Learning Objectives: To better understand the available tests of Eustachian tube function, and how to optimise the techniques for clinical use.
Introduction: Obstructive Eustachian tube dysfunction is a common disorder for which there is no validated or well-characterised clinical test. To identify opening of the Eustachian tube, numerous tests have been developed which require a patient to perform a Valsalva, Toynbee or sniff manoeuvre, or to swallow on demand. These measures have not previously been compared, or technically refined in healthy individuals.
Methods: We compared six tests of Eustachian tube function in 75 ears from 42 participants, determining the most effective patient manoeuvre for each, and our own normative data.
Results: The highest detected opening rates in normal ears were: Patient reported opening 79%; Observed tympanic membrane movement 78%; Tubo-tympano-aerodynamic-graphy (TTAG) 76%; Continuous impedance 88%; Sonotubometry 94%; nine-step test inflation/deflation 93/94%. Valsalva manoeuvres were most effective at opening the Eustachian tube. Toynbee manoeuvres were most effective when the swallow was performed without water. For Valsalva and sniff manoeuvres, there was a significant correlation between the peak nasopharyngeal pressure generated and Eustachian tube opening.
Conclusions: A number of clinical tests are able to record Eustachian tube opening. The choice of patient manoeuvre applied within each test has a significant effect on detected Eustachian tube opening rates, and our results facilitate refinement of the evolving testing techniques. Further studies are required to explore the association between the test technique and results in ears with Eustachian tube dysfunction.
