Otologist Carrie Nieman discusses aspects of the clinical history and exam physicians can look for to accurately diagnose eustachian tube dysfunction and set patients on the right treatment path.
My name is Carrie Niemann, and I'm a natale. Adjust at Johns Hopkins. When patients present with aural fullness and pressure, it can be challenging. We often look in their ears and we see a normal exam, and we still diagnose them with you station tube dysfunction. And for too long, you station tube dysfunction has been this catch all category as a diagnosis. But there are objective findings that we can look for on exams and in our testing to help us make a more confident diagnosis and set us on the right treatment path. First, we need to understand that you station tube dysfunction is actually a spectrum of disorders. We have from one side the station to being too closed or obstructive station tube dysfunction to the other side of the spectrum, where the station tube is to open Patch Lissy station tube dysfunction. The tricky thing is that both of these can present with aural fullness and pressure. It's important that we then go back to our exam are testing to be able to differentiate these two. There is a third type of you station to dysfunction. Barrow challenge you station to dysfunction that present specifically with aural fullness and pressure with flights or changes in barometric pressure, things like scuba diving. In order to differentiate the type of you station tube dysfunction, we need to get a targeted history. So we want to understand. When do they experience the aural fullness and pressure? What are things that make it better? What are things that make it worse? What treatments have they tried? And then other things like Do they have accompanying symptoms things like breath or voice? Toffan E. Which means Do they hear their breathing or their voice kind of echoing inside their head at the same time that they have this aural fullness and pressure? And we also want to think about any other kind of underlying conditions that may put them at risk for the different types of you station tube dysfunction. So do they have any issues with allergies? Are they actively smoking, which may put them at risk for things like obstructive you station tube dysfunction? Or do they have a history of significant weight loss things like a history of gastric bypass surgery, which we sometimes see with patchy tissue station to dysfunction? When examining patients, a good Otis Coptic exam is important. We want to be able to understand. Do we see any signs of it? Fusion? Is there air fluid levels? How about any signs of retraction? Those air particularly important when we're thinking about obstructive you station tube dysfunction. If we think we have a patient who may have patch, lets you station tube dysfunction, there's a maneuver that we can go through in clinic that could help give us the diagnosis. So if you have a patient kind of sit upright in the exam chair and while you're looking at their ear, go ahead and have them close the contra lateral nostril and have them breathe in and out through that, it's a lateral nostril is what you'll be looking for. On that exam, you see movement of the ear drum back and forth in time with their breathing. So what you're looking for specifically, do you see medial lateral excursions of the Tim panic membrane with It's a lateral nasal breathing that really could be diagnostic of patch issue station tube dysfunction. Testing is another important part of making the diagnosis of you station tube dysfunction a timpano. Graham is particularly important when we're thinking about obstructive you station tube dysfunction. So getting a timpano graham, which either shows a negative pressure like a type C timpano graham or fluid like a type B timpano graham could be diagnostic of obstructive you station tube dysfunction. If you're thinking about either obstructive or patch list or barrow challenging station tube dysfunction, the other important part of this is to be able to do an exam off the structure and function of the station To that can be done with either a flexible scope exam or a rigid scope exam, preferably with an angled scope such as a 45 degree angle scope and what you're looking for. There is the opening and closing of the station to valve any kind of inflammation, any other structures that may be impeding the opening and closing of the station tube. Because their characteristic findings that you can see on your exam that are consistent with either obstructive Barrow challenge or patches you station tube dysfunction. If patients present with aural fullness and they have no breath or voice, Tata funny, they have a normal timpano graham. They have a normal exam. They have a normal you station tube exam, it's unlikely to be you station tube dysfunction. So we need to be thinking about what else can it be in one of the most common causes of aural fullness and pressure When it's not you, station to dysfunction is temporomandibular disorders, So being able to do a really thorough exam of the TMJ or the temporomandibular joint and the associated musculature is important in helping boost your confidence in making that diagnosis. And that often entails doing a good intro Orel by manual exam about the massacre and the Terra Coid musculature to understand if there's any tension or tenderness, as more options for treatment and management of you station to dysfunction emerged, things like balloon dilation of the station to the ability to make an accurate diagnosis of you station to dysfunction and specifically the type of you station to dysfunction is critical. In order to ensure the best treatment path and the best patient outcomes