How effective is the Eustachian tube score (ETS) for the diagnosis of chronic obstructive Eustachian tube dysfunction (COETD)?
Background: Obstructive dysfunction of the Eustachian tube (ET) is one of the underlying possible causes of pressure sensations in the ear, fluctuating hearing loss, or ringing in the ears. It may also result in different middle ear pathologies. There is no current gold standard for COETD diagnosis. TMM is a semiobjective method to record ET patency.
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March 2015Study design: Combined, prospective, retrospective clinical study of 215 healthy subjects at a tertiary referral center between August and October 2011, and 171 patients with COETD.
Setting: Department of Otorhinolaryngology–Head and Neck Surgery, Bielefeld Clinical Center, Academic Teaching Hospital, University of Munster, Bielefeld, Germany.
Synopsis: In the healthy cohort, an always-positive Valsalva was reported for 382 ears, an only-sometimes positive Valsalva for 28 ears, and a negative Valsalva for 10 ears. In 240 ears, the Toynbee test was consistently positive, in 58 ears occasionally, and in 132 ears negative. The objective Valsalva was positive in 82.9% and negative in 17.1% of ears. For tympanometry, 425 of 428 examined ears showed a type A and three ears a type B. In the COETD cohort, the objective Valsalva was positive in 37.4% and negative in 62.6% of ears. Tympanometry showed type A in 9.1%, type B in 64.9%, and type C in 26% of ears. Healthy cohort subjects revealed an ET opening at 30 to 50 mbar in TMM in at least 94%; COETD cohort patients showed an immediate ET opening at 30 mbar in 42% and at 50 mbar in 58%. An ETS-7 of 8 or more was found in 83.8% of healthy cohort subjects; 1.6% had an ETS-7 score of 4 or less. About 89.1% of healthy cohort cases had an ETS-7 of 11 or more, and only 1.7% of 7 or less. COETD cohort patients had an ETS-7 of 11 or more in 4.2% of cases and an ETS-7 of <4 in 54.9%.
Bottom line: ETS is a valid and reliable instrument in adult patients with chronic obstructive ETD.