Balloon Dilation of the Eustachian Tube for Baro-Challenge-Induced Otologic Symptoms in Military Divers and Aviators: A Retrospective Analysis

Abstract

<jats:sec><jats:title>Objective:</jats:title><jats:p> To evaluate the effectiveness of balloon dilation (tuboplasty) of the Eustachian tube (BET) in active duty military personnel working in hyper- and hypobaric environments suffering from baro-challenge-induced ETD using functional outcomes. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Military divers and aviators diagnosed with persistent baro-challenge-induced ETD resulting in disqualification from performing flight and dive duties and who elected for treatment with BET were included for analysis. Posttreatment follow-up assessments were undertaken at 1, 6, and 12 months. Outcome measures included successful hyperbaric chamber testing or return to the hyper- or hypobaric environment without significant baro-challenge-induced ETD symptoms and pre- and postdilation Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Mean pretreatment duration of symptoms was 48 months (range: 3-120 months). Following treatment, 92% (12/13) of patients successfully returned to operational duties with resolution of limiting symptoms. Average return to duty time was 8.5 weeks (range: 6-24 weeks). The ETDQ-7 scores improved from a mean of 4.33 (2.57-6.57) predilation to 2.19 (1.00-4.43) postdilation ( Z = 2.73, W = 70, P = .0063). Mean duration of follow-up was 38 weeks (range: 13-70 weeks). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Eustachian tube balloon dilation appears to be a safe and highly effective treatment option for baro-challenge-induced ETD in affected military divers and aviators who work in hyper- and hypobaric environments. Further study is needed to determine whether similar results can be achieved in more diverse subject populations and to assess long-term effectiveness. </jats:p></jats:sec>

Predictive value of the Eustachian Tube Dysfunction Questionnaire‐7 for identifying obstructive Eustachian tube dysfunction: A systematic review

“…However, studies that have administered the ETDQ‐7 to cohorts of symptomatic patients who have not previously undergone tympanometry or other objective testing have found much lower rates of sensitivity (49%‐80%) and specificity of (24%‐78%) 16‐18 . Similarly, multiple studies using the ETDQ‐7 to assess the efficacy of BDET have shown significant discordance between ETDQ‐7 scores and tympanometry 15,20‐23 . When designing a study of diagnostic accuracy (determining test sensitivity and specificity), the test should be administered to a large population of individuals that are the same as that in which the test is intended to be used.…”

“…In our literature review, we identified 19 studies that used ETDQ‐7 and tympanometry to assess for response to treatment for ETD, 14 of which assessed responses to BDET (Table S2). Five of these studies had cohorts with mean baseline ETDQ‐7 scores ≥2.1 and 70% or more of patients with type A tympanograms 15,20‐23 . Twelve of these studies reported both improvements in ETDQ‐7 score and an increased proportion of type A tympanograms after BDET 15,20,21,31‐39 .…”

“… 16 , 17 , 18 Similarly, multiple studies using the ETDQ‐7 to assess the efficacy of BDET have shown significant discordance between ETDQ‐7 scores and tympanometry. 15 , 20 , 21 , 22 , 23 When designing a study of diagnostic accuracy (determining test sensitivity and specificity), the test should be administered to a large population of individuals that are the same as that in which the test is intended to be used. Guidelines have been established for designing studies to determine the diagnostic accuracy of a test.…”

“…However, a recent study by Teixeira et al 16 found that a total score of ≥14.5 on the ETDQ‐7 had a sensitivity and specificity of 54% and 78%, respectively, for predicting OETD identified by pressure chamber and inflation‐deflation testing. Additional studies have similarly called into question the sensitivity and specificity of the ETDQ‐7 17‐19 and studies of BDET have shown large numbers of patients with abnormal ETDQ‐7 scores, but normal tympanograms 20‐23 . There is a lack of a consensus regarding the ability of ETDQ‐7 to predict OETD and the degree to which ETDQ‐7 could substitute for objective measures of ET function and the diagnosis of OETD.…”

“…Additional studies have similarly called into question the sensitivity and specificity of the ETDQ‐7 17 , 18 , 19 and studies of BDET have shown large numbers of patients with abnormal ETDQ‐7 scores, but normal tympanograms. 20 , 21 , 22 , 23 There is a lack of a consensus regarding the ability of ETDQ‐7 to predict OETD and the degree to which ETDQ‐7 could substitute for objective measures of ET function and the diagnosis of OETD.…”