title: Tubal function tests with optional myringotomy detect Eustachian tube closing failure in acquired pars flaccida retraction cholesteatoma.
abstract: OBJECTIVE
  To re-evaluate the incidence of Eustachian tube closing failure in acquired middle ear cholesteatoma.
  
  
  METHODS
  Thirty-one cases with acquired middle ear cholesteatoma who received surgery were enrolled. Presence of Eustachian tube closing failure was determined through two Eustachian tube function tests. First Step Tests: Test 1: Positive sniff test identified by retraction of the tympanic membrane upon sniffing was observed. Test 2: The pressure in the external auditory meatus was found to change synchronously with that of the nasopharynx during respiration or upon sniffing. Second step test: For cases with negative First Step Tests, myringotomy was performed and Test 2 was repeated.
  
  
  RESULTS
  Test 1 was positive in six (19.4%) and Test 2 was initially positive in nine (29.0%) out of 31 cases. Twelve out of 31 cases (38.7%) were positive for either one of the tests. The remaining 19 cases with initial negative test results subsequently received myringotomy and were subjected to Test 2 again. Positive results were obtained in five (13.9%) additional cases, and a final total of 17 (54.8%) out of 31 cases were positive for Eustachian tube closing failure.
  
  
  CONCLUSIONS
  Sniff test with optional myringotomy may be useful for preoperative diagnosis of Eustachian tube closing failure.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan; Department of Otolaryngology Head & Neck Surgery, Pattani Hospital, Pattani, Thailand.
authors.forename: Phawana
authors.initials: P
authors.lastname: Asawapittayanont
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan; Sen-En Rifu Otological Surgery Center, Miyagi, Japan. Electronic address: ryoukich@hotmail.com.
authors.forename: Ryoukichi
authors.initials: R
authors.lastname: Ikeda
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Oshima
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan; Sen-En Rifu Otological Surgery Center, Miyagi, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Miyazaki
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Tetsuaki
authors.initials: T
authors.lastname: Kawase
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Katori
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan; Sen-En Rifu Otological Surgery Center, Miyagi, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D004427:Ear Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D005064:Eustachian Tube / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation; D038781:Otoscopy; D057234:Preoperative Period; D011312:Pressure; D012119:Respiration; D055815:Young Adult
keywords: Cholesteatoma; Eustachian tube; Middle ear; Sniff test