Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle.
HNO-Gemeinschaftspraxis Berlin Zehlendorf, Berlin, Germany.
Otol Neurotol. 2023 Jun 1;44(5):e305-e310. doi: 10.1097/MAO.0000000000003852. Epub 2023 Mar 24.
To assess the rate of dilatory (chronic obstructive) eustachian tube dysfunction (ETD) in adult patients scheduled for surgery for chronic inflammatory middle ear disease.
We included adult patients with chronic inflammatory middle ear disease (chronic suppurative otitis media, adhesive otitis media [middle ear atelectasis], cholesteatoma). We excluded patients with pathologies that do not stem from ETD (e.g., noninflammatory chronic middle ear disease [e.g., otosclerosis], tumors, solely external auditory canal conditions), patients scheduled for implantable electronic hearing devices independent of disease, patients with otitis media with effusion and scheduled paracentesis or ventilation tubes only, patients with previous radiotherapy or previous balloon eustachian tuboplasty, and children and patients unable to complete questionnaires.
We evaluated ETD with Valsalva maneuver and in case of negative or unclear Valsalva with the eustachian tube score (ETS). A negative Valsalva maneuver and an ETS score of 5 or lower were used to define dilatory (chronic obstructive) ETD.
Rate of ETD in the included patients.
From a total of 482 consecutive patients, 350 patients had positive Valsalva maneuver or ETS score higher than 5. From the 193 patients with negative or unclear Valsalva maneuver, 77 patients had an ETS score of 5 or lower, and 55 rejected further diagnostics with ETS.
Based on a large cohort of adult patients with chronic inflammatory middle ear disease scheduled for middle ear surgery, the majority (82%) seems to have no dilatory (chronic obstructive) ETD that can be detected with current routine clinical methods and tubomanometry. Common pathophysiological explanations should be questioned critically, especially in the context of communication with patients.
评估慢性炎症性中耳疾病患者接受手术治疗时发生迁延性（慢性阻塞性）咽鼓管功能障碍（ETD）的比例。
我们纳入了慢性炎症性中耳疾病（慢性化脓性中耳炎、粘连性中耳炎[中耳萎陷]、胆脂瘤）的成年患者。我们排除了由 ETD 以外的疾病引起的患者（例如，非炎症性慢性中耳疾病[例如耳硬化症]、肿瘤、单纯外耳疾病）、与疾病无关的独立植入式电子听力设备的患者、仅患有分泌性中耳炎并进行鼓膜切开术或置管的患者、先前接受过放疗或球囊咽鼓管成形术的患者，以及儿童和无法完成问卷调查的患者。
我们通过瓦尔萨尔瓦动作（Valsalva maneuver）和在瓦尔萨尔瓦动作结果不确定或为阴性的情况下通过咽鼓管评分（ETS）评估 ETD。使用阴性瓦尔萨尔瓦动作和 ETS 评分为 5 或更低来定义迁延性（慢性阻塞性）ETD。
纳入患者的 ETD 发生率。
在总共 482 例连续患者中，350 例患者的瓦尔萨尔瓦动作阳性或 ETS 评分大于 5。在 193 例瓦尔萨尔瓦动作结果不确定或为阴性的患者中，77 例患者的 ETS 评分为 5 或更低，55 例患者拒绝进一步行 ETS 检查。
根据一项针对计划接受中耳手术的慢性炎症性中耳疾病成年患者的大型队列研究，大多数（82%）患者似乎没有可通过当前常规临床方法和咽鼓管测压术检测到的迁延性（慢性阻塞性）ETD。应批判性地质疑常见的病理生理学解释，特别是在与患者沟通的背景下。
