Interpretation of Normal and Abnormal Tympanogram Findings in Eustachian Tube Dysfunction

Abstract

Objective To characterize the relationship between objective tympanogram values and patient-reported symptoms and associations with common comorbid conditions. Study Design Cross-sectional study with prospective data collection. Setting Tertiary medical center. Methods Patients undergoing routine audiometric evaluation between October 2018 and June 2019 were included. Participants with temporomandibular joint dysfunction, inner ear hydrops, and similar conditions were excluded. Symptoms were assessed with the 7-item Eustachian Tube Dysfunction Questionnaire. Demographics and medical comorbidities were recorded from the medical record. Analysis of tympanometric peak pressure (TPP), demographics, and comorbidities was performed to determine associations with clinically significant eustachian tube dysfunction (ETD) symptoms. Results A total of 250 patients were included with similar demographics: 101 (40.4%) in the asymptomatic group and 149 (59.6%) in the symptomatic group. The median (interquartile range) TPP was –10 (20) daPa and –25 (100) daPa in the asymptomatic and symptomatic groups, respectively. A diagnosis of rhinitis was more likely to be associated with significant ETD symptoms (adjusted odds ratio, 2.61; 95% CI, 1.23-5.63). A subgroup analysis revealed that symptomatic patients with normal TPP values were negatively skewed as compared with asymptomatic patients. This symptomatic group had a higher prevalence of rhinitis and chronic rhinosinusitis than the asymptomatic group. Conclusion Patients with symptoms of ETD may have a TPP within a range typically considered normal per conventional standards. This suggests that the currently accepted interpretation of tympanometry findings may be insensitive for the diagnosis of less severe cases of ETD.

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

“…Symptoms such as ear pain, fullness, and popping may present with a number of conditions such as migraine, 40 superior semicircular canal dehiscence, Meniere's disease, temporomandibular disorders (TMJ), 41 sinus disease, sore throat, or dental pain that may be unrelated to Eustachian tube function. McCoul et al suggested that the presence of normal tympanometry with positive ETDQ‐7 scores may be due to insensitivity of the currently accepted interpretation standards for tympanometry 42 . It is an important point that objective measures of Eustachian tube function such as otoscopy, tympanometry, or tubomanometry are imperfect measures.…”

“…McCoul et al suggested that the presence of normal tympanometry with positive ETDQ‐7 scores may be due to insensitivity of the currently accepted interpretation standards for tympanometry. 42 It is an important point that objective measures of Eustachian tube function such as otoscopy, tympanometry, or tubomanometry are imperfect measures. However, given the number of conditions that may cause the relatively nonspecific symptoms of OETD and how hard it can be to exclude certain conditions, such as TMJ, objective measures of OETD such as tympanometry will always remain critical for accurate diagnosis.…”

Balloon dilation of the Eustachian tube with a seeker‐based device: A registry of 169 patients

“…In the future, the historic criterion of an abnormal tympanogram for diagnosis of ETD may be further refined to reflect the potential for varying degrees of obstructive ETD among patients with type A tympanograms. 19 Statistically and clinically significant improvements were noted in the WPAI and SNOT-22 scores after BDET. The WPAI is a validated measure of work impairment, 15 and in our population, statistically significant improvements were seen in the presenteeism, productivity loss, and activity impairment components of the WPAI at both…”

Association of a standardized measure of nasopharyngeal inflammation with Eustachian tube dysfunction questionnaire score

“…8 Some patients may present with symptoms of ETD yet have normal otologic exams and tympanometry, which highlights the need for additional diagnostic tools. 9 Other conditions like temporomandibular joint disorder and endolymphatic hydrops can manifest similar symptoms, which can make accurate diagnosis a challenge. 10 Although there exist several objective tests of ET function such as tubomanometry and sonotubometry, none are readily available nor practical for clinical use by most otolaryngologists.…”

“…Although the diagnostic evaluation of ETD continues to evolve, it has conventionally been multimodal with contributions from history and physical examination (including pneumatic otoscopy), nasal endoscopy, and audiometry with tympanometry 8 . Some patients may present with symptoms of ETD yet have normal otologic exams and tympanometry, which highlights the need for additional diagnostic tools 9 . Other conditions like temporomandibular joint disorder and endolymphatic hydrops can manifest similar symptoms, which can make accurate diagnosis a challenge 10 .…”