Pyne Justin M, Amoako-Tuffour Yaw, Earle Guy, McIntyre Graham, Butler Michael B, Bance Manohar
Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
J Otolaryngol Head Neck Surg. 2017 Jun 15;46(1):47. doi: 10.1186/s40463-017-0227-x.
Eustachian tube (ET) dysfunction can be very difficult to diagnose accurately. Our aim is to determine whether a newly developed sonotubometric test using clicks can reliably detect ET opening during swallowing in normal ET subjects, and patulous ET (PET) in subjects with ET dysfunction.
Sixteen subjects (19 normal ET ears and 6 PET ears) were individually placed in a sound-isolated audiometry booth and subjected to a 1000Hz click train stimulus, played through the nose. PET subjects were identified through the ET clinic at our institution, while healthy subjects were recruited. Transmission through the ET was recorded by a microphone in the ear ipsilateral to the presenting nostril, during no swallow and swallow states, and this was used to compute a power ratio (power in the frequency range of interest to the whole frequency range). The power transmission ratio both before and after the swallow was averaged, and represented the baseline (BaseR). The power transmission ratio during swallow represented the peak (PeakR). The same process was repeated in the absence of a stimulus to account for swallowing noise. Wilcoxon rank rum tests were performed to determine statistical significance.
It was found that for healthy ET patients, the median difference between the PeakR and BaseR was 0.51 (p = 0.004). For the PET patients in this study, the median difference between the PeakR and the BaseR was 3.30 (p = 0.041). Comparing the baseline between groups revealed that PET patients had a median BaseR 1.05 higher than healthy ET patients. PET patients had a median PeakR of 3.84 higher than healthy ET patients. Both were deemed to be statistically significant (p = 0.003, p = 0.003 respectively). A significant difference was found between median PeakR for the stimulus and no-stimulus condition for the healthy ET group (0.59, p < 0.001) and for the PET group (4.39, p = 0.031), indicating that it was unlikely that swallowing noise caused false positive results.
The results of this study suggest that a novel click stimulus is capable of detecting ET opening during swallowing in healthy patients as well as highlighting PET in diseased subjects.
咽鼓管（ET）功能障碍可能很难准确诊断。我们的目的是确定一种新开发的使用咔哒声的声管测量测试能否可靠地检测正常ET受试者吞咽时的ET开放情况，以及ET功能障碍受试者中的咽鼓管异常开放（PET）。
16名受试者（19只正常ET耳朵和6只PET耳朵）分别被置于隔音的听力测试室，通过鼻子接受1000Hz的咔哒声序列刺激。PET受试者通过我们机构的ET诊所确定，健康受试者则通过招募获得。在不吞咽和吞咽状态下，通过与刺激鼻孔同侧耳朵中的麦克风记录通过ET的传输情况，并用于计算功率比（感兴趣频率范围内的功率与整个频率范围的功率之比）。吞咽前后的功率传输比进行平均，代表基线（BaseR）。吞咽期间的功率传输比代表峰值（PeakR）。在没有刺激的情况下重复相同过程以考虑吞咽噪声。进行Wilcoxon秩和检验以确定统计学意义。
发现对于健康的ET患者，PeakR与BaseR之间的中位数差异为0.51（p = 0.004）。在本研究中的PET患者中，PeakR与BaseR之间的中位数差异为3.30（p = 0.041）。比较组间基线发现，PET患者的中位数BaseR比健康ET患者高1.05。PET患者的中位数PeakR比健康ET患者高3.84。两者均被认为具有统计学意义（分别为p = 0.003，p = 0.003）。在健康ET组（0.59，p <0.001）和PET组（4.39，p = 0.031）中，刺激条件和无刺激条件下的中位数PeakR之间发现了显著差异，表明吞咽噪声不太可能导致假阳性结果。
本研究结果表明，一种新型的咔哒声刺激能够检测健康患者吞咽时的ET开放情况，并突出患病受试者中的PET。
