The repeatability of tests of eustachian tube function in healthy ears

Smith, Matthew; Zou, Charlie C.; Baker, Charlotte A.; Blythe, Andrew J. C.; Hutchinson, Peter J.; Tysome, James R.

doi:10.1002/lary.26534

Cited by 18 publications

(21 citation statements)

References 26 publications

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“…Two forms of ET function test were assessed as index tests: objective and semi-objective measures of ET opening, and symptom-based PROMS. Tests of ET opening for OETD (9 tests) and PETD (5 tests) were performed according to optimal methods previously identified[ 9 , 10 ] or standard procedure (PETD tests). Details of the tests of ET opening, their various methods and the repeats performed can be found in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“…All participants underwent all OETD and PETD tests in a single session, with a single assessor (MS). Although previous work suggested fatigue and test interactions were minimal[ 10 ], the index tests were applied in a partly-randomised manner; tympanometry and the nine step test were always applied first to prevent residual middle ear pressure influencing results, while the order of the other tests was randomised using an online random sequence generator[ 14 ]. PROMs were also completed in a randomised order.…”

Section: Methodsmentioning

confidence: 99%

“…Raw test data were initially analysed using descriptive statistics in accordance with diagnostic criteria described in the literature and previous work[ 9 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…For tests measured on a continuous or ordinal scale, sensitivity and specificity were calculated at pre-specified and novel diagnostic thresholds ( Table 2 , column 3). As test repetitions were employed to improve repeatability of findings[ 10 ], novel thresholds using the repetitions were generated to allow interpretation. Receiver operating characteristic (ROC) curves were also plotted and the area under the curve (AUC) estimated.…”

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: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Raw test data were initially analysed using descriptive statistics in accordance with diagnostic criteria described in the literature and previous work[ 9 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

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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“…All participants underwent all tests in a single session, with a single assessor (M.E.S.). Although previous work suggested that fatigue and test interactions were minimal [Smith et al, 2017b], the index tests were applied in a partly randomised manner; tympanometry and the 9-step test were always applied first to prevent residual ME pressure influencing results, whilst the order of the other tests was randomised using an online random sequence generator. The PROMs were also completed in a randomised order.…”

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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