The Performance of Patient-reported Outcome Measures as Diagnostic Tools for Eustachian Tube Dysfunction

Smith, Matthew; Cochrane, I.; Donnelly, Neil; Axon, Patrick; Tysome, James R.

doi:10.1097/mao.0000000000001931

Cited by 18 publications

(41 citation statements)

References 37 publications

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“…While the PROMs consistently showed good sensitivity, the 71.0% to 81.8% overall PROM positive rate in the cohort resulted in very poor specificity. It is likely that the nature of the symptoms covered by the PROM items meant that patients with conditions such as hearing loss, Meniere’s Disease or temporomandibular joint (TMJ) dysfunction also scored highly, as has previously been demonstrated[ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Details of the tests of ET opening, their various methods and the repeats performed can be found in Table 1 . Two PROMs were completed by patients: the CETDA[ 11 ] and ETDQ-7[ 12 ]. Composite measures of ET function were also assessed: the 5- and 7-item Eustachian Tube Scores (ETS and ETS-7) were calculated for each case, combining patient-reported symptoms with tubomanometry results in a simple numerical scale, with lower scores indicative of OETD[ 13 ].…”

Section: Methodsmentioning

confidence: 99%

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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%

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

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“…The response to item 6 of the Cambridge ETD assessment (CETDA), "Uncomfortable pressure or pain felt in your ear during an aeroplane flight or on passing through a tunnel," was analysed to provide an ordinal measure of baro-challenge-induced symptoms. The CETDA is a 10-item patient-reported outcome measure (PROM) for ETD, with each item scored according to a 5-point Likert score [Smith et al, 2018a]. The CETDA was completed for the tested ear only.…”

Section: Identification Of Patients With Significant Oetd-related Symmentioning

confidence: 99%

“…Some of the selected ET function tests allowed the assessment of passive or active ET opening in isolation (see fourth column, Table 1). In addition to the opening tests, two ETD-specific PROMs were completed by each patient: the CETDA [Smith et al, 2018a] and the ETDQ-7 [McCoul et al, 2012].…”

Section: Et Function Testsmentioning

confidence: 99%

Eustachian Tube Function in Patients with Symptoms on Baro-Challenge

Smith¹,

Bance²,

Tysome³

2020

Audiol Neurotol

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Objectives: To explore the relationship between aural symptoms during baro-challenge and the underlying measured Eustachian tube (ET) function. Two key questions were addressed. (1) In patients who have features of obstructive ET dysfunction, is there a measurable underlying difference in ET function between those who experience severe symptoms on baro-challenge and those that do not? (2) What is the diagnostic value of ET function tests in the identification of patients with severe symptoms on baro-challenge? Methods: Patients with symptoms of obstructive ET dysfunction were recruited, with the presence of aural symptoms on baro-challenge established via the clinical history and analysis of the Cambridge ET Dysfunction Assessment, a patient-reported outcome measure (PROM). ET function tests were assessed in each patient: 9 objective and semi-objective measures of ET opening, and 2 symptom-based PROMs. The tests' results were grouped by type of ET opening assessed, generating passive and active dysfunction scores. Individual test results were assessed for diagnostic accuracy in reference to features in the history or PROM-based evidence of symptoms on baro-challenge. Results: Both passive and active opening of the ET was significantly reduced in ears with a history of pain on baro-challenge. Some patients had apparent severe obstructive ET dysfunction without symptoms on baro-challenge, whilst others had symptoms but normal test results. No individual test of ET opening was of diagnostic value in predicting those ears likely to experience pain or exacerbated symptoms on baro-challenge. Conclusion: The relationship between aural pain during baro-challenge and ET function appears more complex than had been assumed, with pain possibly related to factors other than just ET function.

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“…The 7-Item ETD Questionnaire (ETDQ-7) has undergone initial validation trials with translation into several languages23, 24, 25, 26, 27 and has gained use as an outcome measure in both clinical and research use. The 10-item Cambridge ETD Assessment (CETDA) was developed and validated more recently 28 . However, both have been found unable to discriminate between patients with obstructive and patulous ETD 26 , 28 .…”

Section: Assessment Of Eustachian Tube Functionmentioning

confidence: 99%

Advances in Eustachian tube function testing

Smith

Bance

Tysome

2019

World j. otorhinolaryngol.-head neck surg.

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Obstructive and patulous Eustachian tube dysfunction provide a significant diagnostic and management challenge. The development of new treatments such as balloon Eustachian tuboplasty has generated renewed interest in measuring Eustachian tube function, as a method of selecting appropriate patients for intervention, and measuring their treatment outcomes.This review summarises recent findings relating to Eustachian tube function assessment. Increasingly it is recognised that patient reported outcome measures based on symptoms are highly non-specific and non-diagnostic, and clinical assessment alone may not permit the selection of individuals with abnormal Eustachian tube opening. Tests of Eustachian tube opening therefore may represent a practical and objective addition to patient assessment in clinic, allowing the identification of individuals with abnormal (patulous or obstructive) Eustachian tube function. A diagnostic pathway is described on this basis.More work is required to validate the described Eustachian tube function tests, and there remain individuals, such as those with dysfunction limited to pressure challenges, in whom function tests have yet to fully characterise the disorder.

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The Performance of Patient-reported Outcome Measures as Diagnostic Tools for Eustachian Tube Dysfunction

Cited by 18 publications

References 37 publications

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

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

Eustachian Tube Function in Patients with Symptoms on Baro-Challenge

Advances in Eustachian tube function testing

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