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Sharma A, MacDowell S, Punjabi N, Kejriwal S, Sharma V, Inman JC. Smoking Pack Years and Eustachian Tube Dysfunction. OTO Open 2024; 8:e166. [PMID: 38974178 PMCID: PMC11225076 DOI: 10.1002/oto2.166] [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: 04/17/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To determine the effect of smoking history on the risk of developing obstructive eustachian tube dysfunction (OETD). Study Design Cross-sectional review. Setting National database. Methods Data from the National Health and Nutrition Examination Survey (1999 to present) was analyzed. OETD was defined as middle ear pressure less than -100 decapascals (daPa). Nonsmokers, current smokers, with tympanometry data were analyzed. Patients under the age of 18, with myringotomy tubes, or with a sinus problem/earache/cold in the past 24 hours were excluded. The relative risks (RRs) for developing OETD were calculated for nonsmokers versus smokers and those with greater versus less than 10, 20, and 30 pack years (py). Results A total of 9472 patients met inclusion criteria (54.1% female, 75.9% non-Hispanic, mean age 43, 20.3% smokers). The RR of having OETD for smokers versus nonsmokers was 1.75 [95% confidence interval, CI: 1.45-2.11]. The RR of having OETD for patients with a 10+ py was 1.97 [95% CI 1.57-2.47], 20+ py was 2.29 [95% CI 1.76-2.95], and 30 py or greater was 2.08 [95% CI 1.49-2.90]. Conclusion In this study, smoking roughly doubled the risk of developing OETD, as represented by a single measurement of negative middle ear pressure less than -100 daPa. The definition of OETD used in this study was limited, as it did not include symptomology, and more work is needed to examine additional covariates. However, these results may guide future research to better counsel and screen patients for OETD.
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Affiliation(s)
- Arjun Sharma
- School of MedicineCalifornia University of Science and MedicineColtonCaliforniaUSA
| | - Sam MacDowell
- School of MedicineCalifornia University of Science and MedicineColtonCaliforniaUSA
| | - Nihal Punjabi
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University HealthLoma LindaCaliforniaUSA
- School of MedicineCase Western Reserve UniversityClevelandOhioUSA
| | - Sameer Kejriwal
- John A. Burns School of MedicineUniversity of HawaiiHonoluluHawaiiUSA
| | - Vikram Sharma
- College of Letters and SciencesUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Jared C. Inman
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University HealthLoma LindaCaliforniaUSA
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Herrera M, Miranda E, Villarreal I, Crespo T, Plaza G. Assessing the usefulness of tubomanometry as a diagnostic tool in Eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08724-8. [PMID: 38809266 DOI: 10.1007/s00405-024-08724-8] [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: 11/07/2023] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE This study aims to evaluate the validity and reliability of tubomanometry (TMM) in diagnosing obstructive Eustachian tube dysfunction (OETD) before balloon Eustachian tuboplasty (BET). METHODS A prospective cohort study was conducted, involving 25 patients with sinonasal pathology, 75 patients with middle ear disease, and 25 healthy subjects, totaling 250 ears. All participants underwent comprehensive physical examinations, including TMM, nasal videoendoscopy, otoendoscopy, Valsalva maneuver (VM), tympanometry, and audiometry. Additionally, various scales such as ETDQ-7 and ETS-7 were employed. Tympanometry served as the gold standard for assessing OETD, and comparisons were made among the measures across the three groups. RESULTS Among the 125 participants, 44.8% (n = 56) were female, and 55.2% (n = 69) were male, with ages ranging from 19 to 93 years (M = 48.5; SD = 15.6). In our study, VM demonstrated high sensitivity (86.3%) when tympanometry was considered the gold standard. Conversely, TMM, ETDQ-7, and ETS-7 exhibited high specificity, with ETDQ-7 showing the highest specificity (87.4%). Regarding TMM, all R values in patients within the middle ear disease group were pathological (R > 1). CONCLUSION TMM has exhibited notable specificity as a diagnostic tool compared to tympanogram and VM. Nonetheless, the combination of TMM and ETDQ-7 has enabled us to conduct a diagnostic assessment with high sensitivity and specificity for chronic OETD diagnosis.
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Affiliation(s)
- Mayte Herrera
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Estefanía Miranda
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Ithzel Villarreal
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Teresa Crespo
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Carretera del Molino 2, Fuenlabrada, 28942, Madrid, Spain.
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario La Zarzuela, Madrid, Spain.
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Faizal B, Latheef B, Kartha N. Comparison of Video Nasopharyngoscopy and Tympanometry in Suspected Eustachian Tube Dysfunction - A Prospective Study. Indian J Otolaryngol Head Neck Surg 2024; 76:1682-1689. [PMID: 38566713 PMCID: PMC10982197 DOI: 10.1007/s12070-023-04384-y] [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: 10/24/2023] [Accepted: 11/19/2023] [Indexed: 04/04/2024] Open
Abstract
Objective Tympanometry is widely used for diagnosing Eustachian tube dysfunction (ETD). However, in clinical practice, it is not uncommon to come across patients with symptoms of ETD with a normal tympanogram. Dynamic slow motion video endoscopy (DSMVE) of Eustachian tube (ET) and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) are other tools to diagnose ETD. Primary aim of the study was to compare DSMVE and tympanometry in diagnosing ETD. Secondary objective was to find an association between DSMVE and ETDQ-7. It was a prospective diagnostic validity study in the department of Otorhinolaryngology at a tertiary care centre. Patients with symptoms suggestive of ETD with intact tympanic membrane (TM) and aged above 12 years were evaluated. The study duration was 17 months. The parameters assessed were tympanic membrane(TM) retraction by otoscopy, DSMVE, tympanometry and ETDQ-7 questionnaire. To test the significance of association and difference between tympanogram and nasopharyngoscopy, Chi-Square t test and McNemar's tests were applied. Out of 107 ears, DSMVE, tympanometry, ETDQ- 7 and otoscopy detected ETD in 51, 31,70 and 57 ears respectively. DSMVE and tympanometry together detected ETD in 29 ears and did not detect in 54 ears. Both these diagnostic methods were not comparable statistically (moderate agreement- Kappa value- 0.542). Comparison of DSMVE with ETDQ-7 was statistically significant (p-value- 0.004). Video nasopharyngoscopy cannot be a stand- alone diagnostic aid for ETD. ETDQ-7 questionnaire showed higher concordance with nasopharyngoscopy than tympanometry. Diagnostic accuracy was more when all four parameters were assessed together.
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Affiliation(s)
- Bini Faizal
- Department of ENT, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India
| | - Binshy Latheef
- Department of ENT, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India
| | - Niveditha Kartha
- Department of Biostatistics, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India
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Zhang H, Zhang Q, He K, Chen M, Chen Y, Su D, Tang H, Lin W, Chen S. Dilatation Eustachian tuboplasty with a Eustachian tube video endoscope and supporting balloon. J Laryngol Otol 2024; 138:246-252. [PMID: 38084610 PMCID: PMC10876451 DOI: 10.1017/s0022215123001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate the feasibility and safety of employing a Eustachian tube video endoscope with a supporting balloon as a viable treatment and examination option for patients with Eustachian tube dysfunction. METHODS A study involving nine fresh human cadaver heads was conducted to investigate the potential of balloon dilatation Eustachian tuboplasty using a Eustachian tube video endoscope and a supporting balloon catheter. The Eustachian tube cavity was examined with the Eustachian tube video endoscope during the procedure, which involved the dilatation of the cartilaginous portion of the Eustachian tube with the supporting balloon catheter. RESULTS The utilisation of the Eustachian tube video endoscope in conjunction with the supporting balloon catheter demonstrated technical ease during the procedure, with no observed damage to essential structures, particularly the Eustachian tube cavity. CONCLUSION This newly introduced method of dilatation and examination of the Eustachian tube cavity using a Eustachian tube video endoscope and the supporting balloon is a feasible, safe procedure.
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Affiliation(s)
- Huasong Zhang
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
- Department of Otolaryngology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen Key Laboratory of ENT, Institute of ENT, Shenzhen, China
| | - Qing Zhang
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Kunwu He
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Minqi Chen
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Yucheng Chen
- School of Medicine, University of Central Lancashire, Preston, Lancashire, UK
| | - Dongliang Su
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Haobin Tang
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Weifen Lin
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
| | - Shuhua Chen
- Department of Otolaryngology, Second People's Hospital of Foshan (Affiliated Foshan Hospital of Southern Medical University), Foshan, China
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Sahin Ceylan D, Sacli Y, Gultekin G, Avsar B, Ozver AG. Do Flights Affect Hearing in Hot Air Balloon Pilots? Am J Audiol 2023:1-10. [PMID: 37992408 DOI: 10.1044/2023_aja-23-00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
PURPOSE This study aimed to reveal occupational effects on the hearing of hot air balloon (HAB) pilots and examine the relationship between the duration of experience and these effects. METHOD This study included 31 male HAB pilots and a control group of 32 male participants. Tympanometry, eustachian tube function (ETF) test, pure-tone audiometry, and transient evoked otoacoustic emission (TEOAE) tests were performed. RESULTS Pure-tone audiometry results were significantly worse at 125, 500, and 6000 Hz in the right ear and 125, 500, 4000, and 6000 Hz in the left ear in the HAB group than the control group. Although tympanometry evaluation parameters did not differ between the HAB and control groups, ETF test was significantly worse in the HAB group than the controls bilaterally. TEOAE results were significantly worse at 1000, 2000, and 4000 Hz in the right ear and 4000 Hz in the left ear in the HAB group than the controls. There was a significant positive correlation for 125, 4000, 6000, and 8000 Hz between the duration of experience and right ear hearing thresholds. For the left ear, the duration of experience showed a significant positive correlation at 3000, 4000, 6000, and 8000 Hz. When the relationship between the duration of experience and TEOAE results was evaluated, a significant negative correlation was found at 4000 Hz in the left ear. CONCLUSION In HAB pilots, in whom eustachian tube dysfunction is quite common, noise and high altitude affected hearing, especially low and high frequencies, and the duration of experience was found to be associated with hearing thresholds.
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Affiliation(s)
- Didem Sahin Ceylan
- Faculty of Health Sciences, Department of Audiology, Üsküdar University, Istanbul, Turkey
| | - Yeter Sacli
- Faculty of Health Sciences, Department of Audiology, Üsküdar University, Istanbul, Turkey
- Department of Audiology and Speech Disorders, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Gokce Gultekin
- Faculty of Health Sciences, Department of Audiology, Üsküdar University, Istanbul, Turkey
- Department of Audiology, Language and Speech Disorders, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Turkey
| | - Busemnaz Avsar
- Faculty of Health Sciences, Department of Audiology, Üsküdar University, Istanbul, Turkey
| | - Aleyna Goncu Ozver
- Faculty of Health Sciences, Department of Audiology, Üsküdar University, Istanbul, Turkey
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Sandoval M, Navarro JJ, Martínez-Beneyto P, Herrera M, Alfaro J, López F, Marco J, Plaza G. Balloon Eustachian tuboplasty for obstructive Eustachian tube dysfunction: retrospective multicentre cohort study of 248 patients. Eur Arch Otorhinolaryngol 2023; 280:4045-4055. [PMID: 36976369 PMCID: PMC10382357 DOI: 10.1007/s00405-023-07906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To present the results after balloon eustachian tuboplasty (BET) in patients with obstructive Eustachian tube dysfunction (OETD) grouped up into: baro-challenge, chronic serous otitis media and adhaesive otitis media. METHODS A retrospective study was carried out on patients who underwent BET surgery. As outcome measures, otoscopy, tympanometry, Eustachian tube dysfunction questionnaire-7 (ETDQ-7) and ability to perform the Valsalva manoeuvre were recorded at baseline and at 3, 12 and 24 months after BET. A p value of 0.05 was used to indicate a statistically significant difference for all statistical tests. RESULTS Three hundred and nineteen ears (248 patients) were included with a 3-month follow-up, 272 ears had a 12-month follow-up, and 171 ears had 24-month follow-up. Globally, a statistical significance improvement in all groups in all outcome measures was found. According to BET indication, in the baro-challenge group, there was no improvement in otoscopy, but ETDQ-7, Valsalva manoeuvre and tympanogram improved significantly. In the chronic serous otitis media group, otoscopy, ETDQ-7 and Valsalva manoeuvre were significantly improved in all the three timelines, including the avoidance of a new transtympanic tube after the BET in over 80% of cases. In the adhaesive otitis media group, Valsalva manoeuvre improved significantly, ETDQ-7 decreased and tympanogram improved but not significantly. Few mild complications were reported. CONCLUSIONS BET is an effective method for the treatment of OETD in all etiologic groups. The greatest benefit was observed in patients with baro-challenge. A long-term follow-up is recommended since the benefit seems to increase over time.
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Affiliation(s)
- Marta Sandoval
- Department of Otolaryngology, Hospital Clínic Barcelona, Universitat de Barcelona (UB), C. Villarroel 170, 08036 , Barcelona, Spain.
- Departament de Medicina i Especialitats Médicoquirúrgiques, Facultat de Medicina, Universitat de Barcelona (UB), C. Casanova 143, 08036, Barcelona, Spain.
| | - Juan-J Navarro
- Department of Otolaryngology, Hospital Universitario de Donostia, Donostia-San Sebastian, Spain
| | | | - Mayte Herrera
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jorge Alfaro
- Department of Otolaryngology, Hospital Quirónsalud Zaragoza, Zaragoza, Spain
| | - Felipe López
- Department of Otolaryngology, Hospital Sant Joan Despí-Moisès Broggi, Barcelona, Spain
| | - Jaime Marco
- Department of Otolaryngology, Hospital Clínico Universitario, Valencia, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
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Kaderbay A, Karkas A, Schmitt D, Mura T, Lavieille JP, Venail F. Balloon dilation for persistent unilateral chronic obstructive Eustachian tube dysfunction is effective: a prospective multicentre study. Eur Arch Otorhinolaryngol 2023; 280:1101-1109. [PMID: 35932313 DOI: 10.1007/s00405-022-07578-2] [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: 02/17/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Balloon dilatation of the Eustachian tube (BDET) is an option for treating chronic obstructive Eustachian tube dysfunction (COETD). In this prospective multicentric study, the main objective was to evaluate the results of BDET in unilateral COETD refractory to medical treatment. METHODS Adults with unilateral COETD whose Eustachian Tube Score (ETS) was less than 5 despite medical pressure therapy were included. The primary endpoint was the change in ETS measured at 2, 6, and 12 months after BDET. Secondary objectives were the evolution of clinical symptoms assessed by the Eustachian Tube Questionnaire (ETDQ-7), audiometry, tympanometry, and otoscopy changes after BDET. RESULTS Twenty-eight patients were included between May 2014 and December 2017 and were treated with BDET without adverse effects in three different referral centers. Population's median age was 52 (Q25; Q75: 24, 82) years. The median follow-up time was 381 (Q25; Q75: 364; 418) days. The median ETS was 2 (Q25; Q75: 1; 4) before BDET. There was a significant improvement in ETS at 2 and 6 months and 1 year after BDET (score at 1 year: 6 (Q25; Q75: 2; 8) (p < 0.0001)). There was a significant, sustained improvement in the ETDQ-7 with a score of 4.21 (Q25; Q75-3.50; 4.79) before BDET and 3.43 (Q25; Q75-2.43; 4.14) (p = 0.0012) at 1 year. There was a suggestive improvement in tympanometry results at 1 year (p = 0.025). CONCLUSION BDET provides an improvement in symptoms and objective measures assessed at 1 year in patients with COETD who have failed medical treatment. TRIAL REGISTRATION NCT02123277 (April 25, 2014).
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Affiliation(s)
- Akil Kaderbay
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - Alexandre Karkas
- Oto-Rhino-Laryngology, Head and Neck Surgery Department, Saint-Etienne University, Hôpital Nord, Saint Etienne, France
| | - David Schmitt
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Thibault Mura
- Medical Information Department, Montpellier University, CHU La Colombière, Montpellier, France
| | - Jean Pierre Lavieille
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Frédéric Venail
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.,Neurosciences Institute of Montpellier, INSERM U1298 and Montpellier University, Montpellier, France
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Characteristics of tympanogram in symptomatic Eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2023; 280:581-587. [PMID: 35796829 DOI: 10.1007/s00405-022-07503-7] [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: 04/15/2022] [Accepted: 06/09/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To identify the characteristics of tympanogram in symptomatic Eustachian tube dysfunction (SETD) patients. METHODS One hundred and twenty-four unilateral SETD patients presenting with type A tympanograms who underwent balloon dilation of the Eustachian tube (BDET) were recruited and assigned into effective BDET group and ineffective BDET group based on treatment effect. The unaffected ear in the same patient served as normal control. Fifty-one patients with sudden sensorineural hearing loss (SSHL) and 46 patients with Meniere's disease (MD) were selected for cases of non-ETD ear fullness. Demographics, 7-item Eustachian Tube Dysfunction Questionnaire score (ETDQ-7), and tympanograms were recorded and analyzed preoperatively and postoperatively. RESULTS Of the 124 SETD patients included in the study 94 (75.8%) showed good response to BDET based on decreased ETDQ-7 scores. There were no significantly differences in the values of tympanometric peak pressure (TPP) between diseased ears and healthy ears in SETD patients, as well as in SSHL and MD patients. Instead, TPP shifts (the difference between two values of TPP obtained under a Valsalva and Toynbee maneuver) were remarkably reduced in affected ears compared with those in unaffected ears in effective BDET group at baseline. Moreover, TPP shifts in these SETD ears significantly raised and reached the levels in healthy ears postoperatively. CONCLUSIONS This study demonstrated TPP shifts are decreased in a subset of SETD patients presenting with type A tympanograms and these patients are more likely to show good response to BDET.
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Maddineni S, Ahmad I. Updates in Eustachian Tube Dysfunction. Otolaryngol Clin North Am 2022; 55:1151-1164. [DOI: 10.1016/j.otc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yang HH, Alonso J, Ishiyama A, Gopen QS, Suh JD, Wang MB, Wells C, Wung V, Lee JT. Clinical Predictors of Symptom Improvement Following Eustachian Tube Balloon Dilation. Ann Otol Rhinol Laryngol 2022:34894221129912. [PMID: 36226334 PMCID: PMC10359951 DOI: 10.1177/00034894221129912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to identify clinical predictors of treatment response to Eustachian Tube Balloon Dilation (ETBD) as measured by changes in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores. METHODS One hundred thirteen patients who underwent ETBD at an institution from 2017 to 2021 completed ETDQ-7 pre- and post-operatively. We conducted multivariable regression analyses with ETDQ-7 normalization (<2.1 post-op), minimum clinically important difference (MCID) (>0.5 pre-op - post-op), and quantitative improvement in ETDQ-7 score as outcome variables. Pre-operative ETDQ-7 score, tympanogram type, chronic otitis media, chronic rhinosinusitis (CRS), inferior turbinate hypertrophy, deviated septum, allergic rhinitis, and rhinorrhea were included as covariates. Models controlled for age, sex, ethnicity, prior ear or sinus surgery, and follow-up duration. RESULTS The mean age was 49 years old. 51% were females, and all patients had pre-operative ETDQ-7 above 2.1. After a mean follow-up period of 13 months, 77% achieved MCID and 37% had normalized. Higher pre-operative ETDQ-7 score was associated with greater ETDQ-7 score improvement (B = 0.60, 95% CI = [0.37, 0.83]) and greater odds of achieving MCID (aOR = 1.65; 95% CI = [1.06, 2.59]). A history of CRS improved chances of achieving MCID (aOR = 4.53; 95% CI = [1.11, 18.55]) and a history of chronic otitis media predicted increased odds of ETDQ-7 normalization (aOR = 2.88; 95% CI = [1.09, 7.58]). CONCLUSIONS Our findings suggest that ETBD was highly effective among patients with pre-operative ETDQ-7 above 2.1. Furthermore, higher pre-operative ETDQ-7 score, CRS, and chronic otitis media predicted more favorable symptomatic benefit from ETBD. These factors may be important to consider when counseling potential candidates for this procedure.
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Affiliation(s)
- Hong-Ho Yang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jose Alonso
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Quinton S Gopen
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Christine Wells
- Office of Advanced Research and Computing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vivian Wung
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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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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Moon S, Lee Y, Jung J, Moon IS, Bae SH. Association Between Eustachian Tube Dysfunction Questionnaire-7 Scores and Eustachian Tube Function Test Results in Symptomatic Patients With a Normal Drum. J Audiol Otol 2022; 26:142-146. [PMID: 35538865 PMCID: PMC9271737 DOI: 10.7874/jao.2021.00654] [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] [Received: 11/25/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives We investigated the clinical validity of and correlation between the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores and the eustachian tube function test (ETFT) results in patients with a normal drum. Subjects and Methods The study included 49 patients (93 ears) with unilateral or bilateral ear fullness over >3 months. All patients were administered the ETDQ-7 survey and underwent the ETFT on the same day. The receiver operating characteristic (ROC) curve and the association between the results were statistically analyzed. Results ETDQ-7 scores were not significantly correlated with the ETFT results or with middle ear pressure. ETDQ-7 scores in patients with eustachian tube dysfunction (ETD) were significantly higher than those in patients with normal ETFT results (p=0.039) when ETD was defined as a pressure change <10 daPa on the ETFT. The area under the ROC curve was 0.631, with a sensitivity of 37.0% and specificity of 89.4%. Conclusions The ETDQ-7 has limited clinical significance in patients with ETD but a normal drum. Therefore, concomitant objective tests should be performed to diagnose patients with ETD.
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Affiliation(s)
- Seojin Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yujin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Bae SH, Moon S, Jeong M, Moon IS. Revisiting the Diagnostic Performance of the Modified Nine-Step Test for Obstructive and Patulous Eustachian Tube Dysfunction. Diagnostics (Basel) 2022; 12:diagnostics12030732. [PMID: 35328285 PMCID: PMC8947718 DOI: 10.3390/diagnostics12030732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
The nine-step test is a classical method for evaluating Eustachian tube function. It directly assesses the patient’s capacity to equilibrate middle ear pressure by swallowing. However, there are insufficient studies to appraise its diagnostic performance. The purpose of this study is to evaluate the sensitivity, specificity, and cut-off value of the nine-step test in patients with obstructive Eustachian tube dysfunction (oETD) and patulous Eustachian tube (PET). Enrolled subjects were divided into three groups. Control (50 ears of healthy volunteers), oETD (19 ears with oETD), and PET (29 ears with PET). Receiver operating characteristics curve analysis was conducted to evaluate the diagnostic performance of maximal peak pressure difference (ETTmd) in the nine-step test. Both the oETD group and the PET group showed decreased ETTmd. The nine-step test showed moderate accuracy when used to diagnose oETD (area under the curve = 0.875) and PET (area under the curve = 0.769). The highest diagnostic performance was observed when the cut-off value was 13 daPa for both the oETD group (sensitivity = 73.7%, specificity = 90.0%) and the PET group (sensitivity = 58.6%, specificity = 90.0%). The nine-step test has moderate diagnostic performance for oETD and PET.
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Standring RT, O'Malley EM, Greene JB, Russell JL, McCoul ED. Balloon dilation of the Eustachian tube with a seeker-based device: A registry of 169 patients. Laryngoscope Investig Otolaryngol 2021; 6:975-982. [PMID: 34667839 PMCID: PMC8513429 DOI: 10.1002/lio2.652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To collect real-world data on the safety and effectiveness of balloon dilation of the Eustachian tube using a seeker-based device in patients with persistent/chronic symptoms of Eustachian tube dysfunction. METHODS A multicenter, prospective, single-arm registry was conducted from June 2018 through August 2020 at 10 US centers, including tertiary care and private practices. Primary endpoints included mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and the serious related adverse event rate. Secondary endpoints include changes in middle ear assessments, surgical intervention rate, and changes in Sino-Nasal Outcome Test and Work and Activity Impairment (WPAI) questionnaires. RESULTS A total of 169 participants were treated with balloon dilation of the Eustachian tube, with 166 and 154 participants completing the 6-week and 6-month follow-ups, respectively. Repeated measures analysis of the change in ETDQ-7 scores indicated statistically significant improvement (-2.1; 95% CI -2.40, -1.84; P < .0001) at 6-month follow-up. The minimum clinically important difference of improvement was achieved by 85% of participants at 6 months. Four nonserious adverse events were reported. Middle ear functional assessments were improved in the majority of participants with abnormal baseline findings. There were no statistically significant differences in the change from baseline ETDQ-7 scores between participants who had concurrent procedures and those who did not. WPAI scores demonstrated significant improvement. CONCLUSION Real-world evidence supports the clinical studies demonstrating that balloon dilation of the Eustachian tube with a seeker-based device is a safe and effective procedure to treat ETD symptoms. LEVEL OF EVIDENCE 3.
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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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Abstract
Interpretation of tympanometry commonly relies on the historical convention of classifying findings according to large and arbitrary threshold shifts of tympanometric peak pressure (TPP). This convention had value for prior generations of otolaryngologists in diagnosing severe, chronic middle ear disease requiring surgical intervention but may not be well suited for the present-day evaluation of less severe disease. The existing definition of a type C curve (less than -100 daPa) is likely insensitive to detect subtle abnormalities, including some presentations of obstructive eustachian tube dysfunction. The accuracy of clinical diagnosis may be improved by reporting the absolute values of TPP and moving beyond classification according to arbitrary thresholds.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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