Eustachian Tube Ventilatory Function Research Articles

Re: “The Effects of Hypoxia on Middle Ear Pressure Regulation” by Alshukry et al.

High Altitude Medicine & BiologyVol. 21, No. 2 Letters to the EditorFree AccessRe: “The Effects of Hypoxia on Middle Ear Pressure Regulation” by Alshukry et al.Avi ShupakAvi ShupakAddress correspondence to: Avi Shupak, MD, Unit of Otoneurology, Lin Medical Center, 35 Rothschild Avenue, Haifa 3515209, Israel E-mail Address: shupak@012.net.ilUnit of Otoneurology Lin and Carmel Medical Centers, and The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel.Search for more papers by this authorPublished Online:17 Jun 2020https://doi.org/10.1089/ham.2020.0018AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear Editor,I have read with great interest the article by Alshukry et al. (2020) entitled “The Effects of Hypoxia on Middle Ear Pressure Regulation.” The authors reported that mild systemic hypoxia of 95% SO2 would hamper Eustachian tube function as reflected by increased latency between pressure application in the nasopharynx and the measurement of a pressure change in the ear canal. The main role of the Eustachian tube is middle ear ventilation enabling pressure equalization with the ambient atmosphere. This function is modulated by physiological stimuli having sensory and effector components of feedback circuits between the middle ear and Eustachian tube (Eden et al., 1990). In that regard, the most likely sensory component includes those associated with chemoreception involving detection of altered oxygen and carbon dioxide tensions. One would wonder why mild hypoxia, which increases the ventilatory drive mediated by chemoreceptors, would have the opposite effect on the Eustachian tube ventilatory function?I would like to draw the attention of interested readers to our previous publications related to the effects of middle ear cleft hypoxia and systemic hyperoxia on the Eustachian tube function, which unfortunately were not cited or discussed in Alshukry et al. article. In these studies on the cynomolgus monkey model, the Eustachian tube function was evaluated by the forced response and inflation–deflation tests. When flushing the middle ear with hypoxic gas mixture of 12% oxygen 88% nitrogen we found lower opening, steady-state, and closing pressures, lower passive and active resistance, and greater dilatory efficiency of the Eustachian tube for the forced response test. In addition, for applied middle ear overpressure, the maximum pressure change during a swallow, the average pressure drop for all swallows, and the percentage of the applied pressure equalized were greater under hypoxic condition (Shupak et al., 1996). Under systemic condition of breathing 100% oxygen, higher opening, closing, and steady-state pressures were observed. Also, the percentage of the applied pressure equalized, and the maximal pressure change on a single swallow in the deflation test were both lower under hyperoxic conditions (Shupak et al., 1997). These results demonstrate that in contrast to Alshukry et al. (2020) findings, hypoxia would improve Eustachian tube function, whereas hyperoxia might impair it.ReferencesAlshukry A, Lagier C, Della Vedova C, Salburgo F, Lavieille JP, and Montava M. (2020). The effects of hypoxia on middle ear pressure regulation. High Alt Med Biol 21:99–104. Link, Google ScholarEden AR, Gannon PJ, and Laitman JT. (1990). Mechanisms of middle ear aeration: anatomic and physiologic evidence in primates. Laryngoscope 100:67–75. Crossref, Medline, Google ScholarShupak A, Tabari R, Swarts JD, Bluestone CD, and Doyle WJ. (1996). Effects of tympanic-cavity oxygen and carbon-dioxide tensions on the eustachian tube ventilatory function. Laryngoscope 106:221–224. Crossref, Medline, Google ScholarShupak A, Tabari R, Swarts JD, Bluestone CD, and Doyle WJ. (1997). Effects of systemic hyperoxia on eustachian tube ventilatory function. Laryngoscope 107:1409–1413. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Volume 21Issue 2Jun 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Avi Shupak.High Altitude Medicine & Biology.Jun 2020.210-210.http://doi.org/10.1089/ham.2020.0018Published in Volume: 21 Issue 2: June 17, 2020Online Ahead of Print:April 6, 2020PDF download

Conformity between sonotubometry and tympanometry in examining eustachian tube ventilatory function in adults with normal hearing

Sonotubometry is a noninvasive, easy-to-perform test for examining the ventilatory function of the Eustachian tube, and it can be performed in subjects with intact or perforated tympanic membranes. To examine the ventilatory function of the Eustachian tube, three components, namely acoustic intensity (amplitude), frequency, and the duration of Eustachian tube opening, are assessed as parameters. On the contrary, tympanometry measures the ventilatory function of the Eustachian tube on the basis of changes in middle ear pressure. This study examined the conformity between sonotubometry and tympanometry as tools for evaluating Eustachian tube ventilatory function in adults with normal hearing. In this cross sectional study of 40 subjects with normal hearing, sonotubometry was performed via 10 s of wet swallowing, and tympanometry was performed following the Toynbee or Valsalva maneuver. The data were analyzed using the kappa test and McNemar’s analysis. Significant differences and weak conformity were noted for the measurements of Eustachian tube ventilatory function between sonotubometry and tympanometry. The results indicated that sonotubometry can be an option for evaluating Eustachian tube ventilatory function.

Different reactions of human nasal and Eustachian tube mucosa after hyperbaric oxygen exposure: a pilot study

Impairment of Eustachian tube function has been observed after hyperbaric oxygen treatment as well as after diving on oxygen used as breathing gas. The aim of the present study was to evaluate the influence of hyperbaric oxygen exposure on Eustachian tube ventilatory function and airflow characteristics of the nose. Six police task force divers performing two consecutive dives within a regular training schedule on oxygen were examined. Middle ear impedance, and nasal airflow velocities before and after diving as well as on the morning after the dive day were measured. Middle ear impedance decreased overnight in comparison to pre-dive values (P = 0.027) as well as compared to the value after the first dive (P = 0.032). Rhinoflowmetry did not reveal any changes of nasal airflow velocities related to the dives. Furthermore, no association between middle ear impedance and nasal airflow velocities was found. An impairment of Eustachian tube ventilatory function was obtained after hyperbaric oxygen exposure during dives employing oxygen as breathing gas. This impairment, however, was not associated with altered airflow characteristics of divers' noses. Thus, it seems unlikely that hyperbaric oxygen exerts an effect on the nasal mucosa similar to that on the Eustachian tube mucosa.

A simplified approach to assess variations in Eustachian tubal ventilatory function by Bortnick-Miller apparatus in chronic otitis media cases (dry) before surgery

Aim: The aim of this study is to see the different functional gradings of Eustachian tube ventilatory function as assessed by Bortnick-Miller (B-M) apparatus in chronically diseased middle ears (dry cases) planned to undergo tympanoplasty and to correlate the results with the past experiences. Materials and Methods: This study consisted of 29 cases of chronic suppurative otitis media, inactive stage having central perforation. Tubal function was evaluated by B-M apparatus based on ability of tube assimilating the applied positive and negative pressure. Tubal opening pressure was noted after applying positive pressure while residual intratympanic pressure after 10 swallows was recorded after applying negative pressure. Results: This study revealed that results of tubal manometry in diseased ears cover a wide spectrum of normal function to partial/non-function. 51.72% of cases were able to equalize applied negative pressure, 41.39% partially equalizing, while 6.89% of cases were completely unable to equalize applied negative pressure. Conclusion: Our results of aspiration method with the help of BM apparatus explicitly suggest that tubal function in chronically diseased ears deviates from that of normal ears. It perpetually reflects that varied results of middle ear reconstructive surgeries could be anticipated in accordance with different tubal function gradings.

Sonotubometry in Children With Otitis Media With Effusion Before and After Insertion of Ventilation Tubes

To test the outcome of sonotubometric measurement in children with otitis media with effusion (OME) before and after insertion of ventilation tubes. Eustachian tube ventilatory function was tested in children with OME. To test validity, sonotubometric testing took place before insertion of ventilation tubes (ie, glue ear) and 1 week and 3 months after grommet insertion (ie, aerated middle ear cavity). One set of measurements consisted of 10 acts of swallowing. The outcomes of the tests were compared with those in otologically healthy controls. All testing took place during an outpatient clinic otorhinolaryngologic consultation in a city hospital. Thiry-three children with OME and 61 otologically healthy children (controls). Surgical grommet insertion. Sonotubometric measurements before and after insertion of ventilation tubes. Fewer incidences of the opening of the eustachian tube were recorded in the measurements before insertion of ventilation tubes compared with after insertion. The number of incidences of opening recorded after insertion of ventilation tubes did not significantly differ from measurements in healthy controls. Sonotubometric testing in children with OME reveals a low incidence of eustachian tube opening. Shortly after insertion of ventilation tubes, sonotubometry revealed no difference in eustachian tube ventilatory function compared with measurements in healthy controls. The low incidence of eustachian tube opening before grommet insertion may be attributable to decreased opening or dampening of the sound transmission by the middle ear fluid.

Results of Sonotubometry in Testing Eustachian Tube Ventilatory Function in Children with Cleft Palate

In previous studies, an updated sonotubometry setup was tested in healthy adults and children to test its validity and reproducibility in the assessment of the ventilatory function of the eustachian tube (ET). The results were promising, but further investigations were needed to confirm the discriminative potential of this sonotubometry setup. Our objective in the present study was to test the discriminative potential of an updated sonotubometry setup in children with cleft palate. The ET ventilatory function was tested in 56 children with cleft palate, ie, children with impaired ET function, and compared to the outcomes in 61 healthy children who served as a control group. All of the children were between 5 and 9 years of age. To test the reproducibility, we performed the sonotubometric testing in 2 sessions of 10 acts of swallowing each. Spearman's coefficient was used to test the correlation between the 2 sets of measurements. The results of measurements in the cleft palate group were compared with those in the otologically healthy control group and analyzed by means of a Mann-Whitney U test. Opening of the ET was recorded in at least 1 of the 2 measurement sessions in 57% of the children with cleft palate, as compared to 82% in the control group. The mean number of openings was lower in the cleft palate group than in the control group (respectively, 2.3 versus 3.7 out of 10; p < .01). The first and second sessions were highly correlated in both the cleft palate group and the control group, with Spearman's coefficients of, respectively, 0.96 and 0.89. The results of this study show that this updated sonotubometry setup has the potential to discriminate between these groups of children with various states of ET ventilatory function. Furthermore, the results of this study once again show that this updated sonotubometry setup is capable of assessing ET ventilatory function in both healthy children and children with cleft palate and that the measurements are highly reproducible. A persistent disadvantage remains that in 18% of the 61 healthy children there was no ET opening that could be registered, which still prohibits a definite assessment at the individual level.

Reproducibility of sonotubometry as Eustachian tube ventilatory function test in healthy children

To devise a simple and reliable diagnostic procedure to test Eustachian tube function routinely in an ENT outpatient setting. One method to measure ET ventilatory function is sonotubometry. The reproducibility of a recently updated sonotubometry set-up was tested in healthy children. The test population comprised 61 school children aged from 6 to 8 years. Only otologically healthy children were included. Health state was established by means of a 12-item questionnaire. To test reproducibility, sonotubometric testing took place in two sessions of 10 acts of swallowing each. Spearman's coefficient was used to test the correlation between the two sets of measurements. All testing took place at a primary school in a nearby village. Opening of the ET was recorded in at least one of the two measurement sessions in 82% of the children. The first and second sessions were highly correlated, with a Spearman's coefficient of 0.89. In otologically healthy children, opening of the ET was recorded frequently using the updated sonotubometry set-up. Measurement results had high reproducibility. Therefore, the test forms a useful method to assess ET ventilatory function in otologically healthy children. The performance of this updated version needs to be established in children with otological diseases.

Validation of sonotubometry in healthy adults

Frequent active opening of the eustachian tube (ET) allows ventilation of the middle ear and equilibration of pressure changes. Active opening is accomplished by the contraction of the paratubal muscles during swallowing. Because a disturbance of the ventilatory function of the ET may contribute to the development of otitis media with effusion, it is important to investigate ET function. Sonotubometry can be used to detect whether the ET can open or not during swallowing acts. We developed a sonotubometer to test ET ventilatory function in 36 healthy adults. The width of the test signal frequency was between 5500 and 8500 Hz (centre frequency of 7000 Hz) and the loudness was 95 dB. To test reproducibility, testing took place in two sessions of 10 swallowing acts each. Opening of the ET could be registered in 91.6 per cent of the subjects in at least one of the two measurements. The first and the second measurements were highly correlated, with a Spearman's coefficient of 0.907. We confirmed that there is generally a good ventilatory ET function in otologically healthy adults, although, in a few cases, ET opening was not registered. Furthermore, we confirmed that our sonometric test equipment had acceptable reproducibility. Sonotubometry is a promising method for assessing ventilatory ET function. Research is ongoing to test the discriminative power of sonotubometry in children with various otological conditions.

Sonotubometry: Eustachian Tube Ventilatory Function Test: A State-of-the-Art Review

Disturbance of any of the ET functions may contribute to the development of otitis media. Sonotubometry measures the ventilatory function using sound. The qualities of sonotubometry as a test for eustachian tube ventilatory function have been studied by various investigators. The development of the method is described in the review, and a summary of the study results is provided to make an estimate of the diagnostic potential of this eustachian tube function test. The English-language literature on the topic was searched systematically by Medline and Pubmed using the following key words: ventilatory function, eustachian tube, sonotubometry, and function test. There were no limits for the year of publication. Articles that described the method itself (validity, reproducibility, diagnostic value) were studied in detail. All the articles described in study selection were used for this review. The technique of sonotubometry has been improved gradually over the years. The results of sonotubometry are at least as good as those of other function tests. However, because the results still tend to be ambiguous in children and otitis media is most common in this population, the reproducibility and application of sonotubometry must be evaluated further. Sonotubometry has great advantages over other function tests, but it is not used routinely to assess eustachian tube ventilatory function because its value for clinical practice has not yet been adequately demonstrated. The review showed that sonotubometry can be improved further and that efforts to do so seem justified because it forms a particularly promising method to assess eustachian tube function in children with suspected eustachian tube disease.

Late-phase allergy and eustachian tube dysfunction

Objective: This study investigated the role of late-phase allergy in the development of otitis media with effusion. Methods: Brown Norway rats were sensitized to ovalbumin and later challenged transtympanically. Eustachian tube ventilatory function was assessed 2, 4, 8, 24, 28, and 32 hours postchallenge by measuring passive opening and closing pressures, active clearance of positive and negative middle ear pressure, and mucociliary clearance. Results: The results demonstrate that exposure to transtympanic allergen induces eustachian tube dysfunction and subsequent formation of effusion. Allergic animals showed significant increases in passive and active opening pressures, as well as a decreased ability to actively clear middle ear pressure. Finally, the mucociliary was significantly impaired in all sensitized rats exposed to transtympanic allergen. Conclusion: These findings demonstrate that late-phase allergy leads to significant eustachian tube dysfunction and subsequent formation of effusion by impairing the ventilatory and clearance functions of the eustachian tube. (Otolaryngol Head Neck Surg 2001;125:339-45.)

Effects of systemic hyperoxia on eustachian tube ventilatory function.

Middle ear negative pressure and effusions, decreased middle ear compliance, and abnormal tympanometry results have been described after diving on oxygen. Middle ear gas hyperoxia has been shown to down-regulate the eustachian tube ventilatory function (ETVF). The purpose of the present study was to investigate to what extent systemic hyperoxia in the face of air-equivalent middle ear gas composition might interfere with the ETVF. ETVF was investigated in four young adult female cynomolgus monkeys by the forced-response and inflation-deflation tests using air while the animals breathed either room air or 100% normobaric oxygen. Higher opening, closing, and steady-state pressures were observed under systemic hyperoxia. The percentage of the applied pressure equalized, and the maximal pressure change on a single swallow in the deflation test were both lower under hyperoxic conditions. The results show that systemic hyperoxia might impair ETVF. This observation adds to our understanding of the pathophysiology of middle ear dysfunction observed after diving on oxygen.

Effects of middle ear oxygen and carbon dioxide tensions on eustachian tube ventilatory function.

The objective of this study was to determine the effect of middle ear (ME) gas composition on eustachian tube ventilatory function (ETVF). ETVF was evaluated by using forced-response and inflation-de-flation tests in four alert cynomolgus monkeys during test sessions with different gas compositions. The ME was flushed with one of the four gas mixtures: 1. air; 2. 12% oxygen, 88% nitrogen; 3. 100% oxygen; and 4. 5% carbon dioxide, 21% oxygen, and 74% nitrogen before and during testing. The results documented lower opening, steady-state, and closing pressures, lower passive and active resistance, and greater dilatory efficiency following ME flushes with the hypercarbic and hypoxic gas mixtures when compared to the others. Also, for applied ME overpressure, the maximum pressure change during a swallow, the average pressure drop for all swallows, and the percentage of the applied pressure equalized were greater under hypoxic and hypercarbic conditions. These results show that ME gas composition affects ETVF and support feedback modulation of ME pressure regulation.

Evidence in infants with cleft palate that breast milk protects against otitis media: Paradise J.L.; Elster B.A.; Tan L.Pediatrics (USA) (1994) 94/6 I (853–860)

Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusion-free on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media.We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first.Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P < .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable.Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.

Evidence in Infants With Cleft Palate That Breast Milk Protects Against Otitis Media

Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusion-free on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media. We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first. Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P < .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable. Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.

Eustachian Tube Function and Mastoid Pneumatization

We investigated the relationship between the Eustachian tube's ventilatory function and the pneumatization of mastoid air cells. In 65 adults (66 ears) with chronic otitis media (COM), ventilatory Eustachian tubal function was evaluated by the inflation-deflation test, while the area of mastoid air cells was measured by the rectangular method on X-ray film. Group I represents good function in both the inflation and deflation tests. Group II represents good function in the inflation test but poor function in the deflation test. Group III represents a poorly functioning Eustachian tube in both tests. The opening pressure in Group III was statistically higher than in Group I and Group II. The area of mastoid air cells in Group I was statistically larger than in Group III. There was no correlation between opening pressure and area of mastoid air cells in COM. Postoperative failure of the tympanic membrane was frequently found in Group III. We discuss the tubal function and pneumatization of mastoid air cells.

Effect of upper respiratory tract infection on eustachian tube ventilatory function in the preschool child.

A prospective tympanometric and microbiologic study of 28 pre-schoolchildren was undertaken to better define the effect of acute URI on induction of eustachian tube dysfunction. Significant negative middle ear pressure was present in 12.7% of tympanograms from well children. However, abnormal tympanograms were detected during 74.7% of acute URIs. The abnormality was present on day 1 or 2 of illness in the majority of cases; 10.1% of illnesses were complicated by OME. Respiratory viruses or Sp were etiologically implicated in 40.5% of illnesses; isolation rates of Pn and HF from well and ill children were similar. Although colonization of the nasopharynx of well children with Pn or HF was associated with a higher incidence of abnormal middle ear pressure, colonization with Pn or HF during URI did not influence the frequency of tympanogram abnormality.

Manometric measurement of Eustachian tube ventilatory function.

Although initial manometric studies of Eustachian tube ventilatory function in both normal and abnormal ears suggested that this technique provided an accurate physiologic assessment of ventilatory function, recent studies have questioned the physiologic nature of these tests. In an effort to clarify this controversy, the tubal ventilatory capacity of 51 ears in which Eustachian tube function was clinically normal was assessed manometrically. Similar measurements were made in 18 ears in which Eustachian tube function was clinically normal except for a complaint of aural fullness. This group showed poorer ventilatory function than normal ears, but the most striking result was the inability of over 50% of the normal group to equilibrate negative pressure to a level within the normal range of 0 to -50 mm H2O. It is postulated that Eustachian tube ventilatory function exhibits a range of individual variability such as is characteristic of other biologic systems.

Longitudinal assessment of Eustachian tube function in children.

Eustachian tube function was evaluated in 27 children (32 ears) with tympanostomy tubes at 6-week intervals for 12 to 30 months. Using a modified inflation-deflation test of passive and active ventilatory function, it was found that the ears had persistent functional obstruction. Most ears exhibited no significant change in tubal function throughout the observation period. There was no difference in the ventilatory function when the nasal airway was congested (other than due to purulent upper respiratory tract infection) and not congested. However, significant seasonal effects on Eustachian tube ventilatory function were recorded: function was poorer in the winter than in the summer. No relationship was found between Eustachian tube ventilatory function and the age of the child.

An examination of variables involved in tympanometric assessment of eustachian tube function in adults.

Eustachian tube function was assessed tympanometrically in a group of normal adults. A pressure-swallow technique of assessing Eustachian tube ventilatory function was administered with positive and negative induced pressures in the range of +/- 200 mm to +/- 400 mm H2O. This study indicated the relative efficiency of measurement of Eustachian tube function under each of the experimental conditions. Recommendations of procedures for further clinical data collection are presented.

Clinical assessment of eustachian tube ventilatory function.

AbstractThe persisting incidence of middle ear effusion subsequent to the advent of antibiotics and the development of a sophisticated microsurgical armamentarium and technique has been the continuing impetus to arrive at a method for evaluating eustachian tube function. The aspiration test developed by Flisberg, et al., has been thought to test most satisfactorily physiological tubal function by measuring the capability of the tube to equilibrate an induced negative pressure in the middle ear by deglutition.This technique was utilized to evaluate tubal function in 92 ears with tympanic membrane perforations. In 21 ears perforation was the result of trauma, recent but not acute. The remaining 71 ears have persistent perforations as a result of chronic otitis media; 18 ears were actively draining when they were tested; 53 ears were dry, without evidence of drainage, at the time of test.This investigation has shown that ears presenting dry perforations as a result of chronic otitis media demonstrate a continuum of function from full capability to reduce negative pressure to total inability to reduce such pressures; that no discernable difference in eustachian tube performance exists, however, among ears with quiescent perforations as a result of trauma or chronic otitis media; that active drainage manifesting an inflammatory mucosal process further severely compromises tubal ventila‐tory function by facilitating “locking” at high negative pressures; that age, while exerting some influence on the tube, in that adults show some increased capability for tubal function and some compromise in such function is present in childhood, that the influence of age is hardly striking; that tubes manifesting a total inability to reduce negative pressure do tend to be associated with ears with recurrent or refractory mucosal disease.However, this technique may also be challenged. It has been suggested that normal tubes should be capable of reducing negative pressure to within zero to ‐50 mm H2O. Other studies, however, have shown little correlation between middle ear pressure as measured by tympanometry and tubal function tested by this method. A disparity also exists in the high incidence of poor tubal function by this technique as compared to the success rates in tympanoplasty in existing large series; that while some investigators are able to demonstrate the tendency for poorer results in ears with poor tubal function testing, prediction of surgical success and failure is feasible in only a minority.It is the conclusion of this study that a negative result in testing for eustachian tube function is not a contraindication to tympanoplasty, and it is difficult to enthusiastically support this test as being capable of measuring the physiological normal of the tube or as a prognostic indicator to results in tympanoplasty.