title: Tests of Eustachian Tube Function: the Effect of Testing Technique on Tube Opening in Healthy Ears.
abstract: There is no agreement on the best clinical test for Eustachian tube (ET) dysfunction. Numerous tests have been developed to detect ET opening, and all require a patient to perform a Valsalva, Toynbee or sniff maneuver, or to swallow on demand. We aimed to characterize existing tests of ET function in healthy ears, and identify the optimal method and patient maneuver for each test. Our own normative data is presented alongside published comparisons.
  
  
  
  Diagnostic test cohort study.
  
  
  
  Tertiary referral center.
  
  
  
  Seventy-five healthy ears from 42 volunteers.
  
  
  
  Six tests of ET function, each performed using multiple different patient maneuvers.
  
  
  
  Detected ET opening rate for each test-maneuver combination.
  
  
  
  The highest detected opening rates were: Sonotubometry 94%; nine-step test inflation/deflation 93/94%; continuous impedance 88%, patient-reported opening 79%; observed tympanic membrane movement 78%; and Tubo-tympano-aerodynamic-graphy 76%. Valsalva maneuvers were most effective at opening the ET. Toynbee and swallow maneuvers were more effective when performed without water, when compared to with water. For Valsalva and sniff maneuvers, there was significant correlation between the peak nasopharyngeal pressure generated and the ET opening rate.
  
  
  
  Based on ET opening detection rates, we recommend the use of dry swallows with sonotubometry and the nine-step test. When testing patient-reported opening and observed membrane movement, and when performing Tubo-tympano-aerodynamic-graphy and impedance tests, we recommend the use of Valsalva maneuvers. Further studies are required to explore the association between the test technique and results in ears with ET dysfunction.
authors.affiliation: *Addenbrooke's Hospital, University of Cambridge †Clinical School, University of Cambridge, Cambridge, UK.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Smith
authors.forename: Andrew J C
authors.initials: AJC
authors.lastname: Blythe
authors.forename: Charlotte
authors.initials: C
authors.lastname: Baker
authors.forename: Charlie C
authors.initials: CC
authors.lastname: Zou
authors.forename: Peter J A
authors.initials: PJA
authors.lastname: Hutchinson
authors.forename: James R
authors.initials: JR
authors.lastname: Tysome
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003939:Diagnostic Techniques, Otological; D004427:Ear Diseases / Q000503:physiopathology; D005064:Eustachian Tube / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014636:Valsalva Maneuver