Diagnostic value of computed tomography in Eustachian tube dysfunction

Investigate radiological findings on temporal bone computed tomography, which are associated with obstructive Eustachian tube dysfunction and determine its diagnostic validity.

The present study was conducted as a prospective, cross-sectional case series study in a tertiary referral center. Forty patients with clinically diagnosed unilateral Eustachian tube dysfunction and older than 16 years old underwent pre interventional radiological assessment by temporal bone computed tomography while performing a Valsalva-maneuvre to enhance visualization of Eustachian tube lumen. The Eustachian tubes were assessed for intersite morphological differences, presence of mucus in the lumen or middle ear cleft and secretion retention or mucosal swelling in the adjacent sinuses. Image analyses and radiological statements about the side of pathology were delivered blinded to the clinical diagnoses.

The radiologic detection of mucus/mucosal edema in Eustachian tube or adjacent middle ear cleft structures was associated with the pathological side (t (1, N = 40) = 3.60, p = 0.001 < 0.05). On the contrary, there is no association between radiological findings of sinonasal disease and side of Eustachian tube dysfunction (x² (1, N = 40) = .00, p = 1.00 > 0.05). The diagnostic value of radiologic assessment in Eustachian tube dysfunction has a sensitivity and specificity of 52,5 and 97,5% respectively.

The sensitivity of radiologic assessment is rather low, and hence it is inappropriate as a screening tool for Eustachian tube dysfunction in routine clinical practice. In the case of present CT-scans of the temporal bone, the focus should be laid on the detection of mucus in the Eustachian tube or adjacent structures, as a predictor of disease.