Niels Højvang Holm

Purpose This study aimed to investigate the correlation between Eustachian tube (ET) dimensions and Eustachian tube dysfunction (ETD). Methods A total of 28 patients with ETD symptoms ≥ three months and ten controls underwent 3 Tesla magnetic resonance imaging (MRI) and Cone beam computed tomography (CBCT) scans. The images were fused with software using anatomical landmarks. ET dimensions and angles were registered. Results Patient and control demographics were comparable. The length of ET was longer in ETD ears compared to controls (p = 0.035) but not compared to the ETD patient’s asymptomatic ears (p > 0.05). ET length was longer in males compared to females in the ETD group (p < 0.001). The osseous ET was longer in the patients’ ETD ears compared to their asymptomatic ears. Cartilaginous ET was shorter in controls compared to ETD ears. No significant length differences (p > 0.05) were observed between sides in ET, CET, or OET. A positive correlation was found between ET length and height (p < 0.001). No significant differences in angles were found between ETD ears, asymptomatic ears, or controls against either the horizontal or the sagittal plane. Conclusion Fusion of MRI and CBCT is feasible for evaluating ET. Adjusting for height, no differences in ET length between sexes were found. OET was longer in symptomatic ears, and CET was shorter in controls. ETD seems associated with a longer ET. Ostmann’s Fat Pad and the levator veli palatini muscle were smaller in ETD ears, suggesting atrophy of ET components.

Introduction: The ETDQ‐7 questionnaire has been validated for diagnosing Eustachian tube dysfunction (ETD) and a minimal clinically important difference (MCID) of > 3.5 has been suggested. We aim to assess the use of ETDQ‐7 for assessing ETD and a potential correlation between ETDQ‐7 and the Sino‐Nasal Outcome Test 22 (SNOT‐22).Methods: ETD was based on relevant ear symptoms and objective signs of negative middle ear pressure in 75 consecutive adult patients. Ventilation tube insertion (VTi) was performed on affected ears. ETDQ‐7 and SNOT‐22 scores before and 1 month after VTi were compared to 75 healthy controls.Results: Mean ETDQ‐7 score decreased from 31.9 to 15.8 (p < 0.0001), remained stable on unaffected ears, and was 9.6 in controls. MCID was achieved on all affected ears after VTi. A cut‐off score of > 14.5 for diagnosing ETD yielded 100% sensitivity and 94.2% specificity for ETDQ‐7. Spearman's ρ for total score test–retest was 0.878 (p = 0.000). Cronbach alpha for total score varied from 0.6807 to 0.7266. SNOT‐22 and ETDQ‐7 were correlated at baseline (0.12, p = 0.012). ETD patients scored significantly higher in the nasal, otologic and sleep domains in SNOT‐22 compared to controls.Conclusion: ETDQ‐7 is a very valid tool for ETD diagnostics and assessing the ear‐related effects of VTi. ETDQ‐7 scores reveal residual symptoms after VTi, indicating symptom relief but no cure for the underlying pathophysiology. For future investigation, we suggest assessing ETDQ‐7 scores for each ear separately, higher MCID values, and integration of quality of life measures.Trial Registration: ClinicalTrials.gov: NCT05055115

Objective: To investigate the predictive value of tubomanometry (TMM) in predicting subjective outcome of Balloon Eustachian Tuboplasty (BET) in patients with long‐lasting Eustachian tube dysfunction (ETD).Study Design: Retrospective case series.Setting: Single tertiary referral center.Methods: A total of 111 ETD patients undergoing 194 BET procedures were included. Demographics, TMM measurements, and tympanograms were registered before and 3 to 6 months after BET. The time ratio between the pressure increase in the nasopharynx and the outer ear canal was labelled R value.Results: At follow‐up, 58.8% of the patients were satisfied with BET outcomes. The prevalence of normal R values increased significantly at 30 mbar (12%, P = .024), 40 mbar (14%, P = .0082), and 50 mbar (13%, P = .011). The prevalence of R = 0 decreased at all three pressure levels (−20%, P = .0001; −15%, P = .0013, and −16%, P = .0005, respectively). Type A tympanograms increased from 37% to 56% (P = .0002), while type B tympanograms decreased from 44% to 25% (P = .0006). Stratifying TMM measurements (R ≤ 1, R > 1, and R = 0) showed that preoperative R values were not prognostic of subjective outcome. Preoperative type B tympanogram indicated a risk of poor subjective outcome.Conclusion: BET appeared to improve Eustachian tube function with reduced prevalence of pathologic R values and tympanograms. Although preoperative R values were not prognostic, TMM remains promising for assessing Eustachian tube function. Further studies are needed to refine TMM's role in predicting BET efficacy.

Objectives: Our objective is to evaluate the prevalence of tympanic membrane (TM) retractions and management of signs of Eustachian tube dysfunction (ETD) in both children and adults following type 1 tympanoplasty or myringoplasty. Furthermore, to identify potential risk factors for developing ETD and TM retractions.Methods: Retrospective cohort study of 423 patients (5–86 years of age) undergoing 452 procedures. We extracted data from electronic patient journals during scheduled consultations to calculate prevalences and relative risks. The project was reported to the Danish Data Protection Authority, and access to electronic patient journals was approved by the Institutional Board of Gødstrup Hospital.Results: At 1 year postoperative follow‐up, the prevalence of TM retractions was 12.7% and ETD manifestations without a concurrent TM retraction was 4.2%. The graft failure rate was 11.0%. Risk factors for developing TM retractions included preoperative myringosclerosis, history of ipsilateral ear surgery, posterior perforations, and use of perichondrium graft. Conversely, previous contralateral ear surgery and temporal fascia graft use were associated with decreased risk. ETD manifestations were significantly increased in cases of preoperative bilateral perforation, history of ipsilateral ventilation tube, and traumatic TM perforation.Conclusions: TM retractions accounted for 12.7%, ETD manifestations without a concurrent TM retraction 4.2%, and graft failure 11.0%. The dynamic nature of these complications necessitates diligent follow‐up strategies.Level of evidence: Level 4.

Objective: To compare the prevalence of internal carotid artery dehiscence (ICAD) on high-resolution computed tomography (HRCT) and cone beam computed tomography (CBCT) in patients with Eustachian tube dysfunction (ETD). Study Design: A prospective, cohort study. Setting: The outpatient clinic at the Department of Otorhinolaryngology, Head and Neck Surgery at Gødstrup Hospital, Denmark (tertiary referral center). Patients: Patients >18 years of age diagnosed with long-standing ETD undergoing HRCT and/or CBCT prior to balloon Eustachian tuboplasty. Intervention(s): Patients had either initially HRCT and later CBCT performed (HRCT + CBCT group) or solely CBCT (CBCT group). Main Outcome Measure(s): Prevalence of ICAD assessed with HRCT and CBCT. Results: A total of 23 patients were included in the HRCT + CBCT group and 36 patients in the CBCT group. In the HRCT + CBCT group, ICAD was found in 13 temporal bones (28.3%) with HRCT and 7 temporal bones (15.2%) with CBCT (P = 0.0003). No new cases of ICAD were found with CBCT. In the CBCT group, ICAD was found in 6 temporal bones (8.3%). In both HRCT and CBCT, patients suffered from ETD in 61.5% of the ears where ICAD was found. Conclusions: CBCT has a higher specificity than HRCT in diagnosing ICAD in patients with ETD while at the same time using less radiation.

Although acute otitis media (AOM) is a very frequent illness in children, it remains unclear to what extent children with AOM benefit from antibiotics (ABX). This systematic review aimed to clarify this subject by including randomised clinical trials (RCTs) from the pneumococcal vaccine era only. We performed a systematic literature search in four databases from 1 January 2000 to 1 January 2019 for RCTs comparing ABX to placebo in patients with AOM. Pain was registered as the main outcome. Adverse events (AE), development of contralateral otitis media, tympanic membrane perforation, late AOM recurrence, abnormal tympanometry and time to resolution of middle ear effusion were registered as secondary outcomes. Six publications based on five RCTs with 1,862 patients were included. The number needed to treat (NNT) to reduce pain varied from seven (pain at day 7-10) to 28 (pain at day 2-3). The NNT for preventing contralateral otitis was ten. AE were seen in every 13th patient treated with ABX. ABX appears to have a limited effect on both primary and secondary outcomes compared with placebo. A substantial number of patients experienced AE. New RCTs are needed to further clarify the effect. Ideally, RCTs could be conducted in Danish general practices in collaboration with practicing ear, nose and throat specialists to obtain large unselected populations with high rates of vaccine coverage. Until more evidence is provided, ABX should be considered among children younger than two years of age with severe symptoms of AOM, i.e. fewer and affected well-being.

Symptoms of Eustachian tube dysfunction are frequent and multiple. Therefore, clear definitions and diagnostic criteria are important in order to achieve appropriate patient flow. So far, there has been a lack of consensus on this subject, but the proposed definitions and diagnostic criteria in this review may aid to achieve this. Tubomanometry is a diagnostic tool to evaluate Eustachian tube function, and balloon dilation of the Eustachian tube can be a helpful treatment in patients with Eustachian tube dysfunction.