Background: Diagnoses of Eustachian tube dysfunction in Benin City are typically made clinically or with tympanometry. The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) is a scoring system with potential as an alternative tool, particularly useful in resource-challenged settings. This novel tool may not have been previously investigated in this environment for its accuracy.

Objective: The study aimed to compare the diagnostic accuracy of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) to tympanometry (used as the reference standard) in identifying adult patients with Eustachian tube dysfunction at the ENT clinic of the University of Benin Teaching Hospital.

Methodology: This was a hospital-based, prospective diagnostic accuracy study using a case-control design. A total of 150 study participants were recruited, including 75 case participants and 75 controls. The ETDQ-7 instrument was administered to all participants, followed by tympanometry for each. Data were analyzed using the IBM Statistical Package for the Social Sciences (IBM SPSS) version 26.

Results: The diagnostic accuracy of the ETDQ-7 in the study group was found to be 68%, while in the control group, it was 85.4%. The Area Under the Curve (AUC) for the study group was approximately 0.75, and for the control group, it was approximately 0.80.

Conclusion: The ETDQ-7 demonstrates moderate accuracy for the diagnosis of Eustachian tube dysfunction, making it a useful tool for adoption as a screening method. Its ease of administration, noninvasive nature, and reproducibility make it particularly advantageous in settings where resources are limited. However, due to its moderate specificity, it is best utilized as a preliminary screening tool rather than a definitive diagnostic method.

Eustachian tube dysfunction, ETDQ-7, tympanometry, adults

Bluestone CD. Eustachian tube structure, function, and role in middle-ear disease.2nd ed. Raleigh: People’s Medical Publishing House-USA; 2017. p. 1-4.

Sudhoff HH. Eustachian tube dysfunction.In: Watkinson JC, Clarke RW (editors).Scott Brown’s Otolaryngology Head and Neck Surgery. eight edition.London: CRC Press Taylor and Francis group; 2018.p.1039-1044.

Musa E. Pure tone hearing threshold and middle ear function of patients with cleft palate anomaly at smile train centre Kaduna. Faculty of Otorhinolaryngology. 2014. Available from: http://www.dissertation.npmcn.edu.ng/index.php/FMCOrl/article/view/1632

Bluestone CD. Eustachian tube structure, function, and role in middle-ear disease.2nd ed. Raleigh: People’s Medical Publishing House-USA; 2017. p. 9-12.

Akpalaba IO, Ogisi FO. Tympanometric evaluation in cerebral palsy patients in Benin City, Nigeria. Int J Sci Res. 2016;5:429-38.

Shan A, Ward BK, Goman AM, Betz JF, Reed NS, Poe DS, Nieman CL. Prevalence of Eustachian tube dysfunction in adults in the United States. JAMA Otolaryngology–Head & Neck Surgery. 2019 Oct 1;145(10):974-5.

Browning GG, Gatehouse S. The prevalence of middle ear disease in the adult British population. Clinical Otolaryngology & Allied Sciences. 1992 Aug;17(4):317-21.

Somefun AO, Adefuye SA, Danfulani MA, Afolabi S, Okeowo PA.Adult-onset otitis media with effusion in Lagos.The Nigerian postgraduate medical journal.2005 Jun1;12(2):73-6.

Egbe C, Mordi RC, Omoregie R, Enabulele O. Prevalence of otitis media in Okada community,Edo state, Nigeria. Macedonian Journal of Medical Sciences.2010 Sep 15;3(3):299-302.

Alabi BS, Bolaji BO, Segun-Busari S, Aremu SK, Afolabi AO. Outcome of grommet tube insertions among adult Nigerians with serous otitis media. Annals of African medicine 2009 Oct-Dec.8(4):281-286.

Wells WA. Bartolommeo Eustachio: A Great Medical Genius Whose Chief Masterpiece Remained Hidden for One Hundred and Fifty Years. Archives of Otolaryngology. 1948 Jul 1;48(1):58-66.

Schilder AG, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ et al.eustachian tube dysfunction:concesus statement on definition, types, clinical presentation and diagnosis. Clinical Otolaryngology.2015 Oct;40(5):407.

Bluestone CD. Eustachian tube structure, function, and role in middle-ear disease.2nd ed. Raleigh: People’s Medical Publishing House-USA; 2017. p. 65-66.

Ward BK, Ashry Y, Poe DS. Patulous eustachian tube dysfunction: patient demographics and comorbidities. Otology & Neurotology. 2017 Oct 1;38(9):1362-9.

McCoul ED, Anand VK, Christos PJ. Validating the clinical assessment of eustachian tube dysfunction: The eustachian tube dysfunction questionnaire (ETDQ-7).Laryngoscope. 2012;122(5):1137–41.

Hansen LJ, Glad H, Jørkov A, Lundin K, Kirchmann M. Validating the 7-item Eustachian Tube dysfunction questionnaire in Danish. Dan Med J. 2020 Jul 1;67(7):A11190617.

Lin WL, Chou YF, Sun CH, Lin CC, Hsu CJ, Wu HP. Evaluation of thirty patients with eustachian tube dysfunction in Taiwan by questionnaire survey. J Formos Med Assoc. 2020;119(2):621–6.

Schröder S, Lehmann M, Sauzet O, Sudhoff H, Ebmeyer J. Assessment of chronic obstructive eustachian tube dysfunction: Evaluation of the German version of the Eustachian tube dysfunction questionnaire.Hno.2014 Mar 1;62(3):160-2.

Özgür E, Bilgen C, Özyurt BC. Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7. Brazilian Journal of Otorhinolaryngology. 2018 Aug;84(4):435-40.

Gallardo FP, Onishi ET, Lira FI, Suzuki FB, Testa JR. Translation, validation and cultural adaptation of" the Eustachian tube dysfunction Questionnaire-7"(ETDQ-7) to Brazilian Portuguese (BR). Brazilian Journal of Otorhinolaryngology. 2019 Aug;85(4):456-64.

Menezes AS, Ribeiro DC, Guimarães JR, Costa I, Moreira F, Dias L. Translation and validation of the “7-item Eustachian tube dysfunction questionnaire” to European Portuguese (PT). Acta Médica Portuguesa. 2020 Mar 2;33(3):191-7.

Dornhoffer JL, Leuwer R, Schwager K, Wenzel S. A Practical Guide to the Eustachian Tube.Springer-Verlag Berlin.2014. p. 1-4

Helwany M, Tadi P. Embryology, Ear [Internet]. StatPearls.StatPearls Publishing; 2020 [cited 2020 Nov 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32491520.

Anthwal N, Thompson H. The development of the mammalian outer and middle ear. Journal of anatomy. 2016 Feb;228(2):217-32.

Pagano AS, Márquez S, Smith CM, Laitman JT. Identification of critical windows in early development of human upper respiratory tract and middle ear disease. The Anatomical Record. 2021 Sep;304(9): 1953-73.

Mansour S, Magnan J, Ahmad HH, Nicolas K, Louryan S. Middle ear cavity. In Comprehensive and Clinical Anatomy of the Middle Ear 2019 (pp. 19-68). Springer, Cham.

Leuwer R. Anatomy of the Eustachian tube. Otolaryngologic Clinics of North America. 2016 Oct 1;49(5):1097-106.

Songu M, Aslan A, Unlu HH, Celik O. Neural control of Eustachian tube function.The Laryngoscope.2009 Jun;119(6):1198–202.

Doyle WJ. A formal description of middle ear pressure-regulation. Hearing research. 2017 Oct 1; 354:73-85.

Paltura C, Can TS, Yilmaz BK, Dinç ME, Develioğlu ÖN, Külekçi M. Eustachian tube diameter: Is it associated with chronic otitis media development? Am J Otolaryngol - Head Neck Med Surg. 2017 Jul 1;38(4):414–6.

Flisberg K, Ingelstedt S, Örtegren U. The valve and “locking” mechanisms of the eustachian tube. Acta oto-laryngologica. 1963 Jan 1;56(sup182):57-68.

Sakakihara J, Honjo I, Fujita A, Kurata K, Takahashi H. Eustachian Tube Compliance in Sniff-induced Otitis Media with Effusion a Preliminary Study. Acta oto-laryngologica. 1993 Jan 1;113(2):187-90.

Yoshioka S, Naito K, Fujii N, Katada K. Movement of the Eustachian tube during sniffing in patients with patulous Eustachian tube: evaluation using a 320-row area detector CT scanner. Otology & Neurotology. 2013 Jul 1;34(5):877-83.

Bluestone CD. Eustachian tube structure, function, and role in middle-ear disease. second edition. Raleigh: People’s Medical Publishing House-USA; 2017. p.80-81.

Bluestone CD. Eustachian tube structure, function, and role in middle-ear disease. second edition. Raleigh: People’s Medical Publishing House-USA; 2017. p. 75.

Muñoz D, Aedo C, Der C. Patulous eustachian tube in bariatric surgery patients. Otolaryngology—Head and Neck Surgery. 2010 Oct;143(4):521-4.

Knowles MR, Daniels LA, Davis SD, Zariwala MA, Leigh MW. Primary ciliary dyskinesia. Recent advances in diagnostics, genetics, and characterization of clinical disease. American journal of respiratory and critical care medicine. 2013 Oct 15;188(8):913-22.

Massa HM, Lim DJ, Kurono Y, Cripps AW. Middle Ear and Eustachian Tube Mucosal Immunology. In: Metesky J, Warren S, Russell M, Cheroultre H, Lambert BN (eds) Mucosal Immunology: Fourth Edition. [e-book] Academic press. [cited 2021, Jan 20]; 2015. p. 1923–42. Available from: https://www.sciencedirect.com.

Takeuchi O, Akira S. Pattern Recognition Receptors and Inflammation. Vol. 140, Cell. 2010. p. 805–20.

irfi AM, Fufore MB, Quadri OR, Kodiya AM, Nwaorgu OG. Tympanometric findings among Nigerian prison inmates: A cross-sectional survey. Nigerian Postgraduate Medical Journal. 2020 Oct 1;27(4):365.

Orji FT, Mgbor NC. Otoscopy compared with tympanometry: An evaluation of the accuracy of simple otoscopy. Nigerian Journal of Medicine. 2007 Aug 16;16(1):57-60.

Makibara RR, Fukunaga JY, Gil D. Eustachian tube function in adults with intact tympanic membrane. Brazilian journal of otorhinolaryngology. 2010 May 1;76(3):340-6.

Nwosu C, Uju Ibekwe M, Obukowho Onotai L. Tympanometric findings among children with adenoid hypertrophy in Port Harcourt, Nigeria. International Journal of Otolaryngology. 2016 Aug 2;2016.

Fasunla AJ, Ijitola JO, Nwaorgu OG. Tympanometric Patterns of Children with Allergic Rhinitis Treated at a Tertiary Health Institution. OTO open. 2017 Nov;1(4):2473974X17742648.

Mulwafu W, Ensink R, Kuper H, Fagan J. Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015. Global health action. 2017 Jan 1;10(1):1289736.

Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, Irwig L, Levine D, Reitsma JB, de Vet HC, Bossuyt PM. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. Current Pediatrics. 2022 Jul 14;21(3):209-28.

Buderer NM. Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Academic Emergency Medicine. 1996 Sep;3(9):895-900.

Altman D, Machin D, Bryant T, Gardner M, editors. Statistics with confidence: confidence intervals and statistical guidelines. John Wiley & Sons; 2013 Jun 3.

Bewick V, Cheek L, Ball J. Statistics review 14: Logistic regression. Critical care. 2005 Feb;9(1):1-7.

World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013 Nov 27;310(20):2191-4.

Herrera M, Eisenberg G, Plaza G. Clinical assessment of Eustachian tube dysfunction through the Eustachian tube dysfunction questionnaire (ETDQ-7) and tubomanometry. Acta Otorrinolaringologica (English Edition). 2019 Sep 1;70(5):265-71

Van Roeyen S, Van de Heyning P, Van Rompaey V. Responsiveness of the 7-item Eustachian tube dysfunction questionnaire. J Int Adv Otol. 2016 Apr 1;12(1):106-8.

Alkholaiwi F, Alnatheer AM, Theyab RS, Alyousef M, Aldrees T, Dahmash AB, Alghonaim Y. Cross-Cultural Adaptation, Validation, and Arabic Translation of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). International Archives of Otorhinolaryngology. 2023 Jan 20;26:636-42.

Population of Benin city, 2020. Available at: http://populationstat.com/nigeria/benin-city, [Accessed 28th of April,2021].

Tangbumrungtham N, Patel VS, Thamboo A, Patel ZM, Nayak JV, Ma Y, Choby G, Hwang PH. The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis. InInternational Forum of Allergy & Rhinology 2018 May (Vol. 8, No. 5, pp. 620-623).

Wu AW, Walgama ES, Higgins TS, Borrelli M, Vardanyan N, Hopp S, Shamsian A, Hopp ML. Eustachian tube quality of life and severity of disease in patients with chronic rhinosinusitis. American Journal of Rhinology & Allergy. 2020 Jul;34(4):532-6.

Newman AC, Omrani K, Higgins TS, Ting JY, Walgama ES, Wu AW. The prevalence of eustachian tube dysfunction symptoms in temporomandibular joint disorder patients. The Laryngoscope. 2020 Apr;130(4):E233-6.

Marino MJ, Ling LC, Yao WC, Luong A, Citardi MJ. Eustachian tube dysfunction symptoms in patients treated in a tertiary rhinology clinic. InInternational forum of allergy & rhinology 2017 Dec (Vol. 7, No. 12, pp. 1135-1139).

Teixeira MS, Swarts JD, Alper CM. Accuracy of the ETDQ-7 for identifying persons with Eustachian tube dysfunction. Otolaryngology-Head and Neck Surgery.2018 Jan;158(1):83-9.

Smith ME, Bance ML, Tysome JR. Advances in Eustachian tube function testing. World Journal of Otorhinolaryngology-Head and Neck Surgery. 2019 Sep 1;5(03):131-6.

Smith ME, Cochrane IL, Donnelly N, Axon PR, Tysome JR. The performance of patient-reported outcome measures as diagnostic tools for eustachian tube dysfunction. Otology & Neurotology. 2018 Oct 1;39(9):1129-38.