Balloon dilation of the Eustachian tube (BDET) is increasingly used to treat pediatric obstructive Eustachian tube dysfunction (OETD); however, its broader adoption is limited by the cost of commercially available devices. Standard endovascular balloons may offer a cost-effective alternative, but pediatric outcome data are limited. This study evaluated the feasibility, safety, and early clinical outcomes of pediatric BDET performed using standard endovascular balloon catheters. This prospective clinical study included 14 pediatric patients (≥5.5 y) with bilateral OETD (28 ears) who remained symptomatic despite optimized medical therapy and prior standard surgical interventions. All patients underwent endoscopic BDET using standard endovascular balloon catheters. Outcome measures included symptom severity assessed by the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), otoscopic findings, tympanometric classification, pure-tone audiometry, and functional Eustachian tube assessment using the Valsalva maneuver. Analyses accounted for bilateral observations using mixed-effects and generalized estimating equation models. Procedural feasibility and complications were recorded. Fourteen patients (28 ears; mean age 11.3 ± 3.6 y) were analyzed. On the basis of predefined success criteria incorporating symptom improvement, audiological outcomes, functional assessment, and otoscopic findings, the overall success rate was 75%. Linear mixed-effects modeling demonstrated significant improvement in ETDQ-7 scores (mean reduction: -1.921; P < 0.001) and pure-tone average (mean improvement: -15.243 dB; P < 0.001). Generalized estimating equation analysis showed significant improvement in otoscopic findings (OR: 0.030; P < 0.001), tympanometric status (OR: 0.101; P = 0.001), and dynamic endoscopic grade (OR: 0.010; P < 0.001). A positive Valsalva maneuver was achieved in 71.4% of ears ( P < 0.001). No complications occurred in 89.3% of ears; adverse events were minor and self-limited, with no major complications observed. Pediatric BDET using a standard endovascular balloon catheter seems feasible and safe in children with obstructive Eustachian tube dysfunction refractory to conventional management. Early outcomes are comparable to those reported for commercially available systems, supporting the potential role of a lower-cost balloon alternative in appropriately selected pediatric patients. Further controlled studies are warranted to confirm long-term safety and durability of outcomes.

To investigate the efficacy of balloon Eustachian tuboplasty (BET) plus tympanostomy tube insertion (TTI) combined with Eustachian tube auto-inflation (ETA) in patients with radiation-induced otitis media with effusion (RI-OME) secondary to nasopharyngeal carcinoma (NPC). Prospective randomized controlled trial. Class A tertiary general hospital. Sixty-one patients with RI-OME with a follow-up for 12 months. Patients were enrolled and randomly assigned to the control group (BET+TTI) and treatment group (BET+TTI+ETA). The efficacy was evaluated by Eustachian Tube Scores (ETS), Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and hearing threshold. All patients were followed up at 1, 6, and 12 months post-surgery. Both groups demonstrated significant postoperative improvements in ETS, ETDQ-7 scores, and hearing threshold compared with baseline values (P<0.05), with maximal therapeutic effects observed at 6 months followed by gradual decline. Notably, the treatment group showed significantly greater improvements in all 3 parameters than the control group at 6-month and 12-month follow-up (P<0.05). During the 12-month follow-up period, BET+TTI surgery demonstrated efficacy in improving both Eustachian tube function scores and hearing parameters in RI-OME patients, with adjunctive ETA therapy providing additional therapeutic enhancement.

Middle ear pathology and Eustachian tube dysfunction are commonly seen in patients with cleft lip and palate (CLP). Various palatoplasty techniques aim to improve velopharyngeal function, but their impact on middle ear recovery remains incompletely understood. The aim of this study was to compare the recovery of middle ear pathology between two primary palatoplasty techniques through audiometric evaluation. A retrospective cohort study of 211 CLP patients was conducted who underwent primary palatoplasty between January 2023 and December 2024 at a tertiary cleft center. Participants were divided into two groups based on the surgical technique received: Group 1 underwent Modified Two-flap palatoplasty with Intravelar veloplasty, while Group 2 underwent Modified Furlow's palatoplasty. The primary outcome was middle ear status assessed through standardized audiometric evaluation performed preoperatively and 6 months postoperatively. Chi-square test was used for categorical variables and independent t-tests was applied for continuous variables, with p < 0.05 considered significant. After propensity score matching, 76 matched pairs were analyzed with comparable baseline characteristics. Middle ear pathology recovery at 6 months was significantly higher in the Furlow's group (61.8%, 47/76) versus Bardachs group (23.7%, 18/76; p < 0.001). Type A tympanograms increased to 61.8% versus 15.8% respectively. Positive otoacoustic emissions improved to 56.6% versus 22.4% (p < 0.001). Multivariable analysis confirmed Furlow's superiority (OR 5.23, 95% CI 2.58-10.61, p < 0.001). Modified Furlow's palatoplasty demonstrated significantly better recovery of Eustachian tube function compared to Modified Two-flap palatoplasty with Intravelar veloplasty at 6 months post-surgery. This superior outcome is likely attributable to more radical transposition of the Tensor veli palatini muscle in the Furlow's technique, resulting in improved middle ear ventilation and better audiological outcomes in CLP patients.

Assessing Eustachian tube passage and active opening with the Valsalva maneuver: Diagnostic performance, limitations, and its complementary role with sonotubometry.

Tympanoplsty with or without mastoidectmy is highly effective treatment of chronic otitis media in padiatric age group.

Maxillary transverse deficiency is commonly associated with posterior crossbite, crowding, nasal obstruction, and altered craniofacial development. Rapid maxillary expansion (RME) and slow maxillary expansion (SME) are established orthodontic procedures used to correct transverse discrepancies. In recent years, increasing attention has been directed toward the influence of maxillary expansion on hearing and voice because of the close anatomical and functional relationship between the maxilla, nasal cavity, nasopharynx, Eustachian tube, and vocal tract. This review summarizes current evidence regarding the effects of maxillary expansion on auditory and vocal functions. Expansion of the maxilla increases nasal cavity width and improves nasopharyngeal dimensions, which may enhance Eustachian tube function and middle ear ventilation. Several studies have reported improvements in conductive hearing loss, tympanometric findings, and air-conduction thresholds in children with pre-existing middle ear disorders following RME. However, studies involving individuals without baseline auditory impairment often demonstrate minimal or no significant changes. Maxillary expansion may also influence voice production and resonance by altering the dimensions of the oral and nasal cavities. Reported effects include temporary increases in nasalance and minor alterations in acoustic parameters such as formant frequencies. Most voice-related changes are transient and tend to normalize due to neuromuscular adaptation. Evidence regarding long-term vocal effects remains inconsistent. Although existing literature suggests potential benefits of maxillary expansion on hearing and voice, limitations such as small sample sizes, methodological variability, and insufficient long-term data prevent definitive conclusions. A multidisciplinary approach involving orthodontists, otolaryngologists, and speech therapists is recommended when managing patients with associated auditory or speech concerns.

To evaluate the association between chronic rhinosinusitis (CRS) and Eustachian tube dysfunction (ETD) using subjective and objective measures, and the relationship between disease laterality and Eustachian tube function (ETF). Prospective cohort study. Single tertiary medical institution. Eighty-five CRS patients who were candidates for FESS underwent comprehensive evaluation. Subjective assessments utilized the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and Sino-Nasal Outcome Test-22 (SNOT-22). Objective evaluations comprised a 9-step inflation-deflation tympanometric test scored by maximal peak pressure difference (MPD), nasal endoscopy using the modified Lund-Kennedy (MLK) system, sinus CT scored via the Lund-Mackay (LM) system, and acoustic rhinometry measuring the second minimal cross-sectional area (MCA2). Patients were stratified into fair (<14) and poor (≥14) ETF groups based on ETDQ-7 scores. Correlations were analyzed using Pearson coefficients, receiver operating characteristic (ROC) curves, and Bland-Altman plots, with additional assessment of CRS lateralization effects. Poor ETF (ETDQ-7 ≥ 14) occurred in 36.5% of patients and was associated with higher SNOT-22 (median 48.0 vs 31.5, P < .001). ETDQ-7 correlated moderately with SNOT-22 total (r = 0.65). No significant differences in MPD, MLK, LM, or MCA2 were found between fair and poor ET function groups. ROC analysis identified optimal cut-offs of ETDQ-7 > 15 (AUC 0.761) and SNOT-22 > 45 (AUC 0.802). Laterality analysis showed no significant side-specific associations. In CRS, sinonasal symptom burden shows only a moderate association with patient-reported ETD. Higher ETDQ-7 scores often parallel greater SNOT-22 severity, suggesting that PROMs may help identify patients in whom ETD symptoms are partly influenced by CRS.

This study aimed to evaluate peripheral auditory function and Eustachian tube function in individuals engaged in recreational diving compared with non-diving controls, via a multidimensional audiological assessment approach. A total of 49 participants aged 18-50 years were included, comprising 24 individuals actively engaged in scuba or free diving who reported no auditory or neurotological complaints prior to initiating diving, and 25 non-diving controls without any otologic or neurologic disorders. All participants underwent otorhinolaryngologic examination, conventional and wideband tympanometry, Eustachian tube function (ETF) testing, pure-tone audiometry, and distortion product otoacoustic emission (DPOAE) measurements. The subjective ETF was assessed via the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). Pure-tone audiometry, speech audiometry, and conventional tympanometric measurements were not significantly different between the groups (all p > 0.05). In the diver group, the middle ear resonance frequency was significantly lower in at least one ear than in the control group (p < 0.05). Objective ETF testing revealed a higher frequency of Eustachian tube dysfunction in diver group (p < 0.05), and ETDQ-7 scores were also significantly higher in this group (p < 0.05). Additionally, DPOAE measurements revealed significant group differences at higher frequencies, with reduced amplitudes observed in divers (p < 0.05). Recreational diving may be associated with subclinical alterations in middle ear mechanics, Eustachian tube function, and cochlear outer hair cell activity that are not detected by standard audiometric evaluations. The inclusion of wideband tympanometry, objective ETF testing, and high-frequency DPOAE measurements may provide complementary information for audiological evaluation of individuals engaged in recreational diving.

A machine learning prediction model was developed and validated using Clinical Multi-omics (CMO) indicators to assess the risk of postoperative complications in patients with Chronic Otitis Media (COM). This model is intended to aid in perioperative management and individualized intervention. Patients were randomly allocated into a training set (n = 237) and a validation set (n = 101) in a 7:3 ratio. A total of 21 CMO indicators, including demographic, clinical, laboratory, and imaging data, were collected. In the training set, univariate analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and multivariate logistic regression were used to identify core predictive variables. Four machine learning models-Random Forest, Logistic Regression, K-Nearest Neighbors, and Gradient Boosting Machine-were constructed using these variables. Model performance was assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Interpretability was analyzed with SHapley Additive exPlanations (SHAP). Multivariate analysis identified a history of diabetes, previous ear surgery, otorrhea, middle ear mucosal status, cholesteatoma presence, Eustachian tube function score, and preoperative C-reactive protein level as independent risk factors. Among the constructed models, the Random Forest model demonstrated superior overall performance, and the model was 0.885 in the training set and 0.853 in the validation set. The model also showed good calibration. DCA indicated significant clinical net benefit across a wide threshold probability range. SHAP analysis confirmed that a history of previous ear surgery and cholesteatoma presence were the most influential predictors. A machine learning-based prediction model for complications after COM surgery was developed and validated. The Random Forest model performed optimally, effectively predicting complication risk with favorable performance and considerable potential for clinical translation. It can serve as a promising tool for preoperative risk assessment and targeted postoperative monitoring.

Septoplasty is standard surgical procedure performed for correction of deviated nasal septum; it affects middle ear ventilation through altering Eustachian tube function. To determine the effect of septoplasty on Eustachian tube function regarding deviation side. A randomized, prospective controlled trial, in which 40 adult patients who underwent septoplasty (80 ears) were divided into: group A: 40 ears in which Eustachian tube function assessment was done on the affected side (deviated nasal septum), and 40 ears in which the function of Eustachian tube assessment was done on the contralateral side "group B". The nasal obstruction symptom evaluation (NOSE) scale was used to analyze surgical satisfaction, ventilation of middle ear was assessed via Eustachian tube functions by the 7-Item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) test scale, insufflation tests (Valsalva and Toynbee), and tympanometry. These parameters were analyzed and compared, before and after septoplasty. Among the 40 patients, the mean NOSE score was 13.68 ± 2.69 preoperatively and decreased to 5.76 ± 4.48 postoperatively; ETFQ-7 scores decreased from 12.48 ± 4.78 preoperatively to 7.56 ± 3.4 postoperatively; there were 22 functional Eustachian tubes (55%) preoperatively, which increased to 37 (92.5%) postoperatively, while dysfunctional Eustachian tubes decreased from 18 (45%) preoperatively to 3 (7.5%) postoperatively. Type-A curve tympanogram was (52.5%) preoperatively, which increased to (96.25%) postoperatively, while type-C tympanogram was (47.5%) preoperatively and decreased to (3.75%) postoperatively. Basal middle ear pressure was -33.56 daPA for group A and -29.24 daPA for group B preoperatively, and it changed to -18.96 daPA and -12.18 daPA postoperatively, respectively. Septoplasty had a beneficial impact on the Eustachian tube function "ventilation of middle ear".

Ossiculoplasty for Trauma.

Alternative Causes of Obstructive Eustachian Tube Dysfunction.

Otitis media with effusion (OME) is a common condition in children that can lead to hearing loss and developmental delays. Although tympanostomy tube (TT) placement is the standard treatment for persistent OME, recurrence after tube extrusion and the need for reoperation remain significant concerns. To evaluate the clinical effectiveness of autoinflation in reducing OME recurrence and reoperation rates after TT extrusion in pediatric patients. This prospective randomized clinical trial, conducted from September 2019 to August 2022 at a tertiary hospital, enrolled children with chronic OME who underwent TT placement with 2 years of follow-up after TT extrusion. The statistical analysis took place between March 2024 and February 2025. After TT extrusion, patients were randomized to receive autoinflation with the autoinflation device for 5 weeks or to undergo observation alone. The main outcomes were OME recurrence and reoperation rates using otoscopic and tympanometric evaluations. Sixty-six children enrolled in the study; 54 were included in the final analysis (26 in the autoinflation group and 28 in the observation group). Among 54 children (mean [SD] age, 55.5 [18.5] months; 30 [55.6%] male), the recurrence rate was 5 of 26 patients (19.2%) in the autoinflation group and much higher at 10 of 28 patients (35.7%) in the observation group (difference, 16.5 percentage points [pp]; 95% CI, -7.4 pp to 37.8 pp), while the reoperation rate was much lower in the autoinflation group at 2 of 26 patients (7.7%) compared to the observation group at 8 of 28 patients (28.6%; difference, 20.9 pp; 95% CI,-0.29 pp to 40.2 pp). In the autoinflation group, tympanometry showed minimal change from the first follow-up after TT extrusion to after 5 weeks of autoinflation therapy (type A tympanogram: 19 of 26 patients [73.1%] to 20 of 26 patients [76.9%]; type C tympanogram: 7 of 26 patients [26.9%] to 6 of 26 patients [23.1%]). In contrast, the observation group exhibited a decline in type A tympanograms (21 of 28 patients [75.0%] to 16 of 28 patients [57.1%]) and an increase in type C tympanograms (7 of 28 patients [25.0%] to 12 of 28 patients [42.9%]). In this randomized clinical trial, autoinflation after TT extrusion was safe, feasible, and associated with a reduced need for repeat surgical intervention. The observed difference in recurrence was compatible with a clinically meaningful reduction. These findings support the use of autoinflation as a noninvasive rehabilitative strategy to enhance eustachian tube function and maintain middle ear ventilation following TT extrusion. ClinicalTrials.gov Identifier: NCT07122999.

To evaluate the role of orthodontic and craniofacial orthopaedic interventions in the prevention and management of otitis media with effusion (OME), focusing particularly on rapid maxillary expansion (RME) and its implications for Eustachian tube function. A comprehensive search was conducted in PubMed, Embase, and Web of Science using a structured combination of MeSH terms by two expert researchers from inception to December 2024. Randomised and non-randomised prospective studies involving pediatric patients (2-18 years) with chronic OME were included. The effectiveness of preventive measures was compared with alternative treatments or no interventions. Study quality was assessed using the ROBINS-I v2 tool. RME emerges as a promising preventive option for managing OME particularly in patients with orthodontic indications. By addressing structural contributors to Eustachian tube dysfunction, RME improves middle ear health and complements otolaryngological interventions. Integrating orthodontic and otolaryngological strategies represents an effective multidisciplinary approach to reducing OME incidence and recurrence. Further studies are needed to confirm the long-term stability and the generalisability of these observed benefits.

This study aims to investigate the impact of baseline middle ear pressure (MEP) on the detection of Eustachian tube (ET) opening using tubomanometry (TMM) and sonotubometry (STM) in subjects with healthy ET function. Tympanometry is used to evaluate the diagnostic performance of TMM. Eighty-three healthy volunteers (166 ears) underwent tympanometry to establish balanced MEP ranges. For eligible ears, balanced MEP (b-MEP), positive MEP (p-MEP), and negative MEP (n-MEP) were induced through standardized maneuvers. All subjects completed STM and TMM under 3 MEP conditions, with tympanometry performed before and after each procedure. R -values were significantly higher under n-MEP conditions when compared with b-MEP at 30 mbar (median difference +0.22; P <0.001) and at 40 mbar (+0.13; P =0.002). Also, a significant increase in R-value was found under n-MEP conditions when compared with p-MEP at 30 mbar (+0.15; P =0.006). Concurrently, ET opening detection by TMM was significantly higher under n-MEP at 30 mbar (OR 3.67; P <0.05). This enhancement was also evident at 40 mbar and 50 mbar (n-MEP vs. p-MEP: OR 2.54 and 2.78, respectively; all P <0.05). TMM showed high sensitivity under n-MEP (0.93 to 0.97), but limited specificity (0.20 to 0.60). STM outcomes revealed no significant variations across MEP conditions (all P >0.05). The baseline MEP significantly affects TMM assessments, with elevated R -values under n-MEP indicating delayed ET opening, while improving TMM sensitivity. Conversely, STM maintains consistent ET opening rates and acoustic parameters across MEP conditions.

Otitis media with effusion (OME) is a highly prevalent condition in pediatric patients, affecting up to 55% of children under two years of age. Several factors contribute to its development, including immature Eustachian tube function, allergic factors, and adenoidal obstruction, making treatment optimization challenging yet essential due to the potential consequences of this condition. The primary objective of this study is to analyze the influence of various etiological, clinical, and therapeutic variables on functional auditory outcomes using a binary logistic regression model. Secondarily, the study aims to identify whether these variables are associated with adverse outcomes such as the need for hearing aids or delayed language development. This is a single-center, observational, descriptive, and retrospective cohort study conducted between 2020 and 2023, with a 12-month follow-up period. Functional outcomes, risk of complications, and their timing were analyzed, among other variables. A total of 95 patients were included, with a mean age of 3.82 ± 1.94 years, predominantly male (64.21%, n = 61) and with bilateral involvement (85.26%, n = 81). A mean hearing improvement of 9.07 ± 20.07 dB was observed at the end of the follow-up. Multivariable regression analysis revealed that the PTA at 6 months is a significant predictor of long-term auditory outcomes (p = 0.036), while adenoidectomy acts as a protective factor (p = 0.042). Chronic otitis media (COM), PTA at 12 months, and persistent OME were associated with a higher risk of requiring hearing aids (p = 0.036, 0.009, and 0.006, respectively), while the latter two were also linked to a greater risk of delayed language development (p = 0.030 and 0.011). The study identifies that PTA at 12 months, COM, and persistent OME significantly increase the risk of needing hearing aids and speech therapy. Elevated PTA at 6 months is an early predictor of poor prognosis, while adenoidectomy, despite being a protective factor for auditory outcomes, may be associated with earlier complications. Evenmore, this work illustrates how real-world clinical and audiological data can be translated into actionable personalized care pathways, supporting more precise clinical decisions and improving long-term outcomes in children with OME.

Background: The majority of cleft palate patients have been reported to suffer from otitis media with effusion (OME). The improvement of velopharyngeal function (VPF) after palatoplasty might be evidence for the improvement of the function of the Eustachian tube. The improvement of the function of Eustachian tube by palatoplasty has been reported to be effective for the treatment of OME simultaneously with the insertion of a ventilation tube into the tympanic membrane. There are only a few reports that clearly show the association between improvement of VPF and improvement of OME after palatoplasty. In this study, we discussed whether the improvement of VPF after palatoplasty in cleft palate patients with OME improved OME. Methods: Twenty-six patients with cleft palate were included in the study. We retrospectively extracted the information of cleft type, gender, surgical technique, and presence of OME risk factors from electronic medical records. We also investigated the recurrence of OME and the improvement level of VPF at 36 months postoperatively. OME was assessed based on the otolaryngologist's findings in electronic medical records, with a good prognosis group with no symptom of OME, or a recurrence group with prolonged or recurrent OME. Results: At 36 months after palatoplasty, 19 of 23 patients (82.6%) were in the OME good prognosis group and four (17.4%) were in the OME recurrence group. The rate of patients with recurrent OME did not differ significantly by the degree of improvement of VPF. This study indicated that clear association between other risk factors for OME and OME recurrence could not be shown. Conclusion: We observed that most patients with cleft palate who underwent palatoplasty showed a good prognosis for OME at 36 months after surgery. However, further studies are needed to investigate the impact of different surgical techniques on the improvement of OME and the degree to which VPF improves, as well as the effect of each OME risk factor.

Background: Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent otorrhea through a perforated tympanic membrane.Deviated nasal septum (DNS), one of the most common nasal pathologies, leads to ear pathology, mainly due to eustachian tube dysfunction (ETD), altering middle ear pressure.Objectives: To assess the relation between unilateral chronic otitis media and ipsilateral DNS.Materials and methods: This is a prospective study conducted in Ballari Medical College & Research Center, Ballari.Fifty (50) patients with unilateral CSOM, selected randomly, were enrolled for this research.A detailed history taking and systematic clinical examination, including otoscopy and anterior rhinoscopy, were done for all patients.Collected data was entered into a specially designed case record pro forma.Results: In our research, we observed that out of 50 individuals, 30 individuals (60%) had ipsilateral DNS.Statistical analysis demonstrated a significant correlation between unilateral CSOM and ipsilateral DNS, with a p-value of 0.004.Conclusion: A statistically significant correlation was established between unilateral CSOM and ipsilateral DNS.Deviated nasal septum emerges as a critical factor influencing the persistence of CSOM, advocating for the evaluation and management of nasal and paranasal sinus conditions before surgical intervention.Addressing nasal diseases preoperatively will be useful for optimizing treatment outcomes in CSOM management.Clinical significance: The findings highlight the importance of preoperative assessment and correction of nasal pathologies, like DNS, to improve ET function and optimize outcomes in CSOM management.

Abstract Background: Bariatric surgery, widely considered the most effective surgical treatment for obesity and its complications, carries risks and benefits, including a common issue with Eustachian tube defects. This study aims to evaluate the association between weight loss following bariatric surgery and Eustachian tube dysfunction (ETD). Materials and Methods: This descriptive cross-sectional study included 257 patients who underwent bariatric surgery at a tertiary center in Riyadh, Saudi Arabia, between January 2020 and December 2021. Data were obtained through an online questionnaire administered through telephone interviews, which included demographic details, clinical presentation, and an Arabic-validated version of the (ETD-7) questionnaire. Participants with a history of ear disease, symptoms, or previous ear surgery were excluded from the study. Results: In a study involving 314 initial subjects, 257 patients were included, while 58 were excluded due to various criteria, such as previous ear surgery, a history of ETD, or missing data. The demographic analysis revealed a diverse age distribution, with the majority falling between 31 and 50 years and a higher representation of females (63.4%) compared to males (36.6%). Most patients were nonsmokers (83.7%). The body mass index (BMI) analysis is pre- and post-bariatric surgery showed a significant reduction, with a mean preoperative BMI of 45.87 and postoperative BMI of 29.41. Only 8.9% of patients experienced ETD postsurgery, while 91.1% did not report such issues. Conclusion: Our findings suggest that sudden and severe weight loss does not seem to correlate with the development of ETD; more research with more extended follow-up periods using tubal dysfunction testing is needed to uncover the potential underlying causes of these symptoms.

To investigate and identify the most reliable method for assessing Eustachian tube function (ETF) in pediatric patients with otitis media with effusion (OME). A total of 49 ears from pediatric patients diagnosed with OME and 32 healthy control ears were included. The assessment methods for ETF included acoustic immittance measurement (AIM), tubomanometry (TMM), Eustachian tube score (ETS), sonotubometry (STM), and tubo-tympano-aerodynamic-graphy (TTAG). AIM was used as the standard, and the consistency of TMM, ETS, STM, and TTAG was tested with sensitivities of 75.6%, 60.0%, 82.05%, and 53.85%, specificities of 94.4%, 97.2%, 66.67%, and 83.33%, and Youden indices of 0.700, 0.572, 0.487, and 0.372, respectively. ROC analysis revealed an optimal diagnostic threshold for TMM values of 4.5. Significant differences in AIM results were observed between groups stratified by this TMM-based diagnostic threshold (χ2 = 36.690, P = .000). When the TMM values were <4.5, the rate of normal Eustachian tube opening was 5.55%, which increased to 75.56% for values ≥4.5. TMM demonstrates superior diagnostic performance compared to ETS, STM, and TTAG. The combination of AIM and TMM is recommended for the evaluation of ETF in pediatric patients with OME.