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Phenotypic Subtypes of Obstructive Eustachian Tube Dysfunction as Defined by Cluster Analysis.

Jenilkumar H Patel¹, Duncan G J Green², Manal S Malik¹

¹Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana, USA.

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|March 23, 2026

Summary

Researchers identified five distinct subtypes of obstructive Eustachian tube dysfunction (ETD) based on clinical features. These data-driven clusters may help refine diagnosis and treatment strategies for patients with ETD.

Keywords:

cluster analysis endoscopy eustachian tube eustachian tube dysfunction phenotype tympanometry

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Area of Science:

Otolaryngology
Medical Diagnostics
Clinical Research

Background:

Eustachian tube dysfunction (ETD) traditionally has patulous or obstructive classifications.
Obstructive ETD may present with diverse clinical manifestations.
Subtyping obstructive ETD is crucial for targeted management.

Purpose of the Study:

To define distinct subtypes of obstructive ETD.
To identify key clinical features differentiating obstructive ETD presentations.
To establish data-driven clusters for clinical application.

Main Methods:

Cross-sectional study of 490 adult obstructive ETD patients.
Utilized principle component analysis (PCA) and hierarchical cluster analysis.
Analyzed clinical data including symptoms, comorbidities, and diagnostic findings.

Main Results:

Seven key clinical characteristics identified: duration, severity, laterality, constancy, sinusitis, prior pressure equalization tube, and reflux.
Five distinct phenotypic clusters were delineated.
Clusters predicted comorbidity risk (sinusitis, GERD) and diagnostic abnormalities.

Conclusions:

Five data-driven symptom cluster groups for obstructive ETD were identified.
These clusters offer potential for clinical practice translation.
Further research may validate these subtypes for improved patient outcomes.