Obstructive Eustachian Tube Dysfunction Research Articles

Assessing the usefulness of tubomanometry as a diagnostic tool in Eustachian tube dysfunction.

This study aims to evaluate the validity and reliability of tubomanometry (TMM) in diagnosing obstructive Eustachian tube dysfunction (OETD) before balloon Eustachian tuboplasty (BET). A prospective cohort study was conducted, involving 25 patients with sinonasal pathology, 75 patients with middle ear disease, and 25 healthy subjects, totaling 250 ears. All participants underwent comprehensive physical examinations, including TMM, nasal videoendoscopy, otoendoscopy, Valsalva maneuver (VM), tympanometry, and audiometry. Additionally, various scales such as ETDQ-7 and ETS-7 were employed. Tympanometry served as the gold standard for assessing OETD, and comparisons were made among the measures across the three groups. Among the 125 participants, 44.8% (n = 56) were female, and 55.2% (n = 69) were male, with ages ranging from 19 to 93years (M = 48.5; SD = 15.6). In our study, VM demonstrated high sensitivity (86.3%) when tympanometry was considered the gold standard. Conversely, TMM, ETDQ-7, and ETS-7 exhibited high specificity, with ETDQ-7 showing the highest specificity (87.4%). Regarding TMM, all R values in patients within the middle ear disease group were pathological (R > 1). TMM has exhibited notable specificity as a diagnostic tool compared to tympanogram and VM. Nonetheless, the combination of TMM and ETDQ-7 has enabled us to conduct a diagnostic assessment with high sensitivity and specificity for chronic OETD diagnosis.

Combined balloon Eustachian tuboplasty/endoscopic sinus surgery for patients with chronic rhinosinusitis and Eustachian tube dysfunction.

To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD. This randomized controlled trial conducted in a single-institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty-five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22,modified Lund-Kennedy score, Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and serial Eustachian tube function test results were analyzed 3 months postoperatively. The improvement (12.60±6.50) in the ETDQ-7 score in the BET group was significantly higher than that in the control group (6.60±5.58). The ratio of improvement in the ETDQ-7 score was also significantly higher in the BET than in the control group (92%vs. 68%, p=0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02-28.79, p=0.048) and a low post-modified Lund-Kennedy score (OR: 0.15, 95% CI: 0.04-0.54, p=0.004) were significantly associated with ETDQ-7 score improvement. Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD.

Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review.

To report a novel technique in Balloon Dilation of Eustachian Tube (BDET) using an endovascular balloon (EVB), in a prospective cohort. The results are compared with reported outcomes using standard balloons. Demographic information and clinical parameters were collected prospectively fora series of patients with obstructive eustachian tube dysfunction (OETD). Balloon dilation Eustachian tuboplasty was performed under local anesthesia in a tertiary referral center, using the EVB. Systematic literature review was used for comparison, using Medline via "PubMed", "Embase", and "Web of Science". Eight OETD candidates (12 ears) were enrolled; 5 males and 3 females. Average age was 48 (range -23 to 63) years. The most common presenting symptom was aural fullness (9/12), followed by ear pressure (7/12), hearing loss (5/12) and tinnitus (4/12). Otoscopically, tympanic membrane retraction was evident in 10/12 ears, the majority of which was class II-Sade classification. Pre-operative tympanogram was type B and C in 7 and 5 ears, respectively. All BDETs were performed without complications. Post-operative tympanometry was A in 8/12 ears. Post-operatively, Eustachian Tube Dysfunction Questionnaire-7 results reduced to within normal limits (average score ≤3) in 11/12 ears (p = 0.0014). The systematic literature review included 6 papers (193 patients, 262 ETs) with comparable results, most also with little adverse effects. BDET using an EVB is a safe and effective option for OETD. It is well tolerated under local anesthesia in properly selected individuals. The reduced procedural cost may be an important factor in certain healthcare jurisdictions.

Clinical Analysis of Repeat Balloon Eustachian Tube Dilatation

Background and Objectives Obstructive Eustachian tube dysfunction (OETD) is a complex condition in which middle ear ventilation control is impaired. OETD is often not improved by medication nor by nasal washing or nasal spray. On the other hand, balloon Eustachian tube dilatation (BETD) is an effective surgery in OETD although repeating BETD is controversial as it involves additional procedure such as ventilation tube, middle ear steroid irrigation, and trans-tympanic Eustachian tube probing in some cases. This study aims to analyze the clinical differences between patients who received single BETD and repeat BETD, and to evaluate the efficacy of repeat BETD.Subjects and Method For the study, 110 single groups, and 16 repeat groups were selected from patients who underwent BETD from Nov 2019 to Aug 2022. Age, gender, underlying diseases, history of rhinitis and smoking, and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) were analyzed for the selected groups.Results There were no significant differences in gender, underlying disease, or history of rhinitis between the two groups. However, age was significantly younger in the repeat group (45.91 vs. 33.38, <i>p</i>=0.006), while smoking (5.64 vs. 1.66, <i>p</i>=0.01) was significantly higher in the single group. The rate of improvement in the ETDQ-7 was 81.3% in the single group and 69.2% in both initial and repeated surgeries in the repeat group. The complete remission rate was 60% in the single group, and 38.5% in both initial and repeated surgeries of the repeat group.Conclusion For patients who are unsatisfied with the first surgery, it is meaningful enough to recommend repeat BETD, for which additional procedures are performed simultaneously.

A Case of Subcutaneous Emphysema and Pneumomediastinum After Balloon Eustachian Tuboplasty

The Eustachian tube is a passage that connects the middle ear to the nasopharynx and regulates the pressure within the middle ear. If there is persistent inflammation in the mucosa due to infection or allergic reactions, the opening of the Eustachian tube may not function properly, leading to obstructive Eustachian tube dysfunction. If symptoms persist even after three months of conservative treatment, balloon Eustachian tuboplasty may be considered. Although rare, severe complications such as subcutaneous emphysema, pneumomediastinum, and pneumothorax can occur, but there have been no reported cases of such complications in the Republic of Korea so far. Here, we present a case of a 52-year-old male who developed subcutaneous emphysema and pneumomediastinum after undergoing balloon Eustachian tuboplasty and discuss prevention and treatment for possible complications following the procedure.

Balloon dilation improves both the hearing level and the quality of life in patients suffering from obstructive Eustachian tube dysfunction

PurposeChronic obstructive Eustachian tube dysfunction (OETD) can lead to tympanic membrane (TM) retraction and middle ear effusion (MEE) which can cause conductive hearing impairment, which among other ear symptoms can lower the quality of life (QoL). In this prospective study we assess hearing results and subjective changes in QoL following balloon Eustachian tuboplasty (BET) in treatment of OETD.MethodsTotally 25 ears with TM retraction and 18 ears with MEE due to chronic OETD underwent BET as the sole intervention. Outcomes including otoscopy, ability to perform the Valsalva maneuver, tympanometry, audiometry, Eustachian tube inflammation scale and the Glasgow Benefit Inventory questionnaire (GBI) were obtained on all patients preoperatively and 6 months postoperatively.ResultsHearing thresholds improved statistically significantly (p < 0.05) with means of 3 dB in the TM retraction group and 9 dB in the MEE group. Total GBI results indicated a positive influence on patients’ QoL. Valsalva success rate was 80% in patients with TM retraction and 67% in patients with MEE. Tympanometry results improved in 50% of TM retraction patients and in 33% of MEE patients.ConclusionsHere we demonstrated that the BET has a positive impact on patients’ conductive hearing loss and QoL in patients with TM retraction or MEE. Results were better in TM retraction group than in MEE group.

Eustachian tube balloon dilation

Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.

Outcomes of Spontaneous Cerebrospinal Fluid Leak Repair With Concurrent Eustachian Tube Dysfunction.

To compare the presentation and outcomes of patients with and without obstructive eustachian tube dysfunction (oETD) undergoing repair of lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks. Retrospective chart review. Tertiary referral center. Adults with lateral skull base sCSF leaks who underwent repairs from January 1, 2011, to December 31, 2020, were collected. Comparative statistics and effect sizes were used to compare clinical features, operative findings, and outcomes between groups. Of 92 ears from 89 patients included, 51.1% (n = 47) had oETD. There were no differences in demographics between patients with and without oETD. Mean age was 60.7 ± 13.1 versus 58.5 ± 12.8 years (d = -0.17 [-0.58 to 0.24]), mean body mass index was 33.8 ± 8.5 versus 36.0 ± 8.0 kg/m2 (d = 0.27 [-0.14 to 0.68]), and female sex preponderance was 59.6% (n = 28) versus 68.8% (n = 31; Φ = -0.09), respectively. There were no differences in the radiologic number, size, and locations of defects. Patients with oETD had less pneumatized mastoids than those without oETD (p = 0.001; Φ = 0.43). Mean change from preoperative to postoperative air pure-tone average for those with and without oETD was -1.1 ± 12.6 versus 0.1 ± 17.2 dB (d = 0.09 [-0.04 to 0.58]), respectively. Six ears (6.5%; three with and three without oETD) underwent revisions for rhinorrhea/otorrhea between 5 and 28 months postoperatively, during which four leaks were found, the two patients without leaks had oETD. The presentation of sCSF leaks and outcomes of repairs in patients with oETD do not differ from those without oETD. Although postoperative otorrhea might represent an inflammatory or infectious process in patients with oETD, reexploration is warranted if patients do not improve with conservative treatment.

Balloon Eustachian tuboplasty for obstructive Eustachian tube dysfunction: retrospective multicentre cohort study of 248 patients

ObjectiveTo present the results after balloon eustachian tuboplasty (BET) in patients with obstructive Eustachian tube dysfunction (OETD) grouped up into: baro-challenge, chronic serous otitis media and adhaesive otitis media.MethodsA retrospective study was carried out on patients who underwent BET surgery. As outcome measures, otoscopy, tympanometry, Eustachian tube dysfunction questionnaire-7 (ETDQ-7) and ability to perform the Valsalva manoeuvre were recorded at baseline and at 3, 12 and 24 months after BET. A p value of 0.05 was used to indicate a statistically significant difference for all statistical tests.ResultsThree hundred and nineteen ears (248 patients) were included with a 3-month follow-up, 272 ears had a 12-month follow-up, and 171 ears had 24-month follow-up. Globally, a statistical significance improvement in all groups in all outcome measures was found. According to BET indication, in the baro-challenge group, there was no improvement in otoscopy, but ETDQ-7, Valsalva manoeuvre and tympanogram improved significantly. In the chronic serous otitis media group, otoscopy, ETDQ-7 and Valsalva manoeuvre were significantly improved in all the three timelines, including the avoidance of a new transtympanic tube after the BET in over 80% of cases. In the adhaesive otitis media group, Valsalva manoeuvre improved significantly, ETDQ-7 decreased and tympanogram improved but not significantly. Few mild complications were reported.ConclusionsBET is an effective method for the treatment of OETD in all etiologic groups. The greatest benefit was observed in patients with baro-challenge. A long-term follow-up is recommended since the benefit seems to increase over time.

Case Report: Eustachian Tube Dysfunction after Penetrating Facial Trauma.

Traumatic conductive hearing loss (TCHL) is most commonly attributed to tympanic membrane perforations, hemotympanum, or ossicular chain disruption. These complications are generally managed conservatively for up to 6 months with good hearing outcomes. We encountered a case of penetrating facial trauma leading to TCHL because of obstructive Eustachian tube dysfunction (OETD), which is not a previously described etiology for OETD and TCHL. A lysis of scar tissue surrounding the Eustachian tube with balloon dilation was performed in our patient, resulting in resolution of conductive hearing loss. In the absence of traditional signs of TCHL, providers should consider OETD as a potential cause of TCHL. We recommend visualization of the Eustachian tube orifice and balloon dilation if clinically indicated.

Low-temperature plasma radiofrequency ablation tuboplasty and myringotomy: A preliminary report

ObjectiveTo evaluate the efficacy of Low-temperature plasma radiofrequency ablation (RF) tuboplasty and myringotomy for treating chronic otitis media with effusion (COME) with chronic obstructive eustachian tube dysfunction (COETD) involving hypertrophic tissue of the ET orifice. Methods and materialsThis was a prospective study of 43 ears with COME and COETD who underwent RF tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, tympanometry results, and TM status. Success was defined by an improvement in tympanogram type and Valsalva maneuver. Follow-up ranged from 4 weeks to 12 months. ResultsA total of 43 ears (43 patients) were included in the study. Mucosal hypertrophy of the ET orifice was seen in 35 (81.4 %) patients, while polypoid tissue was observed in 8 (18.6 %) patients. All patients completed the 12-month follow-up, the success rate was 95.3 % (41/43) at postoperative 3 months, 39/43 (90.4 %) at postoperative 6 months, and 37/43 (86.0 %) at postoperative 12 months. No procedure-related serious adverse events were reported for any patient, and there were no cases of patulous ET. Stenosis/scar of anterior-post wall in the ET orifice occurred in two patients at 6 months postoperatively and in one patient at 12 months postoperatively, which the Valsalva maneuver was positive. Thus, no further treatment was applied for the ET orifice in 3 patients. The risk of stenosis of the ET orifice was 3/47 (6.4 %). ConclusionsRF eustachian tuboplasty may be an effective treatment for patients with COME, COETD and hypertrophic mucosa in the ET orifice, particularly as an adjunct to balloon tuboplasty.

Balloon Eustachian Tuboplasty with or Without Inferior Turbinectomy for Chronic Nasal Obstruction with Obstructive Eustachian Tube Dysfunction

Balloon Eustachian Tuboplasty with or Without Inferior Turbinectomy for Chronic Nasal Obstruction with Obstructive Eustachian Tube Dysfunction

Symptom Localization May Differentiate Subtypes of Eustachian Tube Dysfunction.

To evaluate the predictive ability of symptom self-localization to distinguish obstructive eustachian tube dysfunction from non-obstructive salpingitis. Adult (age ≥18 years) patients with a primary complaint of aural discomfort who underwent diagnostic nasal endoscopy and tympanometry at a tertiary academic center were enrolled. Symptoms were self-localized by using a single finger on the affected side. All patients completed the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and underwent scoring of eustachian tube inflammation using the Endoscopic Evaluation of the Eustachian Tube (3ET) system. Seventy-three patients were included in the study. Symptoms were localized to the external auditory canal (EAC) in 28 (38.4%), to the infratemporal fossa (ITF) below the lobule in 37 (50.7%), and to the preauricular region in 8 (11.0%). Demographics and medical history were similar between groups. The EAC group had significantly more negative tympanometric peak pressure (TPP) (median, -92.0 daPa; IQR, 95.5) and higher 3ET scores. In contrast, the ITF group had normal TPP (median, -2.0 daPa; IQR, 7.0) and higher 3ET scores. The preauricular group was more likely to have temporomandibular joint or pterygoid muscle pain. ETDQ-7 scores did not differ significantly between groups. Symptom localization is associated with specific objective findings in the evaluation of aural discomfort. Patients with pain localizing to the ITF are more likely to have findings of eustachian tube salpingitis without obstruction whereas patients with symptoms deep in the EAC are more likely to have findings consistent with obstructive eustachian tube dysfunction. 3 Laryngoscope, 133:1818-1823, 2023.

서로 다른 병리의 양측 이관기능부전증 1예

Eustachian tube dysfunction can cause obstructive eustachian tube dysfunction (OETD) and patulous eustachian tube (PET). These two different pathologic dysfunctions have the same symptoms which makes difficulty to diagnose. Herein, we report a case of a patient who had eustachian tube dysfunction with different pathologies simultaneously. A 34-year-old female patient complaints with both ear fullness. After diagnosis of right OETD and left PET, right balloon eustachian tuboplasty with trans-tympanic eustachian tube silicone plug insertion on the left side were performed. To our knowledge, there has been no report of one patient who had different pathologies of eustachian tube dysfunction simultaneously.

Balloon dilation for persistent unilateral chronic obstructive Eustachian tube dysfunction is effective: a prospective multicentre study.

Balloon dilatation of the Eustachian tube (BDET) is an option for treating chronic obstructive Eustachian tube dysfunction (COETD). In this prospective multicentric study, the main objective was to evaluate the results of BDET in unilateral COETD refractory to medical treatment. Adults with unilateral COETD whose Eustachian Tube Score (ETS) was less than 5 despite medical pressure therapy were included. The primary endpoint was the change in ETS measured at 2, 6, and 12months after BDET. Secondary objectives were the evolution of clinical symptoms assessed by the Eustachian Tube Questionnaire (ETDQ-7), audiometry, tympanometry, and otoscopy changes after BDET. Twenty-eight patients were included between May 2014 and December 2017 and were treated with BDET without adverse effects in three different referral centers. Population's median age was 52 (Q25; Q75: 24,82) years. The median follow-up time was 381 (Q25; Q75: 364; 418) days. The median ETS was 2 (Q25; Q75:1; 4) before BDET. There was a significant improvement in ETS at 2 and 6months and 1year after BDET (score at 1year: 6 (Q25; Q75:2; 8) (p < 0.0001)). There was a significant, sustained improvement in the ETDQ-7 with a score of 4.21 (Q25; Q75-3.50; 4.79) before BDET and 3.43 (Q25; Q75-2.43; 4.14) (p = 0.0012) at 1year. There was a suggestive improvement in tympanometry results at 1year (p = 0.025). BDET provides an improvement in symptoms and objective measures assessed at 1year in patients with COETD who have failed medical treatment. NCT02123277 (April 25, 2014).

Tubarial gland involvement in IgG4-related diseases

Background Tubarial glands (TGs) are a collection of unidentified salivary glands overlying the torus tubarius in the nasopharyngeal wall. Immunoglobulin G4-related disease (IgG4-RD) is a chronic fibroinflammatory state that often has multiple organ involvement. Involvement of the head and neck, especially the salivary glands, is common in IgG4-RD. Aims/objectives This study aimed to elucidate the clinical significance of TGs in IgG4-RD. Materials and methods We investigated the local findings of TGs in ten patients with IgG4-RD. Results Nasopharyngeal endoscopic examination revealed oedematous swelling of the nasopharyngeal wall surrounding the TGs, which improved after steroid treatment. Moreover, sonotubometry showed a stenotic pattern in three out of seven patients with IgG4-RD. Conclusions and significance TGs may be involved in IgG4-RD. The swollen TGs may be responsible for obstructive Eustachian tube dysfunction. Further studies are required to clarify the clinical significance and physiological roles of TGs in IgG4-RD.

A Novel Method to Treat Obstructive Eustachian Tube Dysfunction in the Mucosal Type of Chronic Otitis Media

Abstract Introduction Treatment of Eustachian tube dysfunction has remained an enigma for a long time. Balloon tuboplasty, even though effective, is not considered by many, as it is invasive, expensive, and cumbersome. Hence, we tried to find some simple and inexpensive solution for the same in chronic otitis media. In this background, we evaluated the use of the Eustachian barotubometer to treat obstructive Eustachian tube dysfunction in mucosal chronic otitis media. Materials and Methods The pilot study was undertaken in a tertiary referral hospital with 25 cases and 30 controls. Case group patients were administered Eustachian barotubometer therapy along with ciprofloxacin-dexamethasone ear drops and xylometazoline nasal drops until the recovery or up to 10 days. Control group patients received the same ear and nasal drops along with Valsalva maneuver for the same duration. Results The recovery of the Eustachian tube was categorized as complete, partial, or nil. It was found that the case group had 60 and 32% complete and partial recovery, respectively, while it was 33.33 and 13.33% in the control group. The recovery was faster with Eustachian barotubometer therapy than with the Valsalva maneuver. No complications were observed with the new procedure. Conclusion The Eustachian barotubometer is a simple, inexpensive device that can be used to treat Eustachian tube dysfunction in chronic otitis media. This device is particularly suitable for the peripheral health care centers of developing countries.

Clinical Analysis of Ear Congestion after Balloon Eustachian Tuboplasty (BET) with or without Tympanostomy Tube Insertion.

Objective To explore the clinical analysis of ear congestion after balloon Eustachian tuboplasty (BET) with or without tympanostomy tube insertion. Methods A total of 35patients (49 affected ears) with ear congestion following BET with or without tympanostomy tube insertion were recruited from the hospitalized patients from January 2015 to December 2017. The score of Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) 15, visual analogue scale (VAS), and Valsalva scores were recorded before and after operation, and the influencing factors of prognosis were analyzed. The duration of follow-up was 1–4 years. Results All patients showed significantly decreased average preoperative ETDQ-7 score, VAS, and Valsalva score after operation (p < 0.05). The significance of the surgery types, course of disease, severity of tympanic membrane retraction, and tympanogram tracings classification as influencing factors of prognosis did not come up to the statistical standard (p > 0.05). Conclusion The patients showed relatively stable postoperative conditions after 3 years, and there were variations in the range of ETDQ-7 scores at 5 years postoperatively. Patients with levels I and II tympanic membrane retraction showed more favorable surgical effects. Surgical interventions are required for patients diagnosed with obstructive Eustachian tube dysfunction (ETD) after three months of conservative treatment without satisfactory results.

Comparison of outcomes for balloon dilation of the Eustachian tube under local vs general anesthesia.

ObjectiveTo compare the effectiveness of balloon dilation of the Eustachian tube (BDET) under local versus general anesthesia in the treatment of obstructive Eustachian tube dysfunction (OETD).Study DesignRetrospective review.MethodsConsecutive patients ages ≥18 with persistent OETD having failed adequate medical therapy underwent BDET between 2013 and 2018 under local or general anesthesia. Inclusion criteria were persistent type B or C tympanograms with symptoms or type A with symptoms upon barochallenge. Objective outcome measures were tympanometry, otoscopy and the need for additional subsequent intervention (revision dilation and tympanostomy tube). Primary outcome (failure) was defined as no change or worse in tympanogram.ResultsThe 191 patients (332 ETs), ages 18–88 years (mean 58.0) underwent BDET. The 112 patients (59%) were female. The 107 procedures (32%) were performed under local anesthesia. Mean duration of follow‐up was 3.1 years (SD 1.9). Tympanograms improved to type A in 88% for BDET under local and 74% for general anesthesia at 12 months. Probability of being failure‐free at 5 years was 70% (95% confidence interval [CI]: 52%–82%) in the local anesthesia group versus 65% (95% CI: 55%–73%) in the general anesthesia group. Risk of failure did not significantly differ between the groups (HR = 0.60; 95% CI: 0.27–1.31; p = .20).ConclusionBDET under local anesthesia is effective in treating OETD and results in sustained improvements over 2 years. The procedure was successfully performed in all but one case utilizing a precise anesthesia protocol, and results are comparable with the procedure performed under general anesthesia.Level of evidence4

Revisiting the Diagnostic Performance of the Modified Nine-Step Test for Obstructive and Patulous Eustachian Tube Dysfunction.

The nine-step test is a classical method for evaluating Eustachian tube function. It directly assesses the patient’s capacity to equilibrate middle ear pressure by swallowing. However, there are insufficient studies to appraise its diagnostic performance. The purpose of this study is to evaluate the sensitivity, specificity, and cut-off value of the nine-step test in patients with obstructive Eustachian tube dysfunction (oETD) and patulous Eustachian tube (PET). Enrolled subjects were divided into three groups. Control (50 ears of healthy volunteers), oETD (19 ears with oETD), and PET (29 ears with PET). Receiver operating characteristics curve analysis was conducted to evaluate the diagnostic performance of maximal peak pressure difference (ETTmd) in the nine-step test. Both the oETD group and the PET group showed decreased ETTmd. The nine-step test showed moderate accuracy when used to diagnose oETD (area under the curve = 0.875) and PET (area under the curve = 0.769). The highest diagnostic performance was observed when the cut-off value was 13 daPa for both the oETD group (sensitivity = 73.7%, specificity = 90.0%) and the PET group (sensitivity = 58.6%, specificity = 90.0%). The nine-step test has moderate diagnostic performance for oETD and PET.