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Vestn Otorinolaringol ; 86(3): 90-96, 2021.
Article Ru | MEDLINE | ID: mdl-34269031

The article deals with the problem of inflammatory diseases of the external ear. A review of pruritic dermatoses of the external auditory canal was carried out. It has been shown that in chronic dermatoses, the contamination of the skin with bacterial and fungal pathogens significantly increases, which leads to a high risk of developing secondary infectious pathological processes. Treatment of dermatological inflammatory ear diseases includes careful daily hygiene of the external auditory canal and pharmacotherapy, a key aspect of which is the use of topical etiotropic, anti-inflammatory, and symptomatic drugs. The advantage of the combined drug candiderm is described, which, thanks to the unique combination of beclomethasone, gentamicin and clotrimazole in the composition, effectively relieves the symptoms of external ear dermatoses.

Ear Diseases , Otitis Externa , Anti-Inflammatory Agents , Clotrimazole , Ear Canal , Ear Diseases/diagnosis , Ear Diseases/drug therapy , Ear Diseases/etiology , Gentamicins , Humans , Otitis Externa/diagnosis , Otitis Externa/drug therapy
J Laryngol Otol ; 135(8): 695-701, 2021 Aug.
Article En | MEDLINE | ID: mdl-34238392

OBJECTIVES: This study aimed to analyse if there were any associations between patulous Eustachian tube occurrence and climatic factors and seasonality. METHODS: The correlation between the monthly average number of patients diagnosed with patulous Eustachian tube and climatic factors in Seoul, Korea, from January 2010 to December 2016, was statistically analysed using national data sets. RESULTS: The relative risk for patulous Eustachian tube occurrence according to season was significantly higher in summer and autumn, and lower in winter than in spring (relative risk (95 per cent confidence interval): 1.334 (1.267-1.404), 1.219 (1.157-1.285) and 0.889 (0.840-0.941) for summer, autumn and winter, respectively). Temperature, atmospheric pressure and relative humidity had a moderate positive (r = 0.648), negative (r = -0.601) and positive (r = 0.492) correlation with the number of patulous Eustachian tube cases, respectively. CONCLUSION: The number of patulous Eustachian tube cases was highest in summer and increased in proportion to changes in temperature and humidity, which could be due to physiological changes caused by climatic factors or diet trends.

Ear Diseases/epidemiology , Eustachian Tube , Climate , Ear Diseases/diagnosis , Humans , Republic of Korea/epidemiology , Risk Factors , Seasons
Dermatol Surg ; 47(3): 373-376, 2021 03 01.
Article En | MEDLINE | ID: mdl-34328289

BACKGROUND: Chondrodermatitis nodularis helicis (CNH) is a common chronic condition characterized by a tender nodule on the helix or antihelix of the ear which may or may not have accompanying crusting, scaling, or ulceration and that is often difficult to treat. OBJECTIVE: Develop an easy, effective, and durable treatment to reduce the pain and clinical signs including ulcerations associated with CNH using injectable hyaluronic acid (HA). MATERIALS AND METHODS: Twenty-four patients were injected and followed up in 2 to 4 weeks intervals using 0.2 to 0.3 mL of various HA with a high G-Prime. RESULTS: Injectable HA significantly improved the symptoms and also the clinical appearance of all patients treated after 1 or 2 injections except 1 patient. Extrusion of the material through a preexisting ulcer usually required a second follow-up injection 2 weeks later. No adverse events were noted with the injections other than the intentional visible bulging of the injected region with HA. CONCLUSION: Injectable HA provides almost immediate relief from the discomfort of CNH in most cases in less than 1 or 2 weeks, significantly improves the clinical appearance over time and resolves accompanying ulcerations.

Cartilage Diseases/drug therapy , Dermatitis/drug therapy , Ear Diseases/drug therapy , Hyaluronic Acid/administration & dosage , Pain/drug therapy , Wound Healing/drug effects , Adjuvants, Immunologic/administration & dosage , Adult , Aged , Aged, 80 and over , Cartilage Diseases/complications , Cartilage Diseases/diagnosis , Chronic Disease , Dermatitis/complications , Dermatitis/diagnosis , Ear Auricle , Ear Diseases/complications , Ear Diseases/diagnosis , Female , Follow-Up Studies , Humans , Injections, Intralesional , Male , Middle Aged , Pain/etiology
Sci Rep ; 11(1): 10839, 2021 05 25.
Article En | MEDLINE | ID: mdl-34035389

Early detection and appropriate medical treatment are of great use for ear disease. However, a new diagnostic strategy is necessary for the absence of experts and relatively low diagnostic accuracy, in which deep learning plays an important role. This paper puts forward a mechanic learning model which uses abundant otoscope image data gained in clinical cases to achieve an automatic diagnosis of ear diseases in real time. A total of 20,542 endoscopic images were employed to train nine common deep convolution neural networks. According to the characteristics of the eardrum and external auditory canal, eight kinds of ear diseases were classified, involving the majority of ear diseases, such as normal, Cholestestoma of the middle ear, Chronic suppurative otitis media, External auditory cana bleeding, Impacted cerumen, Otomycosis external, Secretory otitis media, Tympanic membrane calcification. After we evaluate these optimization schemes, two best performance models are selected to combine the ensemble classifiers with real-time automatic classification. Based on accuracy and training time, we choose a transferring learning model based on DensNet-BC169 and DensNet-BC1615, getting a result that each model has obvious improvement by using these two ensemble classifiers, and has an average accuracy of 95.59%. Considering the dependence of classifier performance on data size in transfer learning, we evaluate the high accuracy of the current model that can be attributed to large databases. Current studies are unparalleled regarding disease diversity and diagnostic precision. The real-time classifier trains the data under different acquisition conditions, which is suitable for real cases. According to this study, in the clinical case, the deep learning model is of great use in the early detection and remedy of ear diseases.

Ear Diseases/diagnosis , Image Interpretation, Computer-Assisted/methods , Adult , Deep Learning , Ear Diseases/pathology , Early Diagnosis , Endoscopy , Female , Humans , Male , Neural Networks, Computer , Sensitivity and Specificity , Severity of Illness Index , Young Adult
Am J Otolaryngol ; 42(4): 102997, 2021.
Article En | MEDLINE | ID: mdl-33770717

PURPOSE: This study aimed to evaluate the outcomes and satisfaction of ear patients who participated in the smartphone otoscopes telemedicine via WeChat. METHODS: Patients in this study included newly diagnosed outpatients and online patients who did not undergo an outpatient diagnosis. Patients performed regular ear self-examinations, took pictures at home using their smartphone endoscopes, and submitted images to a WeChat community. Otolaryngologist gave timely online feedback. All of the following data were recorded: patients age and gender, disease duration, outpatient diagnosis, side, telemedicine duration, number of telemedicine visits, outcomes, satisfaction. RESULTS: A total of 74 patients were included in the study, including 39 males and 35 females, with an average age of 31.1 ± 13.7 years (range 4-55 years). Of these patients, 68 were outpatients, and 6 directly participated in telemedicine online. The patient's disease duration ranged from 1 day to 15 days, with an average of 4.0 ± 3.0 days. The mean duration was 8.1 days (range: 3-21 days) for telemedicine. The mean number of visits was 2.7 times (range: 2-6 times) for telemedicine. 68 (91.9%) of the 74 patients were cured, 6 (8.1%) were improved, and 0 (0%) were ineffective. Almost all patients were pleased with the telemedicine service, 71.9 0% were very satisfied (n = 62), 28.10% were very satisfied (n = 11), and 0% were dissatisfied (n = 0). CONCLUSIONS: Smartphone otoscopes telemedicine can decrease outpatient follow-up, reduce the risk of cross-infection, increase telemedicine accuracy, and improve patient satisfaction. It is worthy of clinical application in the COVID-19 era.

COVID-19/prevention & control , Ear Diseases/diagnosis , Otoscopes , Smartphone , Telemedicine , Text Messaging , Adolescent , Adult , COVID-19/epidemiology , COVID-19/transmission , Child , Child, Preschool , Communicable Disease Control , Ear Diseases/etiology , Ear Diseases/therapy , Female , Humans , Male , Middle Aged , Patient Satisfaction , Young Adult
Otolaryngol Head Neck Surg ; 165(4): 491-492, 2021 10.
Article En | MEDLINE | ID: mdl-33687296

Interpretation of tympanometry commonly relies on the historical convention of classifying findings according to large and arbitrary threshold shifts of tympanometric peak pressure (TPP). This convention had value for prior generations of otolaryngologists in diagnosing severe, chronic middle ear disease requiring surgical intervention but may not be well suited for the present-day evaluation of less severe disease. The existing definition of a type C curve (less than -100 daPa) is likely insensitive to detect subtle abnormalities, including some presentations of obstructive eustachian tube dysfunction. The accuracy of clinical diagnosis may be improved by reporting the absolute values of TPP and moving beyond classification according to arbitrary thresholds.

Acoustic Impedance Tests/methods , Ear Diseases/diagnosis , Ear Diseases/physiopathology , Ear, Middle/physiopathology , Humans
J Am Vet Med Assoc ; 258(6): 654-660, 2021 Mar 15.
Article En | MEDLINE | ID: mdl-33683965

OBJECTIVE: To characterize the clinical features, treatment, and outcome of aural hematomas in horses. ANIMALS: 7 horses with 1 or 2 aural hematomas (8 ears in total) treated at a veterinary teaching hospital in 2008 through 2019. PROCEDURES: Data retrieved from medical records included signalment, pertinent historical information, clinical signs, diagnostic procedures (including dermatologic assessment), and treatments. Case outcome was determined from documentation in the medical record or via telephone communication with owners or referring veterinarians. RESULTS: 3 horses were presented after recurrence of aural hematoma following treatment by the referring veterinarian. Four horses had a history of allergic skin disease prior to aural hematoma development. Most (6/7) horses were unilaterally affected. Diagnostic assessments included otoscopic evaluation (3 horses), ultrasonography (3 horses), cytologic examination of ear canal swab samples (3 horses), and histologic examination of a pinnal biopsy specimen (1 horse). Of the 8 pinnae, 2 were treated by nonsurgical needle drainage (1 with concurrent corticosteroid injection) and the remaining 6 underwent surgical incision and placement of compressive sutures. Follow-up information was available for 6 horses, and all affected pinnae were fibrotic with 4 horses having permanent drooping of the pinna. One horse developed a hematoma in the contralateral pinna 1 year after hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Equine aural hematoma is a rare condition. The main principle of treatment is drainage, and treatment options commonly used in small animal practice can be successfully applied in horses. Permanent changes in the cosmetic appearance of the pinna are likely to develop owing to secondary fibrosis.

Ear Diseases , Horse Diseases , Animals , Ear Diseases/diagnosis , Ear Diseases/therapy , Ear Diseases/veterinary , Hematoma/etiology , Hematoma/therapy , Hematoma/veterinary , Horse Diseases/diagnosis , Horse Diseases/therapy , Horses , Hospitals, Animal , Hospitals, Teaching , Neoplasm Recurrence, Local/veterinary , Retrospective Studies , Treatment Outcome
ORL J Otorhinolaryngol Relat Spec ; 83(2): 127-129, 2021.
Article En | MEDLINE | ID: mdl-33550298

Eustachian tube dilation (ETD) is a relatively new intervention for the treatment of eustachian tube dysfunction. Though it previously had no assigned billing code, the American Medical Association recently accepted a new Category I Current Procedural Terminology code application for ETD to be effective in January 2021. Reported complications are uncommon and usually minor. Herein, we present a rare case of massive pneumomediastinum following this procedure. Such major complications are critical to report as ETD becomes a more commonly practiced procedure.

Ear Diseases , Eustachian Tube , Mediastinal Emphysema , Dilatation , Ear Diseases/diagnosis , Ear Diseases/etiology , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology
Int Forum Allergy Rhinol ; 11(8): 1177-1186, 2021 08.
Article En | MEDLINE | ID: mdl-33502803

BACKGROUND: Standardized diagnostic criteria for Eustachian tube (ET) dysfunction (ETD) have not been established. The purpose of this study was to characterize the relationship between ET inflammation and ETD symptoms and to determine the diagnostic performance of a quantitative score. METHODS: Patients were enrolled in a rhinology clinic between October 2018 and June 2019. Patients underwent nasal endoscopy and completed the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Nasopharyngeal inflammation identified on endoscopy was quantified using the Endoscopic Evaluation of the Eustachian Tube (3ET) score. Tympanometry was performed as indicated. Comorbid conditions were assigned during the patient encounter. RESULTS: A total of 414 patients were included in the study. Patients with clinically significant ETD symptoms (ETDQ-7 ≥2.1) had higher 3ET scores than those without symptoms. A 1-point increase in 3ET score was associated with a 1.7-fold increase in odds of clinically significant ETD symptoms (adjusted OR [aOR], 1.72; 95% CI, 1.46 to 2.05). The 3ET scores were correlated with ETDQ-7 scores (ρ = 0.54) and 22-item Sino-Nasal Outcome Test (SNOT-22) scores (ρ = 0.52). 3ET scores were not associated with tympanometric peak pressures. Patients with ETD symptoms were more likely to have laryngopharyngeal reflux (aOR, 2.71; 95% CI, 1.24 to 6.18). A 3ET score of 4 predicted symptomatic state in 80% of cases with a specificity of 97.8% and positive predictive value of 96.6%. CONCLUSION: Inflammatory findings at the nasopharyngeal ET orifice are associated with clinically significant ETD symptoms. The 3ET score is specific for a symptomatic state and has potential clinical utility in the evaluation of suspected ETD. ©2021 ARSAAOA, LLC.

Ear Diseases , Eustachian Tube , Ear Diseases/diagnosis , Humans , Inflammation , Sino-Nasal Outcome Test , Surveys and Questionnaires
Int J Pediatr Otorhinolaryngol ; 142: 110615, 2021 Mar.
Article En | MEDLINE | ID: mdl-33440309

BACKGROUND: Red ear syndrome (RES) is a neurological syndrome that is characterized by attacks of redness and pain that is localized in the earlobe, accompanied by a burning sensation, swelling or otalgia. The exact pathophysiology of RES is not known. Several pediatric cases have been described. They show an extreme variability in clinical presentation and therapeutic response, and therefore there are numerous difficulties in the diagnostic-therapeutic approach and in the comprehension of the physiopathology. The goal of this report is to present three clinical cases of red ear syndrome in children. These cases show various characteristics that can give useful indications regarding the differential diagnosis and the pathogenetic mechanisms that are involved, particularly when they are compared with cases published in the literature. CASE-REPORTS: We report three pediatric RES cases: 1) a boy whose condition offered a typical example of the association that occurs between migraine and RES. 2) a girl with idiopathic RES. 3) a child who suffered RES attacks that showed many similarities with trigeminal autonomic cephalalgias. CONCLUSION: Our clinical series shows the different ways in which RES can be expressed and they support the reported scientific literature. We suggest that the different forms of RES have a common final autonomic pathogenetic mechanism that is activated by parasympathetic hyperactivity and sympathetic inhibition. The different temporal characteristics, frequency, etc. may depend on the activation of distinct physiopathological modules that are related to the pain circuits, as suggested by the modular theory which describes that groups of neurons are defined as a module, where each module is responsible for a symptom and the individual's headache is defined by the activated modules.

Ear Diseases , Migraine Disorders , Child , Ear Diseases/diagnosis , Female , Headache/diagnosis , Headache/etiology , Humans , Male , Pain , Syndrome
Eur Arch Otorhinolaryngol ; 278(12): 4733-4741, 2021 Dec.
Article En | MEDLINE | ID: mdl-33486567

PURPOSE: This systematic review describes and evaluates the current literature on remote otological assessment using video-otoscopy with regards to reliability and potential applications. METHODS: Systematic review was conducted in accordance with the PRISMA statement. There was heterogeneity of included studies, so a descriptive analysis was undertaken. RESULTS: Seventeen studies were included for analysis conducted across a variety of healthcare settings. Overall, there was a trend towards acquisition of adequate images for diagnosis by non-otolaryngology-specialist facilitators with reasonable agreement between asynchronous images and controls; however, there was significant variation between the studies. CONCLUSION: Remote otological assessment using video-otoscopy shows potential as a safe and effective method for detecting the presence of ear disease in a wide range of healthcare settings. Barriers to the acquisition of adequate images include the presence of obstructing cerumen, and strategies to deal with this should be considered. Further work is required to evaluate endoscope-based systems to assess whether they will allow the acquisition of higher quality images.

Ear Diseases , Telemedicine , Ear Diseases/diagnosis , Humans , Otoscopy , Reproducibility of Results , Video Recording
Laryngoscope ; 131(5): E1668-E1676, 2021 05.
Article En | MEDLINE | ID: mdl-33170529

OBJECTIVES/HYPOTHESIS: With the increasing emphasis on developing effective telemedicine approaches in Otolaryngology, this study explored whether a single composite image stitched from a digital otoscopy video provides acceptable diagnostic information to make an accurate diagnosis, as compared with that provided by the full video. STUDY DESIGN: Diagnostic survey analysis. METHODS: Five Ear, Nose, and Throat (ENT) physicians reviewed the same set of 78 digital otoscope eardrum videos from four eardrum conditions: normal, effusion, retraction, and tympanosclerosis, along with the composite images generated by a SelectStitch method that selectively uses video frames with computer-assisted selection, as well as a Stitch method that incorporates all the video frames. Participants provided a diagnosis for each item along with a rating of diagnostic confidence. Diagnostic accuracy for each pathology of SelectStitch was compared with accuracy when reviewing the entire video clip and when reviewing the Stitch image. RESULTS: There were no significant differences in diagnostic accuracy for physicians reviewing SelectStitch images and full video clips, but both provided better diagnostic accuracy than Stitch images. The inter-reader agreement was moderate. CONCLUSIONS: Equal to using full video clips, composite images of eardrums generated by SelectStitch provided sufficient information for ENTs to make the correct diagnoses for most pathologies. These findings suggest that use of a composite eardrum image may be sufficient for telemedicine approaches to ear diagnosis, eliminating the need for storage and transmission of large video files, along with future applications for improved documentation in electronic medical record systems, patient/family counseling, and clinical training. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1668-E1676, 2021.

Ear Diseases/diagnosis , Otolaryngology/methods , Otoscopy/methods , Telemedicine/methods , Tympanic Membrane/diagnostic imaging , Feasibility Studies , Female , Humans , Image Processing, Computer-Assisted , Male , Observer Variation , Otolaryngologists/statistics & numerical data , Otolaryngology/statistics & numerical data , Otoscopy/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , Telemedicine/statistics & numerical data , Video Recording
Acta Otolaryngol ; 141(1): 23-28, 2021 Jan.
Article En | MEDLINE | ID: mdl-33185137

BACKGROUND: Current surgical microscopes suffer from inherent constraints in achievable viewing angles and require manual interaction to control settings. Overcoming these limitations may provide benefits for otologic surgical procedures. OBJECTIVES: We present a first feasibility and usability assessment of a novel commercial surgical microscope featuring a virtual-reality interface and hands-free control of a robot-mounted 3D-camera. MATERIALS AND METHODS: Ex vivo feasibility tests were conducted in a human cadaveric head sample based on common otologic procedures. Usability metrics were obtained from feedback forms. In a first clinical case, the device was used to perform a tympanoplasty in a 68-year-old patient with a subtotal tympanic membrane perforation. RESULTS: Overall practicability of using the device for otologic procedures could be confirmed in the ex vivo tests. Beneficial aspects of the novel system which were subjectively encountered in the ex vivo tests and the first clinical case included hands-free control, visualization quality, and teaching potential. CONCLUSIONS AND SIGNIFICANCE: The novel virtual reality 3D-microscope bears potential to provide benefits for various otologic procedures, which will be evaluated more quantitatively in clinical follow-up studies.

Imaging, Three-Dimensional/methods , Microscopy/instrumentation , Microsurgery/methods , Otologic Surgical Procedures/methods , Surgery, Computer-Assisted/methods , User-Computer Interface , Virtual Reality , Aged , Cadaver , Ear Diseases/diagnosis , Ear Diseases/surgery , Equipment Design , Feasibility Studies , Humans , Male , Microsurgery/instrumentation
Eur Arch Otorhinolaryngol ; 278(7): 2219-2224, 2021 Jul.
Article En | MEDLINE | ID: mdl-32797273

OBJECTIVE: To determine the effectiveness of a soft-tissue bulking agent comparing novel approaches of Eustachian tube (ET) augmentation procedures: transpalatinatal Eustachian tube augmentation in local and general anesthesia versus an augmentation with velotraction under general anesthesia. The clinical endpoint was the resolution of symptoms related to unilateral patulous Eustachian tube dysfunction (PETD) requiring no additional revision augmentations. STUDY DESIGN: Combined retrospective clinical chart review. SETTING: Tertiary referral center. METHODS: Patients suffering from PETD underwent one of the following procedures: Group (A) transpalatinatal soft-tissue bulking agent with infiltration/augmentation under local anesthesia in a sitting position, group (B) transpalatinatal soft-tissue bulking agent infiltration/augmentation under general anesthesia in the flat position or group (C) infiltration/transoral augmentation of the ET with velotraction under general anesthesia in a flat position. The requirement to repeat the procedure due to recurrence of any PETD-related symptoms was recorded and retrospectively analyzed. RESULTS: A total of 50 procedures were executed in 50 patients with unilateral PETD. The necessity to perform a second procedure has analyzed a mean of 6 months postoperatively (range: 6-17 months). Compared to the transpalatinatal augmentation in local anesthesia (group A) (100% success rate), the 6-month failure rate was significantly higher for transpalatinatal augmentation under general anesthesia (group B) (80% success rate) and velotraction augmentation under general anesthesia (group C) (67% success rate). Patient cohort with transpalatinatal augmentation under general anesthesia required 20% and augmentation with velotraction under general anesthesia in 33% revision augmentation procedures reviewed at 6 months follow-up (mean follow-up 11.2 months). CONCLUSIONS: Although all different approaches resulted in a reduction of PETD related symptoms, the transpalatinatal ET augmentation in local anesthesia achieved a statistically significant superior clinical improvement. A complete resolution of PETD related symptoms was obtained and required additional procedures. This improvement may be related to the intraoperative "feedback" by the patients in local anesthesia in the sitting position eliminating the necessity for repeated procedures.

Ear Diseases , Eustachian Tube , Otitis Media , Otologic Surgical Procedures , Ear Diseases/diagnosis , Ear Diseases/surgery , Eustachian Tube/surgery , Humans , Retrospective Studies
HNO ; 69(3): 198-205, 2021 Mar.
Article De | MEDLINE | ID: mdl-32885310

BACKGROUND: Patulous Eustachian tube (ET) dysfunction can impair quality of life (QOL) due to autophony, pressure sensation, and an altered impression of sound. In cases of nonspecific complaints the diagnosis of patulous ET can be difficult, and its distinction from chronic obstructive ET dysfunction is particularly challenging. Since there is currently a lack of standardized diagnostic and therapeutic options, a structured diagnostic workup is essential for accurate diagnosis of this condition. The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) was established by McCoul et al. in 2012 for investigating chronic obstructive ET dysfunction. The Patulous Eustachian Tube Handicap Inventory-10 (PHI-10) was published by Kobayashi et al. in 2017 as an instrument to evaluate patulous ET. PATIENTS AND METHODS: The PHI-10 questionnaire was translated into German and validated in a total of 83 patients (41 healthy subjects, 13 patients with tinnitus, 11 patients with patulous ET, and 18 patients with chronic obstructive ET dysfunction). In addition, the PHI-10 (German) was compared to ETDQ­7. RESULTS: The results of the English version of the PHI-10 questionnaire could be confirmed using the German version. The German version of the PHI-10 and the results of the PHI-10 and ETDQ­7 for each group of patients are presented. The ETDQ­7 leads to false-positive results in patients with patulous ET and the PHI-10 generates false-positive results in patients with chronic obstructive ET dysfunction. Both questionnaires result in false-positive results in patients with tinnitus. CONCLUSION: The PHI-10 and ETDQ­7 (German) can be recommended as an additional tool for preoperative assessment of ET dysfunction. However, they insufficiently discriminate between patulous and obstructive ET dysfunction and are not suitable for patients with tinnitus. The strength of the two questionnaires lies in their suitability for use in monitoring therapeutic success during follow-up.

Ear Diseases , Eustachian Tube , Otitis Media , Ear Diseases/diagnosis , Humans , Quality of Life , Surveys and Questionnaires
Otolaryngol Head Neck Surg ; 164(6): 1272-1279, 2021 06.
Article En | MEDLINE | ID: mdl-33076772

OBJECTIVE: To characterize the relationship between objective tympanogram values and patient-reported symptoms and associations with common comorbid conditions. STUDY DESIGN: Cross-sectional study with prospective data collection. SETTING: Tertiary medical center. METHODS: Patients undergoing routine audiometric evaluation between October 2018 and June 2019 were included. Participants with temporomandibular joint dysfunction, inner ear hydrops, and similar conditions were excluded. Symptoms were assessed with the 7-item Eustachian Tube Dysfunction Questionnaire. Demographics and medical comorbidities were recorded from the medical record. Analysis of tympanometric peak pressure (TPP), demographics, and comorbidities was performed to determine associations with clinically significant eustachian tube dysfunction (ETD) symptoms. RESULTS: A total of 250 patients were included with similar demographics: 101 (40.4%) in the asymptomatic group and 149 (59.6%) in the symptomatic group. The median (interquartile range) TPP was -10 (20) daPa and -25 (100) daPa in the asymptomatic and symptomatic groups, respectively. A diagnosis of rhinitis was more likely to be associated with significant ETD symptoms (adjusted odds ratio, 2.61; 95% CI, 1.23-5.63). A subgroup analysis revealed that symptomatic patients with normal TPP values were negatively skewed as compared with asymptomatic patients. This symptomatic group had a higher prevalence of rhinitis and chronic rhinosinusitis than the asymptomatic group. CONCLUSION: Patients with symptoms of ETD may have a TPP within a range typically considered normal per conventional standards. This suggests that the currently accepted interpretation of tympanometry findings may be insensitive for the diagnosis of less severe cases of ETD.

Acoustic Impedance Tests , Ear Diseases/diagnosis , Ear Diseases/physiopathology , Eustachian Tube/physiopathology , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Diagnostic Self Evaluation , Female , Humans , Male , Middle Aged , Prospective Studies , Reference Values , Self Report