Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Otol Neurotol. 2024 Apr 1;45(4):415-418. doi: 10.1097/MAO.0000000000004146. Epub 2024 Feb 28.
Barochallenge-induced Eustachian tube dysfunction (ETD) is difficult to diagnose because the examination is often normal during clinical assessment. In adults, functional tympanometry testing, performed by asking the patient to Valsalva and Toynbee while measuring the pressure shift, can aid in the diagnosis of ETD. However, standardized values do not exist in children. We aim to determine the age at which children can perform these maneuvers and the normative values in this population.
Patients with a normal basic ear examination 4 years and older, presenting to the pediatric Otolaryngology clinic, were recruited. Otoscopy, baseline tympanometry, followed by Valsalva and Toynbee maneuvers were performed. Because there are no pediatric norms, we hypothesized that children would achieve the same minimum normal pressure shift as cited in the adult literature (+20 daPa or higher for Valsalva and -20 daPa or lower for Toynbee). The data were analyzed using receiver operating characteristic curves and logistic regression.
One hundred sixty-eight children (276 ears) were assessed. Participants as young as 4 years old were able to perform a Valsalva and Toynbee. Age cut-offs at which children achieved adult norms were 12.5 years ( p = 0.016) and 8.5 years ( p = 0.071) for Valsalva and Toynbee maneuvers, respectively. Mean pressure shift ranged from +29 to -36 daPa, and males were 2.5 times more likely to achieve Toynbee compared with females ( p = 0.006).
Functional tympanometry testing may be used to help diagnose barochallenge-induced ETD in older children.
巴乔挑战引起的咽鼓管功能障碍（ETD）很难诊断，因为在临床评估中，检查通常是正常的。在成年人中，通过让患者在瓦尔萨尔瓦和托因比时进行功能鼓室测量，同时测量压力转移，可以帮助诊断 ETD。然而，在儿童中没有标准化的值。我们的目的是确定儿童能够进行这些操作的年龄以及该人群中的正常值。
招募了 4 岁及以上基本耳部检查正常、到儿科耳鼻喉科诊所就诊的患者。进行耳镜检查、基础鼓室测量，然后进行瓦尔萨尔瓦和托因比操作。由于没有儿科标准，我们假设儿童将达到与成人文献中引用的相同的最小正常压力转移（瓦尔萨尔瓦为+20 达帕或更高，托因比为-20 达帕或更低）。使用受试者工作特征曲线和逻辑回归分析数据。
评估了 168 名儿童（276 只耳朵）。年龄最小为 4 岁的儿童能够进行瓦尔萨尔瓦和托因比操作。儿童达到成人标准的年龄截止值分别为 12.5 岁（p=0.016）和 8.5 岁（p=0.071），用于瓦尔萨尔瓦和托因比操作。平均压力转移范围为+29 至-36 达帕，男性比女性更有可能达到托因比（p=0.006），概率是女性的 2.5 倍。
功能鼓室测量测试可用于帮助诊断大龄儿童的巴乔挑战引起的 ETD。
