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Presentation and eustachian tube function test results in children evaluated at a specialty clinic
Cuneyt M Alper1,2,3, Miriam S Teixeira1, Beverly C Richert2
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Insights
Eustachian tube dysfunction (ETD) in children often involves adenoids and inflammation. Thorough evaluation and testing are crucial before uniform treatment for pediatric ETD.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Medical Devices
Background:
- Interest in Eustachian tube (ET) dysfunction (ETD) is rising, partly due to new FDA-approved devices for balloon dilation of the ET (BDET) in adults.
- Children have undergone BDET treatment globally and off-label in the US for years, highlighting the need to understand pediatric ETD.
Purpose of the Study:
- To investigate the clinical presentations and diagnostic findings of ETD in children.
- To identify common manifestations and verify Eustachian tube function (ETF) in pediatric patients.
Main Methods:
- Retrospective cross-sectional study analyzing data from 30 children (ages 6.2-17.3) referred to an ETD clinic.
- Utilized otorhinolaryngology exams, nasopharyngeal videoendoscopy, and various Eustachian tube function (ETF) tests.
Main Results:
- Analysis of 60 ears revealed high rates of tympanic membrane perforations (38.3%) and ventilation tube issues (31.7%).
- Nasopharyngeal endoscopy showed significant secretions (42.2%), inflammation (48.8%), and adenoid tissue (46.7%).
- ETF tests indicated abnormal active function in 79.6% and abnormal passive function in 74.1% of ears.
Conclusions:
- Pediatric ETD is frequently linked to residual or regrowing adenoids and inflammation.
- A cautious approach is advised, emphasizing thorough evaluation and testing before standardizing phenotypes and treatments for children with ETD.
Objectives/Hypothesis:
Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET-specific or sinus balloons around the world and off-label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children.
Study Design:
Retrospective cross-sectional study.
Methods:
This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable.
Results:
Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%).
Conclusions:
ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing.
Level Of Evidence:
4 Laryngoscope, 129:1218-1228, 2019.
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