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Comparison of Video Nasopharyngoscopy and Tympanometry in Suspected Eustachian Tube Dysfunction - A Prospective Study

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Abstract

Objective Tympanometry is widely used for diagnosing Eustachian tube dysfunction (ETD). However, in clinical practice, it is not uncommon to come across patients with symptoms of ETD with a normal tympanogram. Dynamic slow motion video endoscopy (DSMVE) of Eustachian tube (ET) and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) are other tools to diagnose ETD. Primary aim of the study was to compare DSMVE and tympanometry in diagnosing ETD. Secondary objective was to find an association between DSMVE and ETDQ-7. It was a prospective diagnostic validity study in the department of Otorhinolaryngology at a tertiary care centre. Patients with symptoms suggestive of ETD with intact tympanic membrane (TM) and aged above 12 years were evaluated. The study duration was 17 months. The parameters assessed were tympanic membrane(TM) retraction by otoscopy, DSMVE, tympanometry and ETDQ-7 questionnaire. To test the significance of association and difference between tympanogram and nasopharyngoscopy, Chi-Square t test and McNemar’s tests were applied. Out of 107 ears, DSMVE, tympanometry, ETDQ- 7 and otoscopy detected ETD in 51, 31,70 and 57 ears respectively. DSMVE and tympanometry together detected ETD in 29 ears and did not detect in 54 ears. Both these diagnostic methods were not comparable statistically (moderate agreement- Kappa value- 0.542). Comparison of DSMVE with ETDQ-7 was statistically significant (p-value- 0.004). Video nasopharyngoscopy cannot be a stand- alone diagnostic aid for ETD. ETDQ-7 questionnaire showed higher concordance with nasopharyngoscopy than tympanometry. Diagnostic accuracy was more when all four parameters were assessed together.

Keynote

The gold standard for the diagnosis of eustachian tube dysfunction is tympanometry (ETD).

It is not uncommon to see patients with clinical features of ETD with a normal tympanogram.

Video nasopharyngoscopy (DSMVE) may be used as an adjunct to tympanometry in assessing ET functions.

Tympanometry, DSMVE, otoscopy and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) could not always diagnose ETD.

Combination of video nasopharyngoscopy, tympanometry, ETDQ- 7 and otoscopy will increase the diagnostic accuracy of ETD.

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Acknowledgements

Department of Audiology- Amrita Institute of Medical Sciences, Kochi

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Authors and Affiliations

  1. Department of ENT, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India

    Bini Faizal & Binshy Latheef

  2. Department of Biostatistics, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India

    Niveditha Kartha

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Contributions

Dr Binshy Latheef: Contributed to acquisition of data, analysis and interpretation; drafting of article; was accountable for all aspects of the research. Dr Bini Faizal: Contributed to the conception, design and analysis of data; revised critically for intellectual content, final approval and is accountable for the accuracy of the work. Miss Niveditha Kartha: Contributed to the methodology, analysis and interpretation of data; drafting and interpretation of results and was involved throughout the study.

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Correspondence to Bini Faizal.

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The study had the approval of the Institutional Ethics Committee and Institution Review Board (IRB- AIMS-2020-189). The research was conducted adhering to the principles of Declaration of Helsinki and informed consent was taken from the participants.

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Faizal, B., Latheef, B. & Kartha, N. Comparison of Video Nasopharyngoscopy and Tympanometry in Suspected Eustachian Tube Dysfunction - A Prospective Study. Indian J Otolaryngol Head Neck Surg 76, 1682–1689 (2024). https://doi.org/10.1007/s12070-023-04384-y

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