The modified maneuver “can be more effective than forcible Valsalva and obviously less dangerous,” Dr. Poe said. “We’ve seen (patients) injure … their ears over forceful Valsalva.”
Explore This IssueJune 2018
The ETD Patient Questionnaire is useful, but don’t rely too much on it, said William Slattery III, MD, president of House Ear Clinic in Los Angeles. Ask your own questions instead.
“I’ve got my standard set of questions that I like to go through,” he said. “The first is, ‘Let’s rule out patulous. Do you hear yourself breathe? Do you hear your voice echo inside your head? Is it positional change? Was there recent weight loss?’ Those four questions are very helpful and I find, many times, no one has asked them (those) questions.”
When he’s trying to determine whether to do a balloon inflation, Dr. Slattery continues with what may seem basic techniques. “I’m putting my fingers on their (TMJ), asking them to open and close their mouth,” he said. “This may seem pretty straightforward. But what I find is there’s so many patients that I get referred in that have seen several people and nobody’s ever tested them … nobody’s done that before. And that helps rule out some of the more simple diagnoses.”
Still, Dr. Slattery, who disclosed speaking fees for J&J and Acclarent Corp., said that his fellows give the ETDQ-7 to all patients complaining of aural fullness. He just cautions otolaryngologists not to base decisions solely on its results. “You can’t just rely on one piece of information alone,” he said. “You’ve got to put all of this together to make your diagnosis.”
Dr. Smouha, who practices with ENT & Allergy Associates in Manhattan, said that while research has validated the effectiveness of the ETDQ-7 questionnaire at assessing symptoms, it is not a differential diagnosis tool. “It’s an outcomes measure for before and after,” he said. “It was never intended for diagnostic measures. … It can’t differentiate between a patulous ET or TMD or any other types of aural fullness.”
The panel also discussed treatment options for ETD. Dr. Chandrasekhar discussed the potential value of surfactants, while disclosing her role as a board member and shareholder for a biotech company developing an ETD surfactant. “The problem at the Eustachian tube is not at (its) orifice, but actually in the lumen, in the cartilaginous portion,” she said. “Some of that problem is actually at the bony Eustachian tube orifice in the middle ear on the other side. The concept being that in the future we may be able to treat conservatively. In the future, we may be able to treat … with something like a surfactant and open up the Eustachian tube and allow for normal physiology.”