The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

Abstract

ObjectiveThe objective is to describe characteristics of patients diagnosed with patulous Eustachian tube (PET) using the Diagnostic Criteria proposed by Japan Otological Society, and to evaluate the efficiency of objective tests to determine patent Eustachian tube.Study designRetrospective.SettingTertiary referral center.SubjectsA retrospective survey of medical records in Sen-En Rifu Hospital identified 78 ears of 56 patients with “Definite PET” diagnosed by the JOS Diagnostic Criteria between January 2017 and December 2017.MethodInitial diagnosis, aural symptoms (voice autophony, aural fullness and breathing autophony), tubal obstruction procedures (posture change and pharyngeal orifice obstruction) and objective findings (tympanic membrane movement, Tubo-Tympano-Aerodynamic Graphy (TTAG) and sonotubometry) were evaluated. In addition, sonotubometry with postural change (Ohta’s method), sitting CT and a newly devised PHI-10 score were also examined.ResultsVoice autophony, aural fullness, and breathing autophony were observed in 93.6%, 87.2%, 78.2%, respectively. In 91% of the ears, PET symptoms improved by postural change from sitting to the lying / forward-bending position. Synchronous movement of the TM upon respiration was observed in 69.1% of the ears. Positive findings of TTAG were observed in 75.6% of ears. Positive findings of sonotubometry were found in 55.1% of ears. Sonotubometry with postural change (Ohta’s method), when the cut-off value of over 10dB was used, was positive in 45.2% of ears. Newly devised PHI-10 score representing severity of subjective symptoms classifying patients into no handicap, mild handicap, moderate handicap and severe handicap were observed in 12.2%, 10.8%, 18.9% and 58.1% of ears, respectively. The evaluation of the extent of patency of the ET by sitting CT indicated completely open, closed-short, and closed-long, in 68.6%, 11.4% and 21.4% of ears, respectively. Compared to the closed group, the completely open group had a significantly higher frequency of positive breathing autophony, positive sonotubometry, and positive Ohta’s method.ConclusionThe characteristics of main symptoms and the efficiency of various tests in PET diagnosis were analyzed based on data obtained from “Definite PET” patients diagnosed by the JOS Diagnostic Criteria. The greater the availability of tests to evaluate PET, the greater the opportunities to diagnose “Definite PET”. In particular, tests measuring pressure transmission between the nasopharynx and middle ear, such as TM observation and TTAG, are more sensitive than sonotubometry measuring sound transmission.

Autophony in inpatients with anorexia nervosa or avoidant restrictive food intake disorder

“…The high prevalence of self-reported autophony symptoms found in our study is suggestive of PET in this patient population. Symptoms of autophony were often accompanied by symptoms compatible with "aural fullness," as previously described in patient cohorts with known PET (Kawamura et al, 2019;Ward et al, 2017). Weight loss from any cause is among the most frequently cited risk factors for PET.…”

Untersuchung standardisierter Anamnesefragebögen zur Diagnostik und Differenzierung von obstruktiven und klaffenden Tubenfunktionsstörungen

“…Er wurde lediglich zur Schweregradeinteilung genutzt und nicht als eigenständiges diagnostisches Instrument. Dabei gaben 12,2 % keine relevanten Beschwerden im PHI-10 an und 58,1 % eine höchstgradige Beeinträchtigung [6].…”

Place of Tubomanometry in Patulous Eustachian Tube Diagnosis

“…Several diagnostic tools have been developed for the analysis of eustachian tube function, but none is reliable enough for gold‐standard diagnosis of patulous ET. The Japan Otological Society suggested reliable and reproducible clinical diagnostic criteria to classify patients with probable or certain PET 15,16 . The Eustachian Tube Dysfunction Patient Questionnaire (EDTQ‐7) self‐questionnaire 17 is also used to assess dysfunction of the ET, even though Van Roeyen et al 18 reported low performances in the diagnosis of PET.…”

“…The Japan Otological Society suggested reliable and reproducible clinical diagnostic criteria to classify patients with probable or certain PET. 15,16 The Eustachian Tube Dysfunction Patient Questionnaire (EDTQ-7) self-questionnaire 17 is also used to assess dysfunction of the ET, even though Van Roeyen et al 18 reported low performances in the diagnosis of PET. Sonotubometry has been used since 1978 5 for PET diagnosis.…”