Outcome Measures for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review

Area of Science:

• Otolaryngology
• Diagnostic Accuracy
• Middle Ear Physiology

Background:

• Baro-challenge-induced Eustachian tube dysfunction (ETD) impairs middle ear pressure regulation.
• Current diagnostic methods for baro-induced ETD are not well-characterized, hindering patient diagnosis and treatment research.

Purpose of the Study:

• To systematically review Eustachian tube (ET) function tests for their potential as outcome measures in baro-induced ETD.
• To assess the diagnostic accuracy of various ET function tests.

Main Methods:

• Systematic review of MEDLINE and CENTRAL databases (inception to March 2017).
• Inclusion of studies measuring ET function in patients with baro-induced ear symptoms or barotrauma.
• Assessment of studies using Standards for Reporting of Diagnostic Accuracy Studies (STARD) criteria.

Main Results:

• Sixteen studies evaluated seven different ET function tests.
• The nine-step test demonstrated variable sensitivity (37-100%) and specificity (57-100%).
• Tympanometry showed poor sensitivity (0-50%) but higher specificity (52-97%); data for other tests were limited.

Conclusions:

• No single ET function test is currently recommended for clinical practice for baro-induced ETD.
• A combination of the nine-step test with objective tests or patient-reported measures is a promising approach for a core set of outcome measures.