M E Smith1, J R Tysome1. 1. Department of Otorhinolaryngology, Cambridge University Hospitals, Cambridge, UK.
Abstract
BACKGROUND: Eustachian tube (ET) dysfunction is a common but poorly understood cause of patient symptoms, and an important aetiological factor in the development of middle ear pathology. Despite this, there are no specific tests of ET function in widespread clinical use and no identified 'gold standard' with which to diagnose the disease. OBJECTIVE: This review aims to review the literature to identify currently available tests of ET function and, where possible, report on their accuracy. TYPE OF REVIEW: Narrative systematic review. SEARCH STRATEGY: MEDLINE, EMBASE, Biosis and the Cochrane library were searched and reference lists reviewed for relevant articles. EVALUATION METHOD: Tests in included studies were required to measure a physiological function of the ET, or play a role in the diagnosis of poor ET function. Significant variation in demographic characteristics, disease presentation and severity, and technological approaches only permitted narrative systematic review. RESULTS: While many tests of ET function have been developed, with some in routine clinical use, all have significant limitations. Published accuracy data are limited and of differing quality due to the variability incomparative tests, and the spectrum of otological disorders associated with ET dysfunction. CONCLUSIONS: Currently, no single test could be considered a 'gold standard' for the diagnosis of ET dysfunction, but there is some evidence that diagnostic accuracy can be improved by combining the results of different objective tests and patient-reported outcome measures. Further development of ET function tests is required to facilitate the accurate diagnosis of patients and allow outcome reporting for new interventions.
BACKGROUND: Eustachian tube (ET) dysfunction is a common but poorly understood cause of patient symptoms, and an important aetiological factor in the development of middle ear pathology. Despite this, there are no specific tests of ET function in widespread clinical use and no identified 'gold standard' with which to diagnose the disease. OBJECTIVE: This review aims to review the literature to identify currently available tests of ET function and, where possible, report on their accuracy. TYPE OF REVIEW: Narrative systematic review. SEARCH STRATEGY: MEDLINE, EMBASE, Biosis and the Cochrane library were searched and reference lists reviewed for relevant articles. EVALUATION METHOD: Tests in included studies were required to measure a physiological function of the ET, or play a role in the diagnosis of poor ET function. Significant variation in demographic characteristics, disease presentation and severity, and technological approaches only permitted narrative systematic review. RESULTS: While many tests of ET function have been developed, with some in routine clinical use, all have significant limitations. Published accuracy data are limited and of differing quality due to the variability incomparative tests, and the spectrum of otological disorders associated with ET dysfunction. CONCLUSIONS: Currently, no single test could be considered a 'gold standard' for the diagnosis of ET dysfunction, but there is some evidence that diagnostic accuracy can be improved by combining the results of different objective tests and patient-reported outcome measures. Further development of ET function tests is required to facilitate the accurate diagnosis of patients and allow outcome reporting for new interventions.