Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7

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Documento de consenso del Comité de Clasificación de la Bárány Society" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "50" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Presbyvestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yuri Agrawal, Raymond Van de Berg, Floris Wuyts, Leif Walther, Mans Magnusson, Esther Oh, Margaret Sharpe, Michael Strupp" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Yuri" "apellidos" => "Agrawal" ] 1 => array:2 [ "nombre" => "Raymond" "apellidos" => "Van de Berg" ] 2 => array:2 [ "nombre" => "Floris" "apellidos" => "Wuyts" ] 3 => array:2 [ "nombre" => "Leif" "apellidos" => "Walther" ] 4 => array:2 [ "nombre" => "Mans" "apellidos" => "Magnusson" ] 5 => array:2 [ "nombre" => "Esther" "apellidos" => "Oh" ] 6 => array:2 [ "nombre" => "Margaret" "apellidos" => "Sharpe" ] 7 => array:2 [ "nombre" => "Michael" "apellidos" => "Strupp" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651921000893?idApp=UINPBA00004N" "url" => "/00016519/0000007300000001/v1_202201140550/S0001651921000893/v1_202201140550/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0001651920301989" "issn" => "00016519" "doi" => "10.1016/j.otorri.2020.11.003" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1063" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2022;73:27-34" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "34" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "VPPB del canal semicircular lateral: estudio prospectivo aleatorizado de la eficacia de 4 maniobras de reposicionamiento" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1656 "Ancho" => 2091 "Tamanyo" => 199156 ] ] "descripcion" => array:1 [ "en" => "Detailed description of performed maneuvers. A–D depicts maneuvers for treatment of left LC-BPPV. In every maneuver performed, the following principle was applied: each mid-position was held for 30s after nystagmus stopped; if no nystagmus was induced with movement during repositioning maneuvers, each mid-position was also held for 30s. A: Gufoni maneuver (geotropic LC-BPPV): The patient, sat upright, was rapidly tilted to the healthy side lying position; the head was then quickly rotated downwards by 45°, with the nose down; the patient was then returned to the sitting position. B: Gufoni-Appiani maneuver (apogeotropic LC-BPPV): The patient, sat upright, was rapidly tilted to the affected side lying position; the head was rotated upwards by 45°; the patient was then returned to the sitting position. C: Barbecue-roll maneuver (geotropic and apogeotropic LC-BPPV): starting with the involved ear down, the patient was instructed to rotate his head rapidly 90° toward healthy side, 5 times, applying an overall 450° rotation. Body turns followed head rotations when induced nystagmus or vertigo fade out, while head position was held. D: Zuma-e-Maia maneuver: The patient, sat upright, was rapidly tilted to the affected side lying position; the head was rotated 90° upwards; the head was rotated more 90° toward the healthy side; the head was slightly flexed and the patient sat back up with the head flexed." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Filipe Correia, Luís Castelhano, Pedro Cavilhas, Pedro Escada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Filipe" "apellidos" => "Correia" ] 1 => array:2 [ "nombre" => "Luís" "apellidos" => "Castelhano" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Cavilhas" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Escada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173573522000138" "doi" => "10.1016/j.otoeng.2020.11.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573522000138?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651920301989?idApp=UINPBA00004N" "url" => "/00016519/0000007300000001/v1_202201140550/S0001651920301989/v1_202201140550/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "41" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "António Fontes Lima, Filipa Carvalho Moreira, Isabel Esteves Costa, Cátia Azevedo, Fernando Mar, Luís Dias" "autores" => array:6 [ 0 => array:4 [ "nombre" => "António" "apellidos" => "Fontes Lima" "email" => array:1 [ 0 => "Antoniofonteslima24@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Filipa" "apellidos" => "Carvalho Moreira" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Esteves Costa" ] 3 => array:2 [ "nombre" => "Cátia" "apellidos" => "Azevedo" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Mar" ] 5 => array:2 [ "nombre" => "Luís" "apellidos" => "Dias" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Otorhinolaryngology, Hospital de Braga, 4715 Braga, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desviación del septo nasal y función de la trompa de Eustaquio: estudio prospectivo de control de casos basado en timpanometría, tubomanometría y ETDQ-7" ] ] "textoCompleto" => "IntroductionEustachian tube (ET) dysfunction includes disorders in which ET fails to close or open properly. These are named patulous and obstructive ETD (OETD), respectively, the latter being the most common of the two.<a class="elsevierStyleCrossRef" href="#bib0120">1</a> Patients with ET dysfunction may complain of different otologic symptoms related to the persistent negative middle ear pressure, such as otalgia, aural fulness, hearing impairment, and tinnitus. Moreover, ET dysfunction can contribute to middle ear effusion and chronic otitis media, in the form of tympanic membrane retraction and cholesteatoma.ET dysfunction has been associated with different conditions. Less common conditions are related to mechanic obstruction of the ET opening, namely by extrinsic compression – adenoids and tumors, and fibrosis, for example, as a consequence of trauma or radiotherapy for head and neck cancer.<a class="elsevierStyleCrossRefs" href="#bib0125">2,3</a> More often, ET dysfunction is related to an inflammatory response of the epithelium within the lumen of the tube.<a class="elsevierStyleCrossRef" href="#bib0135">4</a> Inflammation may have different etiologies, frequently divided into irritant and infectious reactions. Proven irritant substances to the ET – such as smoke, acid from pharyngolaryngeal gastric reflux – and infections – viral or bacterial –, may stimulate the release of proinflammatory cytokines which promote edema leading to an inability for an adequate ET opening. Nasal pathology such as allergic rhinitis and chronic rhinosinusitis are also a cause of inflammatory changes in ET opening and have also been associated with ET dysfunction. Nevertheless, the impact of nasal septum deviation (NSD) alone in ET function is not a consensual subject.Although some researchers have supported that NSD could worsen the middle ear ventilation by negative influence on airflow parameters, and advocate that severe NSD can be the cause of failure of ear surgery for chronic otitis media, other studies failed to prove the association.<a class="elsevierStyleCrossRefs" href="#bib0140">5–10</a> Different authors have previously investigated the influence of isolated NSD in the ET function using distinct methodologies: most authors used impedanciometry, through tympanometry or Valsalva and Toynebee tubal function tests to assess tubal function, evaluating patients before and after septal surgery, and comparing results in different moments; one author used a control population (without NSD) and one evaluated ET dysfunction symptomatology evaluation (and none used a validated symptoms scale).<a class="elsevierStyleCrossRefs" href="#bib0140">5–8,10</a>Given the absence of a gold-standard exam to evaluate ET function studies that address the impact of NSD on ET use different methods for its evaluation, which can also make their results difficult to interpret and compare.<a class="elsevierStyleCrossRefs" href="#bib0145">6–9</a>Although there are several papers about the subject, the best test to accurately evaluate ET function is still a matter of debate.A recent review from Smith et al. abridged all the current concepts about ET function evaluation.<a class="elsevierStyleCrossRef" href="#bib0170">11</a> Patient-reported outcome measures (PROMs), such as ET dysfunction questionnaire 7 (ETDQ-7) and 10-item Cambridge ET dysfunction Assessment (CETDA) are repeatable, being valuable to assess the presence and to quantify the severity of ET dysfunction-related symptoms; on the other hand, they are not valuable for diagnostic purposes.<a class="elsevierStyleCrossRefs" href="#bib0120">1,11–13</a> In fact, these PROMs are helpful, above all, to evaluate the impact of different interventions (such as baloon Eustachian tuboplasty) in symptoms and quality of life, and have been added to some recent consensuses regarding the ET dysfunction treatment approach.<a class="elsevierStyleCrossRefs" href="#bib0170">11,12,14</a>Clinical assessment, including PROMs, should be complemented with objective exams. Regarding the latter, they are further divided in indirect measures of ET function (for which tympanometry is the most widely used), tests of ET opening (such as evaluation of the tympanic membrane movement or external auditory canal – tubo-tympano-aerodynamic graph – TTAG – pressure to Valsalva and Toynebee maneuvers, tubomanometry, inflation-deflation tests, or sonotubometry) and tests of ET closure (TTAG, sonotubometry or tubomanometry).<a class="elsevierStyleCrossRef" href="#bib0170">11</a> Tympanometry, sonotubometry, and tubomanometry (TMM) are the ones with greater value in patients in which obstructive pathology of the ET is suspected.<a class="elsevierStyleCrossRef" href="#bib0170">11</a> On the other hand, to evaluate patulous ET dysfunction besides the observation of a breathing-synchronous tympanic membrane movement, exams such as TTAG, sonotubometry and TMM can be valuable. Although none is considered the gold-standard of ET evaluation, they all are reliable and objective, with different sensitivities and specificities.<a class="elsevierStyleCrossRefs" href="#bib0120">1,13,15,16</a>ObjectiveThe first objective of this paper is to compare ET function between patients with NSD and patients with adequate bilateral nasal patency using PROMs and evaluation through objective exams. The second objective is to assess the change in ET function following septal surgery in patients with severe septal deviation.Methods and methodologyThis prospective study was conducted in the department of Otorhinolaryngology of a tertiary hospital after Ethics committee approval (Comissão de Ética do Hospital de Braga – Ref°68_2020). The study was divided into two phases.In the first phase, an opportunistic sample was selected and divided in two groups of patients: 35 patients for group A, with unilateral grade III anterior NSD according to Cottle's classification – marked angulation of the septum with a spur in contact with the lateral wall even after application of a vasoconstrictor; and 35 patients to group B, that comprised one sample of patients with adequate nasal patency bilaterally.Inclusion criteria for both groups included age superior to 18 years old, an intact tympanic membrane (given tympanometry was used) and able to fulfill all evaluation protocol. Exclusion criteria were the following: smoking; having other nasal pathology (such as chronic rhinosinusitis and allergic rhinitis); previous nasal surgery; previous otologic surgery; recent acute otitis media (less than 3 months); previous head and neck radiotherapy; and neuromuscular and swallowing disorders.After selection, both groups were evaluated according to the following protocol:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-2 PROMs were used to assess the impact of nasal obstruction and ET dysfunction in terms of symptomatology and quality of life of these patients: Nasal Obstruction Subjective Questionnaire (NOSE; validated in Portuguese)<a class="elsevierStyleCrossRef" href="#bib0200">17</a> which have five questions, and its results lead to four different categories – mild (5–25), moderate (30–50), severe (55–75) or extreme (80–100) nasal obstruction; and ETDQ7 (validated in Portuguese)<a class="elsevierStyleCrossRef" href="#bib0205">18</a>, with 7 questions, in which a result >14 points is considered compatible with ET dysfunction.</li><li class="elsevierStyleListItem" id="lsti0010">-All the patients underwent nasal endoscopy to exclude anatomical changes or obstruction of the torus tubarius.</li><li class="elsevierStyleListItem" id="lsti0015">-2 objective exams to assess ET function were used after application of a cotton pledget with topical decongestant (fenylephrine 5mg/dL) for 5min in each nostril: tympanometry of both ears and tubomanometry (TMM; tested with 300daPa, 400daPa, and 500daPa) on both sides.</li></ul>The second phase of the study consisted of the re-evaluation of the patients from group A after septoplasty with clinical observation (confirmation of an adequate nasal patency, without significative deformities of the nasal septum), ETDQ7, tympanometry, and TMM.For analysis purposes, we considered three groups, namely preoperative group A, postoperative group A and group B. Tympanometry was considered compatible with ET dysfunction when middle ear pressure was lower than -100daPa (type C) or with no identifiable pressure peak (type B).TMM was performed using the Spiggle and Theis® tubomanometer. The patient under examination was seated in a chair, with the head in a horizontal position. Pre-defined pressures of 30, 40, and 50mbar were applied to the nasopharynx through a nasal applicator. A pressure receptor probe in the external ear detected pressure changes through the movement of the tympanic membrane or through a TM perforation. The patient was instructed to swallow a sip of water, which was the trigger that led the cartilaginous part of the ET to open, resulting in the transmission of the applied pressure in the nasopharynx to the ME. The TMM provides several measures, but the R-value is the one with the most clinical applicability. It refers to the opening latency between application of pressure to the nasopharynx and the pressure changing detected through the external ear probe. TMM was considered abnormal when R-value was >1 (OETD) or =0 (patulous ET dysfunction) for any of the tested pressures.<a class="elsevierStyleCrossRefs" href="#bib0190">15,19</a>Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v24.0 for macOS. Quantitative variables without normal distribution were described as median and interquartile range. Chi-square was used to evaluate the correlation between categorical variables; non-parametric independent Mann–Whitney U Test was used to compare medians between different groups; related-samples Wilcoxon Signed Rank test was used to compare medians in the same group after the surgical intervention, and non-parametric Spearman rho was used to assess the correlation between continuous variables. A p-value <0.05 was used to reject the null hypothesis.ResultsFor each group, 35 patients were selected, with a total of 70 patients.Demographic featuresIn both groups, female patients were predominant (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>There was no statistically significant difference between groups A and B in what gender [χ2 (1, n=70)=1472, p=0.225)] and age (Mann–Whitney U=762.5, p=0.078) concerns.First phase of the studyPROMs scoresMedian scores in NOSE in pre-operative group A and group B were 60 and 15 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>); the average score differed significantly between the two (Mann–Whitney U=1202, p<0.001).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>On the other hand, the score in ETDQ7 was statistically significantly higher in pre-operative group A (median=14) than in group B (median=8) [U=1048, p<0.001].Objective overall ET function assessmentNormal overall ET function evaluated through tympanometry and TMM was considered when both ears or both ET, respectively, had normal function.While the difference in the evaluation through tympanometry was not statistically significant [χ2 (1, n=70)=0.15, p=0.643], there was a statistically significant difference between ET function measured through TMM between preoperative patients of group A and group B [χ2 (1, n=70)=4.2, p=0.040], with better ET function in group B (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). No patients had a result in TMM compatible with patulous TMM (R=0).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Correlation between the side of the deviation and ET dysfunctionAccording to our data, regarding the patients of preoperative group A, the side of the nasal deviation does not correlate with the side of the dysfunction assessed through either tympanometry or TMM (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Correlation between PROMsBased on the results of our study (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), there is a positive moderate correlation between the scores in NOSE and ETDQ7, which means that patients with higher scores in NOSE tend to have higher scores in ETDQ7 (rs=0.57, p<0.001).Second phase of the studyThe postoperative evaluation of the patients (from group A) who underwent septoplasty was performed between 3 and 6 months after surgery.Regarding symptomatology evaluation through ETDQ7 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), a Wilcoxon Signed-Ranks Test indicated that the postoperative median=11, was statistically significantly lower than the preoperative median, median=14, Z=0, p<0.001.In terms of objective ET function measures (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), a McNemar test showed that the difference in the proportion of patients with abnormal tympanometry in preoperative group A and postoperative group A was not statistically significant, p=0.250. On the other hand, there was a statistically significant difference in the proportion of patients with findings compatible with ET dysfunction in TMM between preoperative and postoperative group A (p=0.031), higher in the former.DiscussionSinonasal pathology has been associated with ET dysfunction through inflammation of peritubal mucosa. Conditions such as upper respiratory tract infection, allergic rhinitis, chronic rhinosinusitis can be the trigger of ET dysfunction symptomatology.<a class="elsevierStyleCrossRef" href="#bib0125">2</a> Several authors have argued that NSD alone could be a cause of ET dysfunction.Different physiopathologic mechanisms tried to explain the influence of NSD on ET function: a deviated septum could cause ciliary disturbances, resulting in nasal secretions stagnation, increasing the risk of infections; airflow turbulence could lead to microorganisms and pollutants deposition in ET opening, resulting in inflammation and mechanical obstruction; this turbulence could also have a drying effect, increasing tubal mucous viscosity and surface tension, and a stimulating effect on autonomic nerve supply of ET, leading to changes in ET function.<a class="elsevierStyleCrossRefs" href="#bib0215">20,21</a>By selecting patients with severe NSD without associated nasal pathologies, and comparing it to a control population, we were able to evaluate the contribution of NSD alone.To assess if our control sample was representative of the general population, we compared the prevalence of ET dysfunction in this population with available literature. Our study revealed a prevalence of ET dysfunction in group B of 5.7% which is similar to the reported in a populational study in the United States of America, of 4.6% (both using tympanometry as diagnostic criteria).<a class="elsevierStyleCrossRef" href="#bib0225">22</a> There are no studies in the literature regarding ET dysfunction prevalence using TMM.As expected, in our population with NSD (pre-operative group A) we found higher scores in NOSE; this group also had higher scores in ETDQ7 than the control group, and this difference was statistically significant; besides, there was an association between the two, which means that patients who have more complaints related to nasal obstruction, also have more complaints which are usually linked to ET dysfunction. The data should be carefully analyzed, given that, according to recent studies, despite having a high sensitivity, ETDQ7 specificity is very low, with a low positive predictive value; this means it should not be used to make ET dysfunction diagnosis alone, but is important to evaluate symptoms and impact on quality of life in this patients.<a class="elsevierStyleCrossRef" href="#bib0120">1</a>Preoperative group A and group B had similar results in terms of tympanometry; that was not the case using TMM, showing a statistically significant association between septal deviation and ET dysfunction was shown using TMM. Akyildiz et al. reported worse ET function evaluated through tympanometry in patients with NSD comparing to patients without septal deviation.Another interesting finding of our research was that there was no statistically significant correlation between the side of the NSD and side of the ET dysfunction. This finding was consistent with the results reported by Akyildiz et al.<a class="elsevierStyleCrossRef" href="#bib0140">5</a> Along with this line of thinking, a possible explanation is that septal deviation is related to turbulent airstreams, which are a cause of edema and stagnation of secretions in nasal and postnasal cavities.<a class="elsevierStyleCrossRef" href="#bib0215">20</a> Moreover, the inferior turbinates may have an important role, related to the usual compensatory hypertrophy of the inferior turbinate on the opposite side of the NSD. This way, it may impair the function of the ipsilateral ET, but also the contra-lateral, which is consistent with our results. Accordingly, besides septoplasty, inferior turbinoplasty may be considered when treating these patients.Finally, our results also showed an improvement in ET dysfunction symptomatology and ET function evaluated through ETDQ7 and TMM, respectively, but not through tympanometry, in postoperative group A (patients with grade III NSD). As in our research, Salvinelli et al. found an improvement in ET dysfunction symptomatology, but no statistically significant difference in tympanometry results.<a class="elsevierStyleCrossRef" href="#bib0145">6</a> On the other hand, an enhancement in ET function evaluated through tympanometry was found by some authors that verified an improvement after surgery based on ME pressures.<a class="elsevierStyleCrossRefs" href="#bib0140">5,7,8</a> In what concerns TMM usage to assess ET function in patients with septal deviation, there are no studies available in the literature evaluating the prevalence of ET dysfunction with this tool. The fact that we only found differences in TMM evaluation can relate to the better sensitivity and accuracy of this exam compared to tympanometry, and the lack of identification of mild ET dysfunction cases with isolated use of the latter exam.<a class="elsevierStyleCrossRefs" href="#bib0120">1,13</a> Tympanometry has other well-known limitations, such as the impossibility of using it to evaluate ET function in patients with TM perforation; moreover, patients with intermittent obstructive ET dysfunction may also be missed by this exam.<a class="elsevierStyleCrossRef" href="#bib0180">13</a> On the other hand, TMM surpasses these limitations as it simulates a physiologic ET opening, and may be used to evaluate patients with TM perforations.<a class="elsevierStyleCrossRefs" href="#bib0180">13,23</a> This enhances the need to change the paradigm of evaluating patients with suspected ET dysfunction only with tympanometry, demanding the usage of exams such as TMM for a complete patient's evaluation.Implications for clinical practiceET dysfunction, besides being associated with aural symptoms, can contribute to otologic pathology, such as COM, and be a cause of unsuccess in ME surgery. So, it is mandatory to evaluate patients regarding the presence of ET dysfunction before ME surgery and, if possible, correct the underlying causes before the ear intervention.According to our data, ET dysfunction in a patient with severe NSD has a higher prevalence (using TMM) than in patients with no NSD, and also more complaints of ET dysfunction symptoms; besides, our results indicate that septal surgery might be an adequate mean for improving ET dysfunction in those cases. However, not all patients with NSD will have ET dysfunction, which means ET function exams and ET dysfunction symptomatology scores should guide the surgeon when deciding whether to proceed or not with septal surgery before ear surgery for chronic otitis media.Limitations and advantagesAlthough the chosen population was controlled, the final sample is small given the strict criteria used for selection. As tympanometry was used as one of the methods to evaluate ET function, only patients with intact tympanic membrane were included (given that tympanometry result would not reflect ET function but the perforation itself); accordingly, the prevalence of ET dysfunction in both populations might be underestimated as ET dysfunction can be a cause of the tympanic membrane perforation.Nasal patency evaluation was subjective given the absence of Acoustic Rhinometry and Rhinomanometry in the authors’ department; however, to surpass this, the authors chose patients with severe anterior NSD. As a consequence, this investigation does not answer the question regarding the impact of septal surgery on ET dysfunction on patients with mild and moderate septal deviations. Nonetheless, it does answer the main question, which is if NSD has or does not have an impact in ET function.On the other hand, according to the authors’ knowledge, this is the first study that addresses the relation between NSD and ET dysfunction using validated PROMs and TMM. Given the better sensitivity for ET dysfunction of TMM compared to tympanometry, this research represents a step toward clearing a subject which has been a cause of discussion for several years.<a class="elsevierStyleCrossRef" href="#bib0120">1</a> Besides, as our inclusion and exclusion criteria were very strict, we were able to isolate the structural problem of septal deviation (excluding other inflammatory pathologies).ConclusionAccording to our results grade III NSD according to Cottle's classification has an impact on ET function. In the absence of other conditions usually related to ET dysfunction, if a patient with severe septal deviation has symptomatology and ET objective function exams compatible with ET dysfunction, septal surgery should be considered in the treatment.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1646216" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods and methodology" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1466618" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1646217" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos y metodología" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1466617" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Objective" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Methods and methodology" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Demographic features" ] 1 => array:3 [ "identificador" => "sec0030" "titulo" => "First phase of the study" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "PROMs scores" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Objective overall ET function assessment" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Correlation between the side of the deviation and ET dysfunction" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Correlation between PROMs" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Second phase of the study" ] ] ] ] ] 7 => array:3 [ "identificador" => "sec0060" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Implications for clinical practice" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Limitations and advantages" ] ] ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-09-11" "fechaAceptado" => "2020-11-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1466618" "palabras" => array:4 [ 0 => "Eustachian tube" 1 => "Eustachian tube dysfunction" 2 => "Nasal septum deviation" 3 => "Tubomanometry" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1466617" "palabras" => array:4 [ 0 => "Trompa de Eustaquio" 1 => "Disfunción de la trompa de Eustaquio" 2 => "Desviación del septo nasal" 3 => "tubomanometría" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined. Objectivecompare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. Methods and methodologya prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) –, and through two objective exams to assess ET function – tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery. Resultswe found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM. Conclusionaccording to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods and methodology" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónAún sigue sin determinarse la influencia aislada de la desviación del septo nasal (DSN) en la función de la trompa de Eustaquio (TE). ObjetivoComparar la función de la TE entre los pacientes con DSN grave y los pacientes con patencia nasal adecuada, en términos de sintomatología y exámenes objetivos, y evaluar el impacto de la septoplastia en la función de la TE en pacientes con DSN grave. Métodos y metodologíaSe realizó un estudio prospectivo seleccionándose 2 muestras oportunistas en la primera fase del mismo: 35 pacientes con DSN grave en el grupo A, y 35 pacientes con patencia nasal adecuada en el grupo B. Se evaluó a ambos grupos utilizando los cuestionarios Nasal Obstruction Subjective Questionnaire (NOSE) y disfunción de TE (ETDQ7), así como mediante 2 exámenes objetivos, para evaluar la función de la TE: timpanometría y tubomanometría (TMM), comparándose los resultados entre los grupos A y B. En la segunda fase del estudio, los pacientes del grupo A fueron sometidos a septoplastia y reevaluados mediante ETDQ7, timpanometría y TMM, comparándose los resultados de antes y después de la cirugía. ResultadosEncontramos una diferencia estadísticamente significativa en NOSE y ETDQ7 entre los pacientes con DSN y los pacientes con patencia nasal adecuada (con puntuaciones superiores en este último), y TMM (con peores resultados en los pacientes con DSN), no siendo estadísticamente significativa la diferencia en la timpanometría. El lado de DNS no se correlacionó con el lado de la disfunción. Tras la septoplastia, los pacientes del grupo A reflejaron puntuaciones menores en ETDQ7 con significación estadística, y existió una menor proporción de pacientes con hallazgos compatibles con la disfunción de la TE utilizando TMM. ConclusiónCon arreglo a nuestros resultados, la DNS en solitario es una causa de disfunción de la TE, pudiendo mejorar la septoplastia la función de la TE en estos pacientes." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos y metodología" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IQR: interquartil range." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Age Median (IQR) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Male \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Female \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Group A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.6% (n=17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.4% (n=18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (IQR=19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Group B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.3% (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.7% (n=23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (IQR=14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p=0.225</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p=0.078 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2803038.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic features of the groups." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ETDQ7: Eustachian Tube Dysfunction Questionnaire 7; IQR: interquartil range; NOSE: Nasal Obstruction Subjective Questionnaire." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Group B \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pre-operative \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Post-operative \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NOSE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (IQR=30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (IQR=5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (IQR=20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ETDQ7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (IQR=17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (IQR=5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (IQR=4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2803039.png" ] ] ] ] "descripcion" => array:1 [ "en" => "PROMs scores." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Group B \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pre-operative \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Post-operative \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tympanometry</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.4% (n=32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.1% (n=34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.3% (n=33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6% (n=3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9% (n=1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7% (n=2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tubomanometry</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0>R>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.1% (n=27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.3% (n=33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.3% (n=33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">R>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.9% (n=8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7% (n=2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7% (n=2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2803037.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Objective exams results." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Narrower side \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wider side \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tympanometry</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.3% (n=33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.3% (n=33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p=1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7% (n=2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7% (n=2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tubomanometry</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0>R>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.4% (n=32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.9% (n=29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p=0.284 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">R>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6% (n=3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.1% (n=6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2803036.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of ET function between side of the deviation in group A (pre-operative)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eustachian tube dysfunction: a diagnostic accuracy study and proposed diagnostic pathway" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. 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Original article

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7

Desviación del septo nasal y función de la trompa de Eustaquio: estudio prospectivo de control de casos basado en timpanometría, tubomanometría y ETDQ-7

António Fontes Lima

Corresponding author

Antoniofonteslima24@gmail.com

Corresponding author.

, Filipa Carvalho Moreira, Isabel Esteves Costa, Cátia Azevedo, Fernando Mar, Luís Dias

Department of Otorhinolaryngology, Hospital de Braga, 4715 Braga, Portugal

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    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Nasal septum deviation and Eustachian tube function&#58; A prospective case-control study based on tympanometry&#44; tubomanometry&#44; and ETDQ-7"
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        "paginaInicial" => "35"
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    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Ant&#243;nio Fontes Lima, Filipa Carvalho Moreira, Isabel Esteves Costa, C&#225;tia Azevedo, Fernando Mar, Lu&#237;s Dias"
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          0 => array:4 [
            "nombre" => "Ant&#243;nio"
            "apellidos" => "Fontes Lima"
            "email" => array:1 [
              0 => "Antoniofonteslima24@gmail.com"
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                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
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          1 => array:2 [
            "nombre" => "Filipa"
            "apellidos" => "Carvalho Moreira"
          ]
          2 => array:2 [
            "nombre" => "Isabel"
            "apellidos" => "Esteves Costa"
          ]
          3 => array:2 [
            "nombre" => "C&#225;tia"
            "apellidos" => "Azevedo"
          ]
          4 => array:2 [
            "nombre" => "Fernando"
            "apellidos" => "Mar"
          ]
          5 => array:2 [
            "nombre" => "Lu&#237;s"
            "apellidos" => "Dias"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Otorhinolaryngology&#44; Hospital de Braga&#44; 4715 Braga&#44; Portugal"
            "identificador" => "aff0005"
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            "identificador" => "cor0005"
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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Desviaci&#243;n del septo nasal y funci&#243;n de la trompa de Eustaquio&#58; estudio prospectivo de control de casos basado en timpanometr&#237;a&#44; tubomanometr&#237;a y ETDQ-7"
      ]
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Eustachian tube &#40;ET&#41; dysfunction includes disorders in which ET fails to close or open properly&#46; These are named patulous and obstructive ETD &#40;OETD&#41;&#44; respectively&#44; the latter being the most common of the two&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Patients with ET dysfunction may complain of different otologic symptoms related to the persistent negative middle ear pressure&#44; such as otalgia&#44; aural fulness&#44; hearing impairment&#44; and tinnitus&#46; Moreover&#44; ET dysfunction can contribute to middle ear effusion and chronic otitis media&#44; in the form of tympanic membrane retraction and cholesteatoma&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">ET dysfunction has been associated with different conditions&#46; Less common conditions are related to mechanic obstruction of the ET opening&#44; namely by extrinsic compression &#8211; adenoids and tumors&#44; and fibrosis&#44; for example&#44; as a consequence of trauma or radiotherapy for head and neck cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;3</span></a> More often&#44; ET dysfunction is related to an inflammatory response of the epithelium within the lumen of the tube&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> Inflammation may have different etiologies&#44; frequently divided into irritant and infectious reactions&#46; Proven irritant substances to the ET &#8211; such as smoke&#44; acid from pharyngolaryngeal gastric reflux &#8211; and infections &#8211; viral or bacterial &#8211;&#44; may stimulate the release of proinflammatory cytokines which promote edema leading to an inability for an adequate ET opening&#46; Nasal pathology such as allergic rhinitis and chronic rhinosinusitis are also a cause of inflammatory changes in ET opening and have also been associated with ET dysfunction&#46; Nevertheless&#44; the impact of nasal septum deviation &#40;NSD&#41; alone in ET function is not a consensual subject&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although some researchers have supported that NSD could worsen the middle ear ventilation by negative influence on airflow parameters&#44; and advocate that severe NSD can be the cause of failure of ear surgery for chronic otitis media&#44; other studies failed to prove the association&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#8211;10</span></a> Different authors have previously investigated the influence of isolated NSD in the ET function using distinct methodologies&#58; most authors used impedanciometry&#44; through tympanometry or <span class="elsevierStyleItalic">Valsalva</span> and <span class="elsevierStyleItalic">Toynebee</span> tubal function tests to assess tubal function&#44; evaluating patients before and after septal surgery&#44; and comparing results in different moments&#59; one author used a control population &#40;without NSD&#41; and one evaluated ET dysfunction symptomatology evaluation &#40;and none used a validated symptoms scale&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#8211;8&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the absence of a gold-standard exam to evaluate ET function studies that address the impact of NSD on ET use different methods for its evaluation&#44; which can also make their results difficult to interpret and compare&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6&#8211;9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although there are several papers about the subject&#44; the best test to accurately evaluate ET function is still a matter of debate&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A recent review from Smith et al&#46; abridged all the current concepts about ET function evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> Patient-reported outcome measures &#40;PROMs&#41;&#44; such as ET dysfunction questionnaire 7 &#40;ETDQ-7&#41; and 10-item Cambridge ET dysfunction Assessment &#40;CETDA&#41; are repeatable&#44; being valuable to assess the presence and to quantify the severity of ET dysfunction-related symptoms&#59; on the other hand&#44; they are not valuable for diagnostic purposes&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;11&#8211;13</span></a> In fact&#44; these PROMs are helpful&#44; above all&#44; to evaluate the impact of different interventions &#40;such as baloon Eustachian tuboplasty&#41; in symptoms and quality of life&#44; and have been added to some recent consensuses regarding the ET dysfunction treatment approach&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">11&#44;12&#44;14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical assessment&#44; including PROMs&#44; should be complemented with objective exams&#46; Regarding the latter&#44; they are further divided in indirect measures of ET function &#40;for which tympanometry is the most widely used&#41;&#44; tests of ET opening &#40;such as evaluation of the tympanic membrane movement or external auditory canal &#8211; tubo-tympano-aerodynamic graph &#8211; TTAG &#8211; pressure to Valsalva and Toynebee maneuvers&#44; tubomanometry&#44; inflation-deflation tests&#44; or sonotubometry&#41; and tests of ET closure &#40;TTAG&#44; sonotubometry or tubomanometry&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> Tympanometry&#44; sonotubometry&#44; and tubomanometry &#40;TMM&#41; are the ones with greater value in patients in which obstructive pathology of the ET is suspected&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> On the other hand&#44; to evaluate patulous ET dysfunction besides the observation of a breathing-synchronous tympanic membrane movement&#44; exams such as TTAG&#44; sonotubometry and TMM can be valuable&#46; Although none is considered the gold-standard of ET evaluation&#44; they all are reliable and objective&#44; with different sensitivities and specificities&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;13&#44;15&#44;16</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objective</span><p id="par0040" class="elsevierStylePara elsevierViewall">The first objective of this paper is to compare ET function between patients with NSD and patients with adequate bilateral nasal patency using PROMs and evaluation through objective exams&#46; The second objective is to assess the change in ET function following septal surgery in patients with severe septal deviation&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methods and methodology</span><p id="par0045" class="elsevierStylePara elsevierViewall">This prospective study was conducted in the department of Otorhinolaryngology of a tertiary hospital after Ethics committee approval &#40;<span class="elsevierStyleItalic">Comiss&#227;o de &#201;tica do</span> Hospital de Braga <span class="elsevierStyleItalic">&#8211; Ref&#176;68&#95;2020&#41;</span>&#46; The study was divided into two phases&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the first phase&#44; an opportunistic sample was selected and divided in two groups of patients&#58; 35 patients for group A&#44; with unilateral grade <span class="elsevierStyleSmallCaps">III</span> anterior NSD according to <span class="elsevierStyleItalic">Cottle&#39;s</span> classification &#8211; marked angulation of the septum with a spur in contact with the lateral wall even after application of a vasoconstrictor&#59; and 35 patients to group B&#44; that comprised one sample of patients with adequate nasal patency bilaterally&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Inclusion criteria for both groups included age superior to 18 years old&#44; an intact tympanic membrane &#40;given tympanometry was used&#41; and able to fulfill all evaluation protocol&#46; Exclusion criteria were the following&#58; smoking&#59; having other nasal pathology &#40;such as chronic rhinosinusitis and allergic rhinitis&#41;&#59; previous nasal surgery&#59; previous otologic surgery&#59; recent acute otitis media &#40;less than 3 months&#41;&#59; previous head and neck radiotherapy&#59; and neuromuscular and swallowing disorders&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">After selection&#44; both groups were evaluated according to the following protocol&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">2 PROMs were used to assess the impact of nasal obstruction and ET dysfunction in terms of symptomatology and quality of life of these patients&#58; Nasal Obstruction Subjective Questionnaire &#40;NOSE&#59; validated in Portuguese&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> which have five questions&#44; and its results lead to four different categories &#8211; mild &#40;5&#8211;25&#41;&#44; moderate &#40;30&#8211;50&#41;&#44; severe &#40;55&#8211;75&#41; or extreme &#40;80&#8211;100&#41; nasal obstruction&#59; and ETDQ7 &#40;validated in Portuguese&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a>&#44; with 7 questions&#44; in which a result &#62;14 points is considered compatible with ET dysfunction&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">All the patients underwent nasal endoscopy to exclude anatomical changes or obstruction of the <span class="elsevierStyleItalic">torus tubarius&#46;</span></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">2 objective exams to assess ET function were used after application of a cotton pledget with topical decongestant &#40;fenylephrine 5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; for 5<span class="elsevierStyleHsp" style=""></span>min in each nostril&#58; tympanometry of both ears and tubomanometry &#40;TMM&#59; tested with 300<span class="elsevierStyleHsp" style=""></span>daPa&#44; 400<span class="elsevierStyleHsp" style=""></span>daPa&#44; and 500<span class="elsevierStyleHsp" style=""></span>daPa&#41; on both sides&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">The second phase of the study consisted of the re-evaluation of the patients from group A after septoplasty with clinical observation &#40;confirmation of an adequate nasal patency&#44; without significative deformities of the nasal septum&#41;&#44; ETDQ7&#44; tympanometry&#44; and TMM&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">For analysis purposes&#44; we considered three groups&#44; namely preoperative group A&#44; postoperative group A and group B&#46; Tympanometry was considered compatible with ET dysfunction when middle ear pressure was lower than -100daPa &#40;type C&#41; or with no identifiable pressure peak &#40;type B&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">TMM was performed using the <span class="elsevierStyleItalic">Spiggle and Theis</span>&#174; tubomanometer&#46; The patient under examination was seated in a chair&#44; with the head in a horizontal position&#46; Pre-defined pressures of 30&#44; 40&#44; and 50<span class="elsevierStyleHsp" style=""></span>mbar were applied to the nasopharynx through a nasal applicator&#46; A pressure receptor probe in the external ear detected pressure changes through the movement of the tympanic membrane or through a TM perforation&#46; The patient was instructed to swallow a sip of water&#44; which was the trigger that led the cartilaginous part of the ET to open&#44; resulting in the transmission of the applied pressure in the nasopharynx to the ME&#46; The TMM provides several measures&#44; but the <span class="elsevierStyleItalic">R-value</span> is the one with the most clinical applicability&#46; It refers to the opening latency between application of pressure to the nasopharynx and the pressure changing detected through the external ear probe&#46; TMM was considered abnormal when <span class="elsevierStyleItalic">R-value</span> was &#62;1 &#40;OETD&#41; or &#61;0 &#40;patulous ET dysfunction&#41; for any of the tested pressures&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">15&#44;19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using Statistical Package for the Social Sciences &#40;SPSS&#41; v24&#46;0 for macOS&#46; Quantitative variables without normal distribution were described as median and interquartile range&#46; Chi-square was used to evaluate the correlation between categorical variables&#59; non-parametric independent Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> Test was used to compare medians between different groups&#59; related-samples Wilcoxon Signed Rank test was used to compare medians in the same group after the surgical intervention&#44; and non-parametric Spearman <span class="elsevierStyleItalic">rho</span> was used to assess the correlation between continuous variables&#46; A <span class="elsevierStyleItalic">p-value</span> &#60;0&#46;05 was used to reject the null hypothesis&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">For each group&#44; 35 patients were selected&#44; with a total of 70 patients&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Demographic features</span><p id="par0105" class="elsevierStylePara elsevierViewall">In both groups&#44; female patients were predominant &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">There was no statistically significant difference between groups A and B in what gender &#91;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> &#40;1&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1472&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;225&#41;&#93; and age &#40;Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>762&#46;5&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;078&#41; concerns&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">First phase of the study</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">PROMs scores</span><p id="par0115" class="elsevierStylePara elsevierViewall">Median scores in NOSE in pre-operative group A and group B were 60 and 15 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#59; the average score differed significantly between the two &#40;Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1202&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand&#44; the score in ETDQ7 was statistically significantly higher in pre-operative group A &#40;median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41; than in group B &#40;median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; &#91;<span class="elsevierStyleItalic">U</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1048&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#93;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Objective overall ET function assessment</span><p id="par0125" class="elsevierStylePara elsevierViewall">Normal overall ET function evaluated through tympanometry and TMM was considered when both ears or both ET&#44; respectively&#44; had normal function&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">While the difference in the evaluation through tympanometry was not statistically significant &#91;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> &#40;1&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;643&#93;&#44; there was a statistically significant difference between ET function measured through TMM between preoperative patients of group A and group B &#91;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> &#40;1&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;040&#93;&#44; with better ET function in group B &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; No patients had a result in TMM compatible with patulous TMM &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Correlation between the side of the deviation and ET dysfunction</span><p id="par0135" class="elsevierStylePara elsevierViewall">According to our data&#44; regarding the patients of preoperative group A&#44; the side of the nasal deviation does not correlate with the side of the dysfunction assessed through either tympanometry or TMM &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Correlation between PROMs</span><p id="par0140" class="elsevierStylePara elsevierViewall">Based on the results of our study &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; there is a positive moderate correlation between the scores in NOSE and ETDQ7&#44; which means that patients with higher scores in NOSE tend to have higher scores in ETDQ7 &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">s</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Second phase of the study</span><p id="par0145" class="elsevierStylePara elsevierViewall">The postoperative evaluation of the patients &#40;from group A&#41; who underwent septoplasty was performed between 3 and 6 months after surgery&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding symptomatology evaluation through ETDQ7 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; a Wilcoxon Signed-Ranks Test indicated that the postoperative median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44; was statistically significantly lower than the preoperative median&#44; median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44; <span class="elsevierStyleItalic">Z</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In terms of objective ET function measures &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; a <span class="elsevierStyleItalic">McNemar</span> test showed that the difference in the proportion of patients with abnormal tympanometry in preoperative group A and postoperative group A was not statistically significant&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;250&#46; On the other hand&#44; there was a statistically significant difference in the proportion of patients with findings compatible with ET dysfunction in TMM between preoperative and postoperative group A &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; higher in the former&#46;</p></span></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">Sinonasal pathology has been associated with ET dysfunction through inflammation of peritubal mucosa&#46; Conditions such as upper respiratory tract infection&#44; allergic rhinitis&#44; chronic rhinosinusitis can be the trigger of ET dysfunction symptomatology&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> Several authors have argued that NSD alone could be a cause of ET dysfunction&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Different physiopathologic mechanisms tried to explain the influence of NSD on ET function&#58; a deviated septum could cause ciliary disturbances&#44; resulting in nasal secretions stagnation&#44; increasing the risk of infections&#59; airflow turbulence could lead to microorganisms and pollutants deposition in ET opening&#44; resulting in inflammation and mechanical obstruction&#59; this turbulence could also have a drying effect&#44; increasing tubal mucous viscosity and surface tension&#44; and a stimulating effect on autonomic nerve supply of ET&#44; leading to changes in ET function&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">By selecting patients with severe NSD without associated nasal pathologies&#44; and comparing it to a control population&#44; we were able to evaluate the contribution of NSD alone&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">To assess if our control sample was representative of the general population&#44; we compared the prevalence of ET dysfunction in this population with available literature&#46; Our study revealed a prevalence of ET dysfunction in group B of 5&#46;7&#37; which is similar to the reported in a populational study in the United States of America&#44; of 4&#46;6&#37; &#40;both using tympanometry as diagnostic criteria&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> There are no studies in the literature regarding ET dysfunction prevalence using TMM&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">As expected&#44; in our population with NSD &#40;pre-operative group A&#41; we found higher scores in NOSE&#59; this group also had higher scores in ETDQ7 than the control group&#44; and this difference was statistically significant&#59; besides&#44; there was an association between the two&#44; which means that patients who have more complaints related to nasal obstruction&#44; also have more complaints which are usually linked to ET dysfunction&#46; The data should be carefully analyzed&#44; given that&#44; according to recent studies&#44; despite having a high sensitivity&#44; ETDQ7 specificity is very low&#44; with a low positive predictive value&#59; this means it should not be used to make ET dysfunction diagnosis alone&#44; but is important to evaluate symptoms and impact on quality of life in this patients&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Preoperative group A and group B had similar results in terms of tympanometry&#59; that was not the case using TMM&#44; showing a statistically significant association between septal deviation and ET dysfunction was shown using TMM&#46; Akyildiz et al&#46; reported worse ET function evaluated through tympanometry in patients with NSD comparing to patients without septal deviation&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Another interesting finding of our research was that there was no statistically significant correlation between the side of the NSD and side of the ET dysfunction&#46; This finding was consistent with the results reported by Akyildiz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> Along with this line of thinking&#44; a possible explanation is that septal deviation is related to turbulent airstreams&#44; which are a cause of edema and stagnation of secretions in nasal and postnasal cavities&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> Moreover&#44; the inferior turbinates may have an important role&#44; related to the usual compensatory hypertrophy of the inferior turbinate on the opposite side of the NSD&#46; This way&#44; it may impair the function of the ipsilateral ET&#44; but also the contra-lateral&#44; which is consistent with our results&#46; Accordingly&#44; besides septoplasty&#44; inferior turbinoplasty may be considered when treating these patients&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Finally&#44; our results also showed an improvement in ET dysfunction symptomatology and ET function evaluated through ETDQ7 and TMM&#44; respectively&#44; but not through tympanometry&#44; in postoperative group A &#40;patients with grade <span class="elsevierStyleSmallCaps">III</span> NSD&#41;&#46; As in our research&#44; Salvinelli et al&#46; found an improvement in ET dysfunction symptomatology&#44; but no statistically significant difference in tympanometry results&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> On the other hand&#44; an enhancement in ET function evaluated through tympanometry was found by some authors that verified an improvement after surgery based on ME pressures&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#44;7&#44;8</span></a> In what concerns TMM usage to assess ET function in patients with septal deviation&#44; there are no studies available in the literature evaluating the prevalence of ET dysfunction with this tool&#46; The fact that we only found differences in TMM evaluation can relate to the better sensitivity and accuracy of this exam compared to tympanometry&#44; and the lack of identification of mild ET dysfunction cases with isolated use of the latter exam&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;13</span></a> Tympanometry has other well-known limitations&#44; such as the impossibility of using it to evaluate ET function in patients with TM perforation&#59; moreover&#44; patients with intermittent obstructive ET dysfunction may also be missed by this exam&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> On the other hand&#44; TMM surpasses these limitations as it simulates a physiologic ET opening&#44; and may be used to evaluate patients with TM perforations&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#44;23</span></a> This enhances the need to change the paradigm of evaluating patients with suspected ET dysfunction only with tympanometry&#44; demanding the usage of exams such as TMM for a complete patient&#39;s evaluation&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Implications for clinical practice</span><p id="par0200" class="elsevierStylePara elsevierViewall">ET dysfunction&#44; besides being associated with aural symptoms&#44; can contribute to otologic pathology&#44; such as COM&#44; and be a cause of unsuccess in ME surgery&#46; So&#44; it is mandatory to evaluate patients regarding the presence of ET dysfunction before ME surgery and&#44; if possible&#44; correct the underlying causes before the ear intervention&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">According to our data&#44; ET dysfunction in a patient with severe NSD has a higher prevalence &#40;using TMM&#41; than in patients with no NSD&#44; and also more complaints of ET dysfunction symptoms&#59; besides&#44; our results indicate that septal surgery might be an adequate mean for improving ET dysfunction in those cases&#46; However&#44; not all patients with NSD will have ET dysfunction&#44; which means ET function exams and ET dysfunction symptomatology scores should guide the surgeon when deciding whether to proceed or not with septal surgery before ear surgery for chronic otitis media&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Limitations and advantages</span><p id="par0210" class="elsevierStylePara elsevierViewall">Although the chosen population was controlled&#44; the final sample is small given the strict criteria used for selection&#46; As tympanometry was used as one of the methods to evaluate ET function&#44; only patients with intact tympanic membrane were included &#40;given that tympanometry result would not reflect ET function but the perforation itself&#41;&#59; accordingly&#44; the prevalence of ET dysfunction in both populations might be underestimated as ET dysfunction can be a cause of the tympanic membrane perforation&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Nasal patency evaluation was subjective given the absence of Acoustic Rhinometry and Rhinomanometry in the authors&#8217; department&#59; however&#44; to surpass this&#44; the authors chose patients with severe anterior NSD&#46; As a consequence&#44; this investigation does not answer the question regarding the impact of septal surgery on ET dysfunction on patients with mild and moderate septal deviations&#46; Nonetheless&#44; it does answer the main question&#44; which is if NSD has or does not have an impact in ET function&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">On the other hand&#44; according to the authors&#8217; knowledge&#44; this is the first study that addresses the relation between NSD and ET dysfunction using validated PROMs and TMM&#46; Given the better sensitivity for ET dysfunction of TMM compared to tympanometry&#44; this research represents a step toward clearing a subject which has been a cause of discussion for several years&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Besides&#44; as our inclusion and exclusion criteria were very strict&#44; we were able to isolate the structural problem of septal deviation &#40;excluding other inflammatory pathologies&#41;&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusion</span><p id="par0225" class="elsevierStylePara elsevierViewall">According to our results grade <span class="elsevierStyleSmallCaps">III</span> NSD according to Cottle&#39;s classification has an impact on ET function&#46; In the absence of other conditions usually related to ET dysfunction&#44; if a patient with severe septal deviation has symptomatology and ET objective function exams compatible with ET dysfunction&#44; septal surgery should be considered in the treatment&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of interests</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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                  "titulo" => "Correlation between the side of the deviation and ET dysfunction"
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            0 => "Eustachian tube"
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            2 => "Nasal septum deviation"
            3 => "Tubomanometry"
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            0 => "Trompa de Eustaquio"
            1 => "Disfunci&#243;n de la trompa de Eustaquio"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The influence of isolated nasal septum deviation &#40;NSD&#41; in the Eustachian Tube &#40;ET&#41; function is still undetermined&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods and methodology</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">a prospective study was conducted&#46; In the first phase of the study&#44; two opportunistic samples were selected&#58; 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B&#46; Both groups were evaluated through Nasal obstruction Subjective Questionnaire &#40;NOSE&#41; and ET dysfunction questionnaire 7 &#40;ETDQ7&#41; &#8211;&#44; and through two objective exams to assess ET function &#8211; tympanometry&#44; and tubomanometry &#40;TMM&#41;&#59; results were compared between group A and B&#46; In the second phase of the study&#44; the patients from group A underwent septoplasty and were re-evaluated through ETDQ7&#44; tympanometry and TMM&#59; results were compared before and after surgery&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 &#40;higher scores in the latter&#41;&#44; and TMM &#40;worse results in patients with NSD&#41;&#59; the difference in tympanometry was not statistically significant&#46; The side of the NSD did not correlate with the side of the dysfunction&#46; After septoplasty&#44; patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">according to our results&#44; severe NSD alone is a cause of ET dysfunction&#59; septal surgery might improve ET function in these patients&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A&#250;n sigue sin determinarse la influencia aislada de la desviaci&#243;n del septo nasal &#40;DSN&#41; en la funci&#243;n de la trompa de Eustaquio &#40;TE&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Comparar la funci&#243;n de la TE entre los pacientes con DSN grave y los pacientes con patencia nasal adecuada&#44; en t&#233;rminos de sintomatolog&#237;a y ex&#225;menes objetivos&#44; y evaluar el impacto de la septoplastia en la funci&#243;n de la TE en pacientes con DSN grave&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos y metodolog&#237;a</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo seleccion&#225;ndose 2 muestras oportunistas en la primera fase del mismo&#58; 35 pacientes con DSN grave en el grupo A&#44; y 35 pacientes con patencia nasal adecuada en el grupo B&#46; Se evalu&#243; a ambos grupos utilizando los cuestionarios Nasal Obstruction Subjective Questionnaire &#40;NOSE&#41; y disfunci&#243;n de TE &#40;ETDQ7&#41;&#44; as&#237; como mediante 2 ex&#225;menes objetivos&#44; para evaluar la funci&#243;n de la TE&#58; timpanometr&#237;a y tubomanometr&#237;a &#40;TMM&#41;&#44; compar&#225;ndose los resultados entre los grupos A y B&#46; En la segunda fase del estudio&#44; los pacientes del grupo A fueron sometidos a septoplastia y reevaluados mediante ETDQ7&#44; timpanometr&#237;a y TMM&#44; compar&#225;ndose los resultados de antes y despu&#233;s de la cirug&#237;a&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Encontramos una diferencia estad&#237;sticamente significativa en NOSE y ETDQ7 entre los pacientes con DSN y los pacientes con patencia nasal adecuada &#40;con puntuaciones superiores en este &#250;ltimo&#41;&#44; y TMM &#40;con peores resultados en los pacientes con DSN&#41;&#44; no siendo estad&#237;sticamente significativa la diferencia en la timpanometr&#237;a&#46; El lado de DNS no se correlacion&#243; con el lado de la disfunci&#243;n&#46; Tras la septoplastia&#44; los pacientes del grupo A reflejaron puntuaciones menores en ETDQ7 con significaci&#243;n estad&#237;stica&#44; y existi&#243; una menor proporci&#243;n de pacientes con hallazgos compatibles con la disfunci&#243;n de la TE utilizando TMM&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Con arreglo a nuestros resultados&#44; la DNS en solitario es una causa de disfunci&#243;n de la TE&#44; pudiendo mejorar la septoplastia la funci&#243;n de la TE en estos pacientes&#46;</p></span>"
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                  \t\t\t\t">51&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Group B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;225</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">Group B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pre-operative&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Post-operative&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NOSE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">60 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ETDQ7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">91&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">97&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>R<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">77&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">94&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">94&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>R<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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Article information

ISSN: 00016519
Original language: English

DOI:10.1016/j.otorri.2020.11.004

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