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reported similar results.6,7 Smith et al (2018) further thorough assessment to identify the ones with OETD ARTIGO ORIGINAL ORIGINAL ARTICLE
compared the test accuracy between patients with ETD and PETD.
and healthy patients, but also other otologic disorders,
such as Menière’s disease, and concluded that its CONCLUSIONS
performance to distinguish between ETD and other Although some authors recommend the diagnosis
otologic disorders was poor.8 According to the previous of ETD solely based on symptoms and signs, our
data, most authors indicate that ETDQ7 is important results showed that clinical diagnosis alone might be
for the assessment of symptoms and its severity, being inadequate, given the interobserver discrepancies. This
useful to evaluate patients before and after certain emphasizes the importance of objectively evaluating
procedures (such as ET balloon dilation), but not as a ETF as complementary to clinical evaluation, which
sole mean for diagnosis of ETD. is particularly significant in selecting patients to ET
Regarding the ETF evaluating objective tests, the ideal interventions, such as balloon tuboplasty. According
exam should be non-invasive, repeatable, and able to to our results, despite ME pressures < 100 daPa in
evaluate changes in ETF with time (since there are ETD tympanometry being diagnostic of OETD, they might
conditions in which its function varies over time).2,3,9 underestimate the true prevalence of ETD. ETDQ7,
Our data regarding tympanometry showed a good given its low specificity, is not adequate for the
specificity, but a poor sensitivity, with a fair AUC. Smith diagnosis of ETD; it has a more important role in the
et al (2018) reported an even lower AUC, of 0.66.6 Its low evaluation before and after an intervention. TMM is the
sensitivity makes it unsuitable to exclude OETD or PETD most accurate of the three, with high sensitivity, and
especially in patients with suspicious symptomatology. moderate specificity.
Although it remains as the most widely-used one, it has
some limitations, namely in patients with perforations Conflito de Interesses
of the TM, in whom the pressure in the middle ear does Os autores declaram que não têm qualquer conflito de
not reflect ETF.3 The patients with intermittent OETD interesse relativo a este artigo.
may also be missed by this exam, especially considering
the variability of ME pressure within only a few hours. Confidencialidade dos dados
TMM, a manometric exam, consists on the application Os autores declaram que seguiram os protocolos do seu
of a pre-defined pressure in the nasopharynx trabalho na publicação dos dados de pacientes.
simultaneously instructing the patient to swallow, that
should result in ET opening; a rising in ME pressure is Proteção de pessoas e animais
recorded by a sealed earpiece.10,11 Our results showed Os autores declaram que os procedimentos seguidos
TMM as the one with the highest AUC between the three estão de acordo com os regulamentos estabelecidos
evaluated. Despite other studies showing a lower AUC pelos diretores da Comissão para Investigação Clínica e
considering clinical diagnosis as the reference, TMM has Ética e de acordo com a Declaração de Helsínquia da
been shown as one of the exams with the best accuracy Associação Médica Mundial.
for ETD diagnosis.6 It is a relatively recent exam, that is
not widely available. Some authors use different cutoffs Política de privacidade, consentimento informado e
for normality, for example, consider ETF normal if the R Autorização do Comité de Ética
> 1 in only one of the three evaluated pressures when Os autores declaram que têm o consentimento por
the other ones have an R < 1, which directly influence escrito para o uso de fotografias dos pacientes neste
sensitivity and specificity. It can be useful to evaluate artigo.
PETD besides OETD, and it is the only exam available at
the moment that is able to quantify ETF.1,3,12,13 Financiamento
More recently, Smith et al (2018), and in accordance Este trabalho não recebeu qualquer contribuição,
with the results of our research, proposed a diagnostic financiamento ou bolsa de estudos.
algorithm for the different types of ETD that included
symptoms, signs, and exam results.3 Regarding OETD, Disponibilidade dos Dados científicos
and in the presence of the proper symptoms and signs Não existem conjuntos de dados disponíveis
constellation, tympanometry should be the first exam publicamente relacionados com este trabalho.
to confirm the diagnosis (except if a TM perforation is
present); even in the absence of a compatible result, Referências bibliográficas
the diagnosis of OETD should not be excluded before 1. Llewellyn A, Norman G, Harden M, Coatesworth A. et al.
TMM or sonotubometry. On the other hand, PETD Interventions for adult Eustachian tube dysfunction: asystematic
diagnosis depends on symptomatology and continuous review. Health Technol Assess. 2014 Jul;18(46):1-180, v-vi. doi:
impedance or TTAG breathing-synchronous fluctuation. 10.3310/hta18460.
This will necessarily change the paradigm in these 2. Tysome JR, Sudhoff H. The Role of the Eustachian Tube in
patients evaluation approach, demanding a more Middle Ear Disease. Adv Otorhinolaryngol. 2018;81:146-152. doi:
10.1159/000485581.
3. Smith ME, Bance ML, Tysome JR. Advances in Eustachian tube
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