Diagnostic criteria for Patulous Eustachian Tube: A proposal by the Japan Otological Society

Kobayashi, Toshimitsu; Morita, Masahiro; Yoshioka, Satoshi; Mizuta, Kunihiro; Ohta, Shigeto; Kikuchi, Toshiaki; Hayashi, Tatsuya; Kaneko, Akihiro; Yamaguchi, Nobumasa; Hashimoto, Sho; Kojima, Hiromi; Murakami, Shingo; Takahashi, Haruo

doi:10.1016/j.anl.2017.09.017

Cited by 55 publications

(54 citation statements)

References 61 publications

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“…The first reason for this is the intermittent nature of obstructive and patulous ETD in some individuals, as ET function may vary over even a relatively short period[ 10 ]. If clinical suspicion is high, repeat testing on another occasion is recommended in test-negative ears, to improve the likelihood that intermittent ETD is detected[ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway

et al. 2018

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Background and aimsEustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD.MethodsIndex tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results.ResultsThe expert panel diagnosis and PROMs results correlated with each other, but not with ET function measured by tests of ET opening. All index tests were found to be feasible in clinic, and acceptable to patients. PROMs had very poor specificity, and no diagnostic value. Combining the results of tests of ET function appeared beneficial. The latent class model suggested tympanometry, sonotubometry and tubomanometry have the best diagnostic performance for obstructive ETD, and these are included in a proposed diagnostic pathway.ConclusionsETD should be diagnosed on the basis of clinical assessment and tests of ET opening, as PROMs have no diagnostic value. Currently diagnostic uncertainty exists for some patients who appear to have intermittent ETD clinically, but have negative index test results.

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Section: Discussionmentioning

confidence: 99%

Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway

et al. 2018

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“…Moreover, objective findings were also evaluated by TM movement, auscultation of voice sounds, TTAG, and sonotubometry. Multiple outcomes should be used because there is no single tubal function test or observation available at this time to evaluate ET function accurately . Postoperative objective findings were generally in good accord with the main outcome using the PHI‐10.…”

Section: Discussionmentioning

confidence: 89%

“…All patients fulfilled the inclusion and exclusion criteria (Table ). All patients were diagnosed by the diagnostic criteria proposed by the Japan Otological Society . These criteria use the terms “definite PET” and “possible PET.” Definite PET is defined as cases of PET with certainty, and possible PET is defined as cases with possibility but less certainty.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

et al. 2019

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Objectives/Hypothesis: To report the efficacy and safety of transtympanic plugging of the eustachian tube (ET) using a silicone plug (Kobayashi plug) for chronic patulous ET (PET).Study Design: Prospective and multicenter trial conducted in which 30 PET patients were resistant to at least 6 months of conservative treatment.Methods: The efficacy and safety of 28 and 27 patients, respectively, were analyzed. All patients fulfilled inclusion and exclusion criteria. The primary end point used the patulous eustachian tube handicap inventory-10 (PHI-10), and the secondary end point used ET function tests such as sonotubometry, tubo-tympano-aerodynamic-graphy, and respiratory movement of the tympanic membrane and auscultation of voice sounds transmitted from the nose through the ET to the external auditory canal at 3months after surgery.Results: PHI-10 scores were 34.4 AE 4.2, 6.4 AE 9, and 5.7 AE 8.6 at screening, and 3 and 6 months after surgery. Twentythree cases (82.1%, 95% confidence interval: 63.1%-93.9%) were judged as successes. There were five cases (17.2%) of middle ear effusion, four cases (13.8%) of tympanic membrane perforation, and one case of tinnitus due to surgery to remove the plug. No severe or life-threatening complications were found.Conclusions: This study revealed the efficacy and safety of silicone plug insertion for severe PET patients.

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“…A wing-like protrusion was designed for each tail of the plug to prevent descent into the nasopharynx, a problem frequently experienced by patients using the prototype plug, which lacked wing-like protrusions (13) . This surgery is usually performed in cases of intractable “Definite PET” diagnosed by the JOS Diagnostic Criteria (16) , (17) ( Table 1 ) and resistant to at least six months of various conservative treatment methods (18) . We have completed a prospective multicenter clinical trial in Japan supported by the development of New Drugs and Medical Devices (Japan Medical Association) from the Japan Agency for Medical Research and development, AMED.…”

Section: Treatment Of Petmentioning

confidence: 99%

Management of Patulous Eustachian Tube

Ikeda

Kikuchi

Oshima³

et al. 2020

JMA J

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Patients with patulous Eustachian tubes (PET) suffer from annoying aural symptoms, such as voice or breath autophony, and aural fullness due to the ET’s abnormal patency. It may lead to an enormous reduction in quality of life. Various treatment methods, including conservative and surgical therapy, have been reported. In most cases, conservative treatment is sufficient to relieve patients of aural symptoms. However, some chronic and severe cases are resistant to traditional conservative therapy. Recently performed prospective and multicenter trials revealed the efficacy and safety of a silicone plug (Kobayashi plug) insertion for patients with severe PET. Patulous Eustachian tube handicap inventory-10 (PHI-10), tubal obstruction procedures, sitting computed tomography (CT), and ET function tests (tubo-tympano-aerodynamic graphy (TTAG) and sonotubometry) are useful for diagnosis as well as selecting candidates for surgery in severe cases.

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Diagnostic criteria for Patulous Eustachian Tube: A proposal by the Japan Otological Society

Cited by 55 publications

References 61 publications

Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway

Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

Management of Patulous Eustachian Tube

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