiven Tubenfunktionsstörungen und eignen sich nicht für Patienten mit Tinnitus. Die Stärke der Fragebögen ist in der Verlaufskontrolle und dem Monitoring von Therapieergebnissen zu sehen.
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Alshehri KA, Saggaf OM, Alshamrani HM, Alnefaie AM, Alghamdi KB. Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Jeddah, Saudi Arabia: Cross-Sectional Survey-Based Study. Interact J Med Res 2020; 9:e14640. [PMID: 33211016 PMCID: PMC7714651 DOI: 10.2196/14640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 02/29/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Obstruction of the Eustachian tube is a common condition that is unpleasant and might lead to various middle ear disorders. Objective This study aimed to estimate the prevalence of Eustachian tube dysfunction (ETD) among the public in Jeddah, Saudi Arabia. Methods This cross-sectional survey-based study was conducted in Jeddah during August 2018 by distributing an electronic survey form to participants from different districts of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study. Results A total of 2372 participants (female, 1535/2372, 64.71%; male, 837/2372, 35.28%; mean age 31.31 years, SD 11.85 years) agreed to contribute to our study. Upon analysis of their answers to the questionnaire, the overall prevalence of ETD in our sample was found to be 42.49% (1008/2372). The prevalence was higher among participants who reported a previous diagnosis of ETD and hearing loss (1897/2372, 80.00% and 1902/2372, 80.21%, respectively). Additionally, participants with a family history of hearing loss had a significantly higher prevalence (1136/2372, 47.92%) of ETD than those with no family history of hearing loss. Our analysis also showed that females were at a greater risk of developing ETD than males (P=.01). Conclusions As per our prevalence data, ETD is a common disease in Jeddah, pointing to the need for more attention, awareness, and research.
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Affiliation(s)
- Khalid A Alshehri
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar M Saggaf
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hussein M Alshamrani
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Khalid B Alghamdi
- Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Besser G, Liu DT, Sharma G, Bartosik TJ, Kaphle S, Enßlin M, Renner B, Mueller CA. Ortho- and retronasal olfactory performance in rhinosurgical procedures: a longitudinal comparative study. Eur Arch Otorhinolaryngol 2020; 278:397-403. [PMID: 32813170 PMCID: PMC7826311 DOI: 10.1007/s00405-020-06300-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/15/2020] [Indexed: 02/06/2023]
Abstract
Purpose Testing olfaction should be an integral part of a clinical work-up in rhinosurgical procedures. Importantly, intact olfactory experience also includes retronasally perceived odors (retronasal olfaction). This study aimed at comprehensively assessing olfaction in patients undergoing rhinosurgical procedures in a comparative manner and evaluating relations to patient-reported outcome measurements (PROMs). Methods Each nostril odor threshold and discrimination, and birhinal identification were tested using Sniffin’ Sticks in 14 subjects assigned for septoplasty (SP), 21 for septorhinoplasty (SRP), and 30 for endoscopic sinus surgery (ESS). The 27-Candy-Smell-Test was used to quantify retronasal abilities. Tests were repeated 3 months after surgery. Results Olfactory dysfunction was preoperatively present in 21% of SP, in 47.6% of SRP, and in 80% of ESS patients. Odor threshold side differences were most frequently found in SRP. Frequently, SRP and ESS patients showed severely impaired retronasal olfaction. Half of included subjects re-visited after 3 months, but olfactory function did not improve overall and rarely on an individual basis to a meaningful extent. Subjective ratings on nasal patency and PROMs were not associated with olfaction nor with changes in olfactory scores. Conclusion Olfactory function can decisively be impaired a priori not only in patients awaiting sinus surgery, but also in those assigned for functional septorhinoplasty. This impairment may not improve in the short term, which has to be taken into account in patient counseling. This study adds to the current literature on olfaction in rhinosurgery with the extension of retronasal testing.
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Affiliation(s)
- Gerold Besser
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gunjan Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina J Bartosik
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian Kaphle
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Max Enßlin
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bertold Renner
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian A Mueller
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Froehlich MH, Le PT, Nguyen SA, McRackan TR, Rizk HG, Meyer TA. Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes. Otolaryngol Head Neck Surg 2020; 163:870-882. [PMID: 32482125 DOI: 10.1177/0194599820924322] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction. DATA SOURCES PubMed, Scopus, and Google Scholar. REVIEW METHODS A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver. RESULTS The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, -3.02 to -1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms (P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline (P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term (P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks (P < .001) and 55.4% in the long term (P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline (P < .001). CONCLUSION Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phong T Le
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Alper CM, Teixeira MS, Swarts JD. Eustachian Tube Function in Adults with Ventilation Tubes Inserted for Otitis Media with Effusion. J Int Adv Otol 2019; 14:255-262. [PMID: 30256199 DOI: 10.5152/iao.2018.4521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the eustachian tube (ET) function (ETF) in adults with ventilation tube (VT) inserted for the treatment of chronic otitis media with effusion (COME). MATERIALS AND METHODS A total of 17 subjects with at least one VT were enrolled. A detailed history was obtained, and risk factors were assessed with questionnaires. Examination including nasopharyngeal video endoscopy and ETF tests, the forced response test (FRT), inflation-deflation test (IDT), and nasal/nasopharyngeal maneuvers (such as sniffing and Valsalva, Toynbee, and the diver's maneuvers) were performed. RESULTS Averages for FRT were 580±333 daPa, 382±251 daPa, and 138±192 daPa for opening pressure, steady-state pressure, and closing pressure, respectively. Most subjects demonstrated minimal or weak active function during the FRT and IDT. While nasopharyngeal maneuvers changed the nasal/nasopharyngeal pressures, they did not significantly change the middle-ear pressures. These results indicated that most subjects had severe obstructive ET dysfunction (ETD) with an ET lumen that required high pressure differences to open and poor active muscular function inadequate for luminal dilation. These results imply that while any treatment to widen the ET, such as balloon dilation of the ET, is not expected to change the voluntary active muscular function, it may reduce the tissue pressures and resistance, thus facilitating luminal opening both passively and actively. CONCLUSION Most patients with VT inserted for the treatment of COME appear to have an abnormal ETF with difficulty in passively opening the ET and weak active muscular function. Management of such patients addressing only passive properties may not be sufficient for the resolution of ETD.
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Affiliation(s)
- Cüneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA; Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Smith ME, Bance ML, Tysome JR. Advances in Eustachian tube function testing. World J Otorhinolaryngol Head Neck Surg 2019; 5:131-136. [PMID: 31750424 PMCID: PMC6849358 DOI: 10.1016/j.wjorl.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022] Open
Abstract
Obstructive and patulous Eustachian tube dysfunction provide a significant diagnostic and management challenge. The development of new treatments such as balloon Eustachian tuboplasty has generated renewed interest in measuring Eustachian tube function, as a method of selecting appropriate patients for intervention, and measuring their treatment outcomes. This review summarises recent findings relating to Eustachian tube function assessment. Increasingly it is recognised that patient reported outcome measures based on symptoms are highly non-specific and non-diagnostic, and clinical assessment alone may not permit the selection of individuals with abnormal Eustachian tube opening. Tests of Eustachian tube opening therefore may represent a practical and objective addition to patient assessment in clinic, allowing the identification of individuals with abnormal (patulous or obstructive) Eustachian tube function. A diagnostic pathway is described on this basis. More work is required to validate the described Eustachian tube function tests, and there remain individuals, such as those with dysfunction limited to pressure challenges, in whom function tests have yet to fully characterise the disorder.
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Affiliation(s)
- Matthew E Smith
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
| | - Manohar L Bance
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
| | - James R Tysome
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
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Lin WL, Chou YF, Sun CH, Lin CC, Hsu CJ, Wu HP. Evaluation of thirty patients with eustachian tube dysfunction in Taiwan by questionnaire survey. J Formos Med Assoc 2019; 119:621-626. [PMID: 31540815 DOI: 10.1016/j.jfma.2019.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Eustachian tube dysfunction (ETD) is a common otolaryngological disorder. The seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was used for the assessment of symptoms related to ETD and treatment outcome. Currently, there is no traditional Chinese version of the ETDQ-7 to diagnose ETD in Taiwan. We aim to verify the reliability and validity of the traditional Chinese version of the ETDQ-7 in a clinical setting. METHODS The traditional Chinese version of the ETDQ-7 was completed by 60 adult subjects composed of 30 healthy controls and 30 subjects diagnosed with ETD. The internal consistency was evaluated using the Cronbach's α coefficient. The discriminant validity was calculated by receiver operating characteristic (ROC) curve as an accuracy measure. RESULTS The overall Cronbach's α coefficient of the traditional Chinese version ETDQ-7 was 0.717. The mean ETDQ-7 total score was 26.97 in the ETD group and 9.27 in the control group. The area under the ROC curve (AUC) was 99.8%, and the sensitivity and specificity of the traditional Chinese ETDQ-7 was 100% and 99.9%, respectively. CONCLUSION The traditional Chinese version of the ETDQ-7 is a valid and reliable, disease-specific rating scale that can be used to quantitatively evaluate the severity of subjective symptoms of ETD in adult patients.
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Affiliation(s)
- Wei-Lin Lin
- Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yi-Fan Chou
- Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chuan-Hung Sun
- Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Ching Lin
- Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chuan-Jen Hsu
- Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Pin Wu
- Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.
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Herrera M, Eisenberg G, Plaza G. Clinical Assessment of Eustachian Tube Dysfunction Through the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and Tubomanometry. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Giunta AA, Liberati L, Pellegrino C, Ricci G, Rizzo S. Eustachian tube balloon dilation in treatment of equalization problems of freediving spearfishermen. Diving Hyperb Med 2019; 49:9-15. [PMID: 30856662 DOI: 10.28920/dhm49.1.9-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Eustachian tube balloon dilation is a minimally invasive surgical procedure used to treat Eustachian tube dysfunction which is not responsive to conventional therapies. METHODS In this cohort intervention series we report the results of balloon dilation in treating refractory equalization problems in 20 freediving spearfishermen; in 19 cases the problem was unilateral and in one case bilateral. All the patients had already received medical and insufflation therapy and four patients had also had nasal surgery. None of these treatments or procedures had achieved improvement. We used a 20 mm x 3 mm disposable balloon catheter inserted through a 70-degree guide catheter and inflated up to 12 ATM three times at three different depths of insertion within the Eustachian tube. Every inflation lasted 120 seconds. RESULTS Fifteen out of 20 patients improved. Ten patients reported a complete resolution of equalization problems, five showed improvement with persistence of a slight equalization delay on the treated side. Five patients did not report any improvement. Two complications occurred: subcutaneous emphysema of the parotid region in one case; and a mild high frequency (4-8 KHz) sensorineural hearing loss in another patient. CONCLUSION Balloon dilation of the Eustachian tube is an effective therapy in the treatment of equalization problems with a good success rate.
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Affiliation(s)
- Antonio Am Giunta
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy.,Corresponding author: Antonio Alberto Maria Giunta, ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy,
| | - Luca Liberati
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| | - Cristina Pellegrino
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| | - Giampietro Ricci
- ENT Department of Santa Maria della Misericordia of Perugia, Piazza Menghini 1, Perugia, Italy
| | - Santino Rizzo
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
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Herrera M, Eisenberg G, Plaza G. Clinical assessment of Eustachian tube dysfunction through the Eustachian tube dysfunction questionnaire (ETDQ-7) and tubomanometry. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:265-271. [PMID: 30086886 DOI: 10.1016/j.otorri.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/20/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Evaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM). MATERIALS AND METHODS Spanish validation of the ETDQ-7. PATIENTS Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. OUTCOME MEASURES The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction. RESULTS The Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction. CONCLUSIONS The Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients' lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction.
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Affiliation(s)
- Mayte Herrera
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - Gustavo Eisenberg
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
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Gallardo FP, Onishi ET, Lira FI, Suzuki FB, Testa JRG. Translation, validation and cultural adaptation of "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) to Brazilian Portuguese (BR). Braz J Otorhinolaryngol 2018; 85:456-464. [PMID: 29753672 PMCID: PMC9443040 DOI: 10.1016/j.bjorl.2018.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/05/2018] [Accepted: 03/20/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Chronic Eustachian tube dysfunction can cause several symptoms and middle ear conditions that can impact patient quality of life. It is estimated to be relatively frequent, affecting approximately 5% of adults. The diagnostic tools for this condition are still inadequate. In 2012, McCoul et al. published a questionnaire for the evaluation of Eustachian tube dysfunction named ETDQ-7. They established its replicability and validity. The cutoff point for the diagnosis of chronic Eustachian tube dysfunction was equal to or greater than 14.5, with 100% sensitivity and 100% specificity. Objective To translate, adapt and validate the ETDQ-7 questionnaire to Brazilian Portuguese. Methods We translated the questionnaire into Brazilian Portuguese and applied it to 50 patients, 20 of whom had chronic Eustachian tube dysfunction, and 30 controls. Results The results obtained with the North-American questionnaire were confirmed in its Brazilian version. The cut-off point for the diagnosis of chronic Eustachian tube dysfunction was ≥14, also exhibiting high sensitivity and specificity, very similar to that of ETDQ-7. Conclusion It is recommended that ETDQ-7 be used to complement the clinical history of patients with chronic Eustachian tube dysfunction; it can also be used as an important tool for diagnosis, patient follow-up and treatment management.
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Ungar OJ, Cavel O, Golan GS, Oron Y, Wasserzug O, Handzel O. The Hebrew version of the Eustachian tube dysfunction questionnaire-7. HEARING BALANCE AND COMMUNICATION 2018. [DOI: 10.1080/21695717.2018.1463756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Omer J. Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Cavel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad S. Golan
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oshri Wasserzug
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model. Eur Radiol 2018; 28:3685-3691. [PMID: 29619519 DOI: 10.1007/s00330-018-5392-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/29/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the technical feasibility of direct Eustachian tube catheterisation and subtraction Eustachian tubography in a cadaver model. METHODS A total of 12 separate sessions were performed on both sides of the Eustachian tube (ET) in six human cadavers. Cadavers were positioned for the submentovertical view on a fluoroscopy table. Endoscopy-guided ET selection was used in the first three cadavers, whereas fluoroscopy-guided ET selection was used in the remaining three. Eustachian tubography was performed by injecting 2 ml of contrast media through a 5-Fr catheter. We recorded the success of ET selection, number of attempts, procedure time, and tubography quality using native and subtraction images (range, 0-3). RESULTS Both endoscopy- and fluoroscopy-guided selections were successfully performed in five of six sessions (83.3%). There were no statistically significant differences between the endoscopy- and fluoroscopy-guided procedures in terms of the number of attempts, procedure time, rate of immediate contrast leak to the middle ear cavity, and quality of tubography (p > 0.05). An excellent quality of tubography was obtained in 83.3% (10 of 12 sessions) of subtraction images and in 33.3% (4 of 12 sessions) of native images. The tubography quality score was significantly higher for the subtraction images than for the native images (p = 0.04). CONCLUSION Subtraction Eustachian tubography using direct catheterisation seems to be technically feasible. The entire ET can be well visualised; thus, this technique can be used as a simple tool for assessment of ET function and anatomy. KEY POINTS • Direct catheterisation of the Eustachian tube is technically feasible. • The entire Eustachian tube could be well visualised by direct Eustachian tubography. • Subtraction Eustachian tubography images have better image quality than native images. • Subtraction Eustachian tubography can provide objective assessment of ET function and anatomy.
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Teixeira MS, Swarts JD, Alper CM. Accuracy of the ETDQ-7 for Identifying Persons with Eustachian Tube Dysfunction. Otolaryngol Head Neck Surg 2017; 158:83-89. [PMID: 28949806 DOI: 10.1177/0194599817731729] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare the accuracy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) in identifying people with eustachian tube (ET) dysfunction based on symptoms and an objective ET function test. Study Design Cross-sectional study. ObjSettingective Tertiary referral center. Subjects and Methods Fifty-five subjects with and without symptoms suggestive of ET dysfunction completed the ETDQ-7 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 (nonintact tympanic membranes). 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 Twenty-five asymptomatic subjects (group 1 = 15 females, 15 white; mean ± SD age, 32 ± 12.8 years) and 30 subjects with ET dysfunction symptoms (group 2 = 17 females, 25 white; age, 27 ± 16.3 years) were included in the analysis. ETDQ-7 sensitivity and specificity regarding correct group assignment were 70% and 100%, respectively, and with respect to predicting PEq5<60%, 54% and 78%. An area under the curve (AUC) of 0.68 (95% CI, 0.53-0.83) at the participant level and 0.64 (95% CI, 0.50-0.77) at the ear level indicated a moderate level of association that was lower, though not statistically significant, for nonintact tympanic membranes (AUC = 0.63 at the participant level and AUC = 0.49 at the ear level). Conclusion The ETDQ-7 score had a higher correlation with the ET dysfunction symptoms than with an objective measure of ET function.
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Affiliation(s)
- Miriam S Teixeira
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J Douglas Swarts
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cuneyt M Alper
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,2 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Alper CM, Luntz M, Takahashi H, Ghadiali SN, Swarts JD, Teixeira MS, Csákányi Z, Yehudai N, Kania R, Poe DS. Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis). Otolaryngol Head Neck Surg 2017; 156:S22-S40. [PMID: 28372527 DOI: 10.1177/0194599816647959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
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Affiliation(s)
- Cuneyt M Alper
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,3 Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michal Luntz
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Haruo Takahashi
- 5 Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Samir N Ghadiali
- 6 Department of Biomedical Engineering, Ohio University, Columbus, Ohio, USA.,7 Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio University, Columbus, Ohio, USA
| | - J Douglas Swarts
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Miriam S Teixeira
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zsuzsanna Csákányi
- 8 Department of Pediatric Otorhinolaryngology, Heim Pal Children's Hospital, Budapest, Hungary
| | - Noam Yehudai
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Romain Kania
- 9 Department of Otorhinolaryngology-Head and Neck Surgery, Lariboisière Hospital, Diderot University, University Paris Sorbonne, Paris, France
| | - Dennis S Poe
- 10 Department of Otology and Laryngology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,11 Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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Özgür E, Bilgen C, Cengiz Özyurt B. Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7. Braz J Otorhinolaryngol 2017. [PMID: 28622915 PMCID: PMC9449182 DOI: 10.1016/j.bjorl.2017.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction During clinical evaluations, in order to interpret patients’ complaints caused by Eustachian tube dysfunction and to monitor the success of the treatment, standardized and disease-related scales are necessary. Objective The aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian tube dysfunction questionnaire-7. Methods Forty patients diagnosed with Eustachian tube dysfunction and 40 healthy individuals were enrolled for the study. After language validation of the Eustachian tube dysfunction questionnaire-7 for Turkish, a scale was completed by the both Eustachian tube dysfunction and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test–retest method, item-total score correlation and internal consistency analysis were used in reliability analyses. Results Cronbach's alpha coefficient was 0.714 for the entire questionnaire. The test–retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the Eustachian tube dysfunction group, total and each item scores were found significantly higher than the control group (p < 0.001). Conclusion The Turkish version of Eustachian tube dysfunction questionnaire-7 was found to be highly valid and reliable. This scale is recommended to use for screening of Eustachian tube dysfunction and evaluating treatment outcome.
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Affiliation(s)
- Erdoğan Özgür
- Nazilli State Hospital, Otorhinolaryngology Clinic, Aydın, Turkey.
| | - Cem Bilgen
- Ege University, Department of Otorhinolaryngology, Izmir, Turkey
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Van Roeyen S, Van de Heyning P, Van Rompaey V. Delayed-Start Study Design for Balloon Dilation of the Eustachian Tube: Alternative for a Randomized Controlled Trial. Front Surg 2017; 4:10. [PMID: 28265561 PMCID: PMC5316550 DOI: 10.3389/fsurg.2017.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shari Van Roeyen
- Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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[Balloon dilatation of the Eustachian tube during middle ear surgery : Study planning and first experiences during recruitment]. HNO 2017; 64:237-42. [PMID: 27002857 DOI: 10.1007/s00106-016-0146-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Eustachian tube dysfunction is considered a major contributor to chronic middle ear disease. In clinical case series, the results of balloon dilation (balloon Eustachian tuboplasty, BET) as a treatment for Eustachian tube dysfunction have been reported. OBJECTIVE This study aims to analyze whether patients undergoing planned surgery for chronic middle ear disease would benefit from additional BET. METHODS In a randomized controlled, patient and observer (not surgeon)-blind clinical study, 100 adult patients with planned surgery for chronic middle ear disease will be investigated. Patients will be randomized into two groups, one of which (50%) will receive additional BET of the affected side during the planned surgery. Eustachian tube function will be evaluated using the Valsalva maneuver and tubomanometry according to Estève, as well as on the basis of patient reports. Various scores will be used as outcome measures, including ETS-5 (Eustachian Tube Score 5), the extended version ETS-7, and the ETDQ-7 (Seven-Item Eustachian Tube Dysfunction Questionnaire). Follow-up is at 3, 6, and 12 months. RESULTS From June to December 2015, 162 patients underwent microscopic ear surgery. Inclusion criteria were not fulfilled by 90 patients. Of the remaining 72 patients with chronic middle ear disease, 12 patients (17%) have been randomized so far, 28 (39%) did not exhibit Eustachian tube dysfunction, and 32 (44%) patients could not be included for other reasons. CONCLUSION The rate of recruitment was lower than expected. Depending on the case number calculations for the patient groups identified in the study for whom BET might be particularly beneficial, multicenter studies in specific disease groups may follow.
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Schröder S, Lehmann M, Korbmacher D, Sauzet O, Sudhoff H, Ebmeyer J. Evaluation of tubomanometry as a routine diagnostic tool for chronic obstructive Eustachian tube dysfunction. Clin Otolaryngol 2016; 40:691-7. [PMID: 25925071 DOI: 10.1111/coa.12451] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to demonstrate the reliability of tubomanometry (TMM) described by Estéve in the diagnosis of chronic obstructive Eustachian tube (ET) dysfunction. STUDY DESIGN Combined prospective and retrospective clinical study. SETTING Tertiary referral centre, affiliated to university. METHODS Two hundred and fifteen healthy subjects were examined once, 25 healthy subjects underwent TMM weekly for 6 weeks, and six healthy subjects were tested three times a day on at least three different days. The results of tubomanometry in healthy subjects were compared to data obtained from 171 patients with chronic obstructive ET dysfunction. RESULTS In healthy subjects, there was an immediate opening of the ET at 30-50 mbar with an R-value ≤ 1 in at least 94% of the cases. In patients with chronic ET dysfunction, an opening of the ET could be registered in only 42% of patients at 30 mbar and in 58% at 50 mbar. The average of the R-value in these subjects always indicated towards a delayed opening (R > 1). When measurements are repeated in the same subject with a weekly interval, the intraclass correlation (ICC) was 0.49 for the TMM with 30 mbar, 0.51 for the TMM with 40 mbar and 0.52 for the TMM with 50 mbar in healthy people. For the patients with symptoms of ET dysfunction, the ICC for up to four repeated measures was 0.50 for the TMM with 30 mbar, 0.53 for the TMM with 40 mbar and 0.54 for the TMM with 50 mbar. A complete agreement of the results in repeated measurements within seconds was present in 86% for 30 and 40 mbar and in 79% for 50 mbar. The ICC was 0.61 for the TMM with 50 mbar, 0.62 for the TMM with 40 mbar and 0.68 for the TMM with 30 mbar. CONCLUSIONS Tubomanometry can support the diagnosis of ET dysfunction. An R-value ≤ 1 indicates a regular function of the ET, an R-value >1 indicates a delayed opening of the ET, and no definable R-value means no detectable opening of the ET. TMM is a reliable and valid instrument to support the diagnosis of chronic obstructive ET dysfunction.
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Affiliation(s)
- S Schröder
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Academic Teaching Hospital University of Münster, Bielefeld, Germany
| | - M Lehmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Academic Teaching Hospital University of Münster, Bielefeld, Germany
| | - D Korbmacher
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Academic Teaching Hospital University of Münster, Bielefeld, Germany
| | - O Sauzet
- Epidemiology and International Public Health, School of Public health, Bielefeld University, Bielefeld, Germany
| | - H Sudhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Academic Teaching Hospital University of Münster, Bielefeld, Germany
| | - J Ebmeyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Academic Teaching Hospital University of Münster, Bielefeld, Germany
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Liu P, Su K, Zhu B, Wu Y, Shi H, Yin S. Detection of eustachian tube openings by tubomanometry in adult otitis media with effusion. Eur Arch Otorhinolaryngol 2016; 273:3109-15. [PMID: 26894415 DOI: 10.1007/s00405-016-3938-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/11/2016] [Indexed: 12/01/2022]
Abstract
Otitis media with effusion (OME) is a common disease and eustachian tube (ET) dysfunction is widely known to be related to the incidence of OME; however, objective evaluation tools for ET function are lacking. To evaluate ET openings by tubomanometry (TMM) in adult patients with otitis media with effusion (OME), the ET patency of 123 ears, including 63 ears of OME patients and 60 control ears, were tested using TMM and tympanometry. ET patency was evaluated by the R value and ET score, and was compared to the tympanogram results. The eustachian tube dysfunction questionnaire (ETDQ-7) was used to assess the severity of the symptoms in OME patients. The results showed that the rates of restricted opening or blocked ET under pressures of 30, 40, and 50 mbar by TMM testing were 10, 5, and 0 %, respectively (control group) and 76.19, 66.7, and 57.97 %, respectively (OME group) (p < 0.05 for all pressure groups). However, the rates were 77.42, 71.97, and 61.29 % in the type B tympanogram group, and 75, 62.5, and 46.87 % in the type C tympanogram group; no significant difference was found at each testing pressure (p = 0.821, 0.246, and 0.516; respectively) between these tympanogram groups. The mean ETDQ-7 score in OME patients was 16.40 ± 10.72, which was significantly negatively correlated with the ET score at 30 and 40 mbar (30 mbar: correlation coefficient -0.29, p = 0.025; 40 mbar: correlation coefficient -0.28; p = 0.030), but not at 50 mbar (correlation coefficient -0.013, p = 0.924). These findings showed that ET blockage or delayed opening were found in most adult patients with OME when evaluated by this innovative and semi objective TMM, testing pressures should be considered when assessing the results of TMM in OME patients.
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Affiliation(s)
- Panpan Liu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Kaiming Su
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Bijun Zhu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Yaqin Wu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Haibo Shi
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Shankai Yin
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
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27
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Schröder S, Lehmann M, Ebmeyer J, Upile T, Sudhoff H. Balloon Eustachian tuboplasty: a retrospective cohort study. Clin Otolaryngol 2015; 40:629-38. [DOI: 10.1111/coa.12429] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Schröder
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - M. Lehmann
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - J. Ebmeyer
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - T. Upile
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - H. Sudhoff
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
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28
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Smith M, Tysome J. Tests of Eustachian tube function: a review. Clin Otolaryngol 2015; 40:300-11. [DOI: 10.1111/coa.12428] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M.E. Smith
- Department of Otorhinolaryngology; Cambridge University Hospitals; Cambridge UK
| | - J.R. Tysome
- Department of Otorhinolaryngology; Cambridge University Hospitals; Cambridge UK
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