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Hsieh CY, Lin WC, Lin CC, Chou YF. Combined balloon Eustachian tuboplasty/endoscopic sinus surgery for patients with chronic rhinosinusitis and Eustachian tube dysfunction. Int Forum Allergy Rhinol 2024; 14:1327-1336. [PMID: 38465787 DOI: 10.1002/alr.23341] [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: 12/06/2023] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD. METHODS This randomized controlled trial conducted in a single-institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty-five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22, modified Lund-Kennedy score, Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and serial Eustachian tube function test results were analyzed 3 months postoperatively. RESULTS The improvement (12.60 ± 6.50) in the ETDQ-7 score in the BET group was significantly higher than that in the control group (6.60 ± 5.58). The ratio of improvement in the ETDQ-7 score was also significantly higher in the BET than in the control group (92% vs. 68%, p = 0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02-28.79, p = 0.048) and a low post-modified Lund-Kennedy score (OR: 0.15, 95% CI: 0.04-0.54, p = 0.004) were significantly associated with ETDQ-7 score improvement. CONCLUSION Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD.
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Affiliation(s)
- Cheng-Yu Hsieh
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Chieh Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chung-Ching Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 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, Tzu Chi University, Hualien, Taiwan
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2
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Anastasiadou S, Bountzis P, Gkogkos DE, Karkos P, Constantinidis J, Triaridis S, Psillas G. Eustachian Tube Dysfunction Diagnostic Pathway-What Is the Current State of the Art and How Relevant Is Chronic Nasal Disease? J Clin Med 2024; 13:3700. [PMID: 38999265 PMCID: PMC11242287 DOI: 10.3390/jcm13133700] [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: 05/01/2024] [Revised: 06/06/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Eustachian tube dysfunction (ETD) presents a complex diagnostic challenge in otolaryngology, compounded by its multifaceted nature and overlapping symptoms with chronic nasal disease. This article examines the intricacies of ETD diagnosis, emphasising the necessity for a consensus on diagnostic procedures. Methods: A review of the literature was performed through the OVID research tool in the Pubmed/Medline databases to identify relevant articles that discuss eustachian tube dysfunction diagnostics as well as its correlation with chronic nasal disease. Results: The literature review harvested 201 articles, and only 51 of them were included in the full text review. A consensus statement was identified on eustachian tube dysfunction, function and diagnostics. It appears that there is significant variability in the diagnostic tools used to identify eustachian tube dysfunction. The main diagnostic approaches used are tympanometry, tubomanometry and sonotubometry, combined with the Patient-Reported Outcome Measure ETDQ-7 questionnaire to support the diagnosis of the condition. Nasal pathology is mostly absent from the retrieved studies, while ear pathology is more commonly mentioned in the current literature. Conclusions: There is no gold standard diagnostic tool to determine the presence of eustachian tube dysfunction. Further discussion, large multicentre studies and focused research are required to achieve a consensus on a diagnostic approach. The authors suggest a diagnostic pathway that combines subjective and objective diagnostic tools to determine the presence of eustachian tube dysfunction. This pathway is simple and can be used in district ENT departments, highlighting the nasal pathology relevance to ETD.
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Affiliation(s)
- Sofia Anastasiadou
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - Polyzois Bountzis
- Department of Mathematics and Physics, Universita della Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | | | - Petros Karkos
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - Jannis Constantinidis
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - Stefanos Triaridis
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
| | - George Psillas
- Department of Medicine, Achepa University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (P.K.); (J.C.); (S.T.); (G.P.)
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Alshehri S, Musleh A. Comparative Efficacy of Different Therapeutic Interventions in Eustachian Tube Dysfunctions: A Cross-Sectional Analysis. Diagnostics (Basel) 2024; 14:1229. [PMID: 38928645 PMCID: PMC11203019 DOI: 10.3390/diagnostics14121229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Eustachian tube dysfunction (ETD) affects a significant portion of the population, manifesting symptoms that impact the quality of life. Despite the prevalence of ETD, there remains a notable gap in comprehensive studies exploring the condition's dynamics within specific demographic contexts, particularly within Saudi Arabia. This study aimed to assess the prevalence and severity of ETD across different demographic groups, to evaluate the efficacy of various treatment modalities, and to identify key predictors of treatment response in a Saudi Arabian cohort. A cross-sectional study was conducted from June 2022 to May 2023 in tertiary care hospitals in the Aseer region, Saudi Arabia. Participants included adults diagnosed with ETD, assessed through clinical symptoms, otoscopic examinations, audiometric evaluations, tympanometry, and the ETDQ-7 questionnaire. The study incorporated advanced diagnostics such as nasopharyngoscopy and pressure equalization tube function tests and involved 154 participants, revealing significant variations in ETD severity, with the 46-60 age group exhibiting the highest mean ETDQ-7 score of 4.85, and urban residents displaying lower severity scores compared to rural counterparts. Pharmacological interventions were most effective, achieving the highest symptom relief and audiological improvement rates of 87.78%. Multivariate regression highlighted age, geographic location, and treatment modality as key predictors of treatment efficacy, with notable interaction effects between climate conditions and treatment types influencing outcomes. The findings underscore the heterogeneity in ETD presentation and the differential efficacy of treatment modalities.
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Affiliation(s)
- Sarah Alshehri
- Otology and Neurotology, Department of Surgery, College of Medicine, King Khalid University, Abha 61423, Saudi Arabia
| | - Abdullah Musleh
- Otolaryngology, Head and Neck Surgery Department of Surgery, College of Medicine, King Khalid University, Abha 61423, Saudi Arabia;
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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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Çallıoğlu EE, Bozdemir K, Soyyiğit Ş, Atalay S, Arslan B. The role of allergic and nonallergic rhinitis on success of type 1 cartilage tympanoplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:102-107. [PMID: 37918634 DOI: 10.1016/j.otoeng.2023.10.001] [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] [Received: 04/02/2023] [Accepted: 07/03/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To investigate the role of allergic rhinitis (AR) and non-allergic rhinitis (NAR) on success of type 1 cartilage tympanoplasty. METHODS This prospective study was conducted on 60 patients who had type 1 cartilage tympanoplasty. The patients were divided into three groups as no-rhinitis (n = 28), NAR (n = 18) and AR (n = 14) groups, based on their symptoms, skin prick tests and/or serum specific IgE levels. AR and NAR groups were treated for their rhinitis symptoms both pre- and postoperatively. The patients were followed up for a minimum of 6 months and compared for graft success rates and audiological outcomes. RESULTS Three study groups were similar for age, gender distributions and preoperative air-bone gaps (p = 0.780, p = 0.167 and p = 0.676, respectively). Postoperative graft perforation rate was 0% in no-rhinitis and AR groups while it was 16.7% in NAR group, with a significant difference among three groups (p = 0.034). The comparison of three study groups for change in the postoperative air bone gaps in comparison with preoperative air bone gaps did not yield any statistically significant result (p = 0.729). CONCLUSION Although AR does not result in failure of type 1 cartilage tympanoplasty in patients treated for rhinitis compared to the control group, NAR does. Pre- and postoperative treatment of patients for rhinitis and employment of cartilage graft may be the key factors for success of surgery in patients with AR. Further studies with a larger sample size are needed.
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Affiliation(s)
- Elif Ersoy Çallıoğlu
- Ankara Bilkent City Hospital, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey.
| | - Kazım Bozdemir
- Yıldırım Beyazıt University, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Şadan Soyyiğit
- Yıldırım Beyazıt University, Department of Allergy and İmmunology, Ankara, Turkey
| | - Saliha Atalay
- Ankara Bilkent City Hospital, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Bengi Arslan
- Ankara Bilkent City Hospital, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey
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Yu X, Zhang H, Zong S, Xiao H. Allergy in pathogenesis of Eustachian Tube Dysfunction. World Allergy Organ J 2024; 17:100860. [PMID: 38274710 PMCID: PMC10809091 DOI: 10.1016/j.waojou.2023.100860] [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: 06/01/2023] [Revised: 10/12/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Eustachian tube dysfunction (ETD) is a condition where the Eustachian tube (ET) fails to function normally, resulting in symptoms such as aural fullness, tinnitus, autophony, and hearing loss. ETD can further lead to middle ear diseases such as otitis media effusion and adhesive otitis media, which is becoming more common in the field of otology. Although the pathogenesis of ETD remains unclear, recent animal studies and clinical experiments have found allergic reactions and allergic diseases are closely related to the occurrence of ETD. As the mucosa of the ET is continuous with that of the nasopharynx and tympanic cavity, it is reasonable to assume that the immunological basis of the ET itself is similar to that of respiratory allergic diseases. However, due to the special anatomical location and complex pathogenesis of the ET, there is still no unified diagnostic gold standard. Additionally, there is an ongoing debate regarding whether ETD can be classified as a distinct disease or even an allergic disease. Furthermore, the effectiveness of anti-allergic therapy in patients with ETD is yet to be fully understood. Therefore, this review elaborates on the possible mechanisms of allergic reactions in the occurrence and development of ETD, and explores the potential role of anti-allergic therapy in managing this condition, in order to provide new insights into the pathogenesis and prevention of ETD.
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Affiliation(s)
| | | | - Shimin Zong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hongjun Xiao
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Lee M, Lee JT. Impact of Sinonasal Disease on Eustachian Tube Dysfunction. CURRENT TREATMENT OPTIONS IN ALLERGY 2023. [DOI: 10.1007/s40521-023-00327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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8
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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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Tubomanometry correlations with patient characteristics and other diagnostic tests of Eustachian tube dysfunction: a cohort study of 432 ears. Eur Arch Otorhinolaryngol 2022; 279:5153-5160. [PMID: 35381864 PMCID: PMC9519667 DOI: 10.1007/s00405-022-07358-y] [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: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
Objectives Currently, there is no consensus regarding the best protocol for diagnosing Eustachian tube dysfunction (ETD). We aimed to evaluate how patient characteristics affect tubomanometry (TMM) results. If an association between patient characteristics and TMM results exists, this should be considered in TMM interpretation. We also wanted to study if TMM correlates with other diagnostic tools of ETD. Methods A retrospective chart review was conducted on all patients with TMM results available from November 2011 to October 2020 at a tertiary referral center, including 432 ears from 219 patients. An association between diagnostic tests and patient characteristics was assessed using regression models. Spearman’s rank correlation was used to analyze correlations between diagnostic tests. Results None of the studied patient characteristics (age, gender, body mass index, smoking, sinonasal disease) was associated with TMM results except for pollen allergy (OR 1.74, 95% CI 1.15–2.63, P = 0.009). TMM results correlated with Valsalva maneuver performance (P < 0.001, ρ = 0.31) and otomicroscopic signs of inadequate middle ear ventilation (P < 0.001, ρ = 0.28). The Eustachian tube dysfunction questionnaire-7 (ETDQ-7) score did not correlate with any diagnostic method. Conclusions TMM results are unaffected by patient characteristics other than pollen allergy. Thus, TMM may be used in ETD diagnostics in a wide variety of patients with straightforward interpretation. TMM correlates with other diagnostic tests studied but not with ETDQ-7. ETDQ-7 does not seem to correlate with other diagnostic tests and appears nonspecific in ETD diagnostics.
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Mârțu C, Cozma S, Cobzeanu B, Vesa D, Butnaru C, Bularda D, Cumpătă A, Rădulescu L. Serous otitis media: Clinical and therapeutic considerations, including dexamethasone (C 22H 29FO 5) intratympanic injection. Exp Ther Med 2022; 23:125. [PMID: 34970348 PMCID: PMC8713185 DOI: 10.3892/etm.2021.11048] [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: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Serous otitis media (SOM) occurs in children and constitutes one of the most significant causes of hearing loss in young age, posing as an important risk factor for long-term hearing loss. SOM is underdiagnosed, most frequently in infants, or the appointment to the ENT doctor is delayed due to non-acute symptomatology. The aim of the present study was to assess 285 patients with SOM diagnosed within a two-year span. The etiology and pathology of hearing loss in patients with different age groups were examined. The importance of a clinical examination and tympanometry was emphasized as absolutely necessary for a correct diagnosis. Treatment targeted Eustachian Tube permeabilization for satisfactory long-term middle ear aeration. Nasal drops with vasoconstrictor drugs (phenylephrine) and disinfectant (colloidal silver 1%) were commonly used, but some patients also benefitted from dexamethasone intratympanic injection. Patients were evaluated at the end of the treatment and follow-up occurred at one month, one year and three years later.
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Affiliation(s)
- Cristian Mârțu
- ENT Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
| | - Sebastian Cozma
- ENT Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
| | - Bogdan Cobzeanu
- ENT Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
| | - Doina Vesa
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800008 Galati, Romania
| | - Corina Butnaru
- ENT Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
| | - Dragoș Bularda
- ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
| | - Adeline Cumpătă
- ENT Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
| | - Luminița Rădulescu
- ENT Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,ENT Clinic, Clinical Rehabilitation Hospital, 700613 Iasi, Romania
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Mehta NK, Ma C, Nguyen SA, McRackan TR, Meyer TA, Lambert PR. Medical Management for Eustachian Tube Dysfunction in Adults: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:849-856. [PMID: 34606099 DOI: 10.1002/lary.29878] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Medical treatment for eustachian tube dysfunction (ETD) is varied, with physician preference driving treatment choice and limited guidance for these options. An evaluation of the efficacy of medical management (MM) for ETD is warranted. METHODS A systematic review of three databases (PubMed, Scopus, and Embase) was performed through December 2020. Adults treated nonsurgically for ETD were included. Exclusion criteria were as follows: patulous ETD, ETD deriving from craniofacial anomalies, or surgical treatment. Data were extracted independently by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of continuous measures, proportions, and risk ratio was conducted. RESULTS Twelve articles were identified by systematic review, with either level 2 or 3 evidence. A meta-analysis of available data was performed on nine studies. A pooled cohort found 50.3% (95% confidence interval [CI], 41.7-59.0) of patients experienced symptomatic improvement with MM. ETDQ-7 scores improved in a clinically nonsignificant manner by -0.88 (95% CI, -1.12 to -0.64) following medical treatment. Further, MM benefited from subacute and chronic symptoms in 30% to 64% and 11% to 50% of cases, respectively. Intranasal corticosteroids (INCS) were not efficacious, improving only 11% to 18% of chronic cases. Therapies such as Politzer devices and Valsalva therapy had minimally beneficial results. CONCLUSION Our review did not find any level 1 evidence for MM of ETD in adults. Available evidence indicates INCS are ineffective for chronic symptoms and the efficacy of nonsurgical options for subacute ETD has yet to be determined. Further randomized controlled trials are needed to discern efficacy of single-agent medical therapies. Laryngoscope, 2021.
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Affiliation(s)
- Neil K Mehta
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Cheng Ma
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Theodore R McRackan
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Paul R Lambert
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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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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