Sensitivity and Specificity of Eustachian Tube Function Tests in Adults

Abstract

Objective Determine if Eustachian Tube (ET) function (ETF) tests can identify ears with physician-diagnosed ET dysfunction (ETD) in a mixed population at high sensitivity and specificity and define the inter-relatedness of ETF test parameters. Methods ETF was evaluated using the Forced-Response, Inflation-Deflation, Valsalva and Sniffing tests in 15 control ears of adult subjects after unilateral myringotomy (Group I) and in 23 ears of 19 adult subjects with ventilation tubes inserted for ETD (Group II). Data were analyzed using logistic regression including each parameter independently and then a step-down Discriminant Analysis including all ETF test parameters to predict group assignment. Factor Analysis operating over all parameters was used to explore relatedness. Results The Discriminant Analysis identified 4 ETF test parameters (Valsalva, ET opening pressure, dilatory efficiency and % positive pressure equilibrated) that together correctly assigned ears to Group II at a sensitivity of 95% and a specificity of 83%. Individual parameters representing the efficiency of ET opening during swallowing showed moderately accurate assignments of ears to their respective groups. Three factors captured approximately 98% of the variance among parameters, the first had negative loadings of the ETF structural parameters, the second had positive loadings of the muscle-assisted ET opening parameters and the third had negative loadings of the muscle-assisted ET opening parameters and positive loadings of the structural parameters. Discussion These results show that ETF tests can correctly assign individual ears to physician-diagnosed ETD with high sensitivity and specificity and that ETF test parameters can be grouped into structural-functional categories.

Balloon Eustachian Tuboplasty

“…The best estimates of the sensitivity and the specificity of Valsalva's test (55%/85%) and the Swallowing tests (52%/ 51%) for ETD are reported by Doyle et al 33 The results Pre-BET swallowing test = 12 never, 1 infrequent; week 8 = 1 never, 6 infrequent, 5 always Pre-BET Valsalva = 9 never, 2 infrequent, 1 always; week 8 = 1 never, 6 infrequent, 5 always Poe (2011) TM status recovered to normal in 2/4 with preoperative intact TM, the 2 remaining had grommets inserted when seen at follow-up.…”

Evaluation of the Turkish version of the Eustachian Tube Dysfunction Questionnaire

“…Although the importance of the intact ET for the ventilation and health of the middle ear mucosa has been known for many centuries, no diagnostic gold standard tool for ET diseases is currently available. [2] Identification of ETD is difficult, and a recent systematic review identified wide variations in the diagnostic criteria employed. [16] In recent years, new therapeutic approaches for chronic obstructive ETD have been developed in several countries.…”

“…Symptoms are often exacerbated with atmospheric pressure changes. [1,2] Patients may also experience pressure, clogged or underwater sensation, popping, ringing and crackling. Chronic ETD may result in variable middle ear pathologies, such as serous otitis media, chronic otitis media, tympanic membrane retractions, and cholesteatoma.…”

“…[3] The lack of an objective gold standard diagnostic method makes it difficult to evaluate ETD patients. [2] During clinical assessment, the medical history of the patient with ETD is critical. The presence of symptoms is important to identify the severity of ETD.…”

Eustachian tube opening measured by sonotubometry is poorer in adults with a history of past middle ear disease

“…paratubal muscle-ET vector relationships) of the ET system 6 . Using a variety of different ETF test protocols, past research reported that constitutive ETF is: poorer in patients with OME and other ME diseases when compared to age-matched subjects without disease (by manometric testing) 7-11 ; poorer in young children when compared to adults (by pressure chamber testing) 12 ; and, at all ages, downgraded during periods with extant co-morbid disease conditions that provoke inflammation in or around the ET (by 9 Step testing) 13,14 .…”