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Observational Study
. 2017 Jan-Feb;83(1):50-58.
doi: 10.1016/j.bjorl.2016.01.010. Epub 2016 Apr 25.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects

Inesângela Canali  1 , Letícia Petersen Schmidt Rosito  2 , Bruno Siliprandi  2 , Cláudia Giugno  2 , Sady Selaimen da Costa  3
Affiliations
Observational Study

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects

Inesângela Canali et al. Braz J Otorhinolaryngol. 2017 Jan-Feb.

Abstract
in English, Portuguese

Introduction: The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results.

Objective: To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests.

Methods: An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant.

Results: Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p=0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p≥0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction.

Conclusion: In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Introdução: O diagnóstico das disfunções da tuba auditiva é essencial para o melhor entendimento da patogênese da otite média crônica. A literatura descreve uma série de testes que avaliam a função tubária; contudo, tais exames são metodologicamente heterogêneos, com diferenças que variam desde os protocolos de aplicação até a padronização dos exames e seus resultados.

Objetivo: Avaliar a variação na pressão na orelha média em pacientes com retração da membrana timpânica e em indivíduos normais durante a realização dos testes de função tubária, e também avaliar a variação intraindividual desses testes.

Método: Estudo observacional do tipo transversal e contemporâneo, no qual o fator em estudo foi a variação na pressão na orelha média durante a realização dos testes de função tubária (manobra de Valsalva, Sniff Test e manobra de Toynbee) em indivíduos normais e em pacientes com retrações timpânicas leves e moderadas/graves. Foram incluídos 38 pacientes (76 orelhas). Os pacientes foram submetidos, em dois momentos diferentes, a testes de função tubária para determinar as medidas de pressão após cada manobra. A análise estatística foi realizada com o uso do programa SPSS, versão 18.0, e consideramos como estatisticamente significativos os valores de p < 0,05.

Resultados: A média ± desvio padrão da idade foi de 11 ± 2,72 anos; 55,3% dos pacientes eram do gênero masculino e 44,7% pertenciam ao gênero feminino. A prevalência de curvas timpanométricas do tipo A foi mais alta entre os participantes com orelhas normais e naqueles com retrações leves, enquanto as curvas timpanométricas do tipo C foram mais frequentes no grupo com retrações moderadas/graves. Observamos pressões aumentadas na orelha média durante a realização da manobra de Valsalva no primeiro momento da avaliação nos três grupos de orelhas (p = 0,012). A variação na pressão não foi significativa para o Sniff Test, nem para a manobra de Toynbee nos dois momentos de avaliação (p ≥ 0,05). Consideramos que a concordância entre as determinações obtidas nos dois momentos diferentes foi fraca a moderada para todos os testes nos três grupos de orelhas, e as variações em termos de discrepância entre as medidas foram maiores nas orelhas com retrações timpânicas moderadas/graves.

Conclusão: Na população estudada, a média das pressões na orelha média apresentou variação significante apenas durante a manobra de Valsalva no primeiro momento de avaliação, nos três grupos de orelhas. As orelhas normais e aquelas apresentando retração leve se comportaram de maneira similar nos testes realizados. As manobras testadas exibiram uma variação intraindividual fraca a moderada, e a maior variação ocorreu nas orelhas com retrações moderadas/graves.

Keywords: Analysis of variance; Análise de variância; Child; Crianças; Doença otológica/fisiopatologia; Ear disease/physiopathology; Eustachian tube/physiopathology; Manobra de Valsalva/fisiologia; Middle ear ventilation/methods; Tuba de Eustáquio/fisiopatologia; Valsalva maneuver/physiology; Ventilação do ouvido médio/métodos.

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Figures

Figure 1
Figure 1
Variability of mean middle ear pressure measurements during Valsalva maneuver at the first and second time points of assessment.
Figure 2
Figure 2
Variability of mean middle ear pressure measurements during the sniff test at the first and second time points of assessment.
Figure 3
Figure 3
Variability of mean middle ear pressure measurements during the Toynbee maneuver at the first and second time points of assessment.
Figure 4
Figure 4
Box plot of differences between time points 1 and 2 for the Valsalva maneuver in the three study groups.
Figure 5
Figure 5
Box plot of differences between time points 1 and 2 for the sniff test in the three study groups.
Figure 6
Figure 6
Box plot of differences between time points 1 and 2 for the Toynbee maneuver in the three study groups.
See this image and copyright information in PMC

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