Assessment of 7-Item Eustachian Tube Dysfunction Questionnaire in a Clinical Population

Eustachian tube dysfunction (ETD) is a common condition among patients presenting to audiology clinics, often accompanied by nonspecific symptoms that complicate diagnosis. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was developed to aid in identifying ETD; however, despite its widespread clinical use, its diagnostic validity has not been consistently demonstrated across patient populations. We evaluate ETDQ-7 performance in a diverse group of patients seen in an audiology clinic and compare it to an objective test of ETD based on modified impedance audiometry.

This retrospective study analyzed ETDQ-7 scores, responses to a custom tinnitus quality questionnaire, pure-tone audiometry, and tympanometry with pressure manipulation in a clinical sample of 300 patients. ETD-positive cases were identified based on the absence of a significant shift in tympanometric peak pressure during swallowing or the Valsalva maneuver.

The total ETDQ-7 score showed low sensitivity and specificity in detecting objectively confirmed ETD, even when the analysis was limited to patients without hearing loss. ETDQ-7 scores did not differ significantly between patients with normal hearing and those with hearing impairment, regardless of ETD status. However, among patients reporting tinnitus, ETDQ-7 scores were positively correlated with the reported bothersomeness of tinnitus-even after excluding the "ringing in the ears" item from the total score.

In patients with tinnitus, ETDQ-7 scores appear to reflect general subjective discomfort caused by tinnitus rather than the presence or severity of ETD. These findings raise concerns about the ETDQ-7's utility as a stand-alone diagnostic tool for ETD in heterogeneous clinical populations.