Variability of Eustachian tube function in children with secretory otitis media. Evaluations at tube insertion and at follow-up

Objective: Despite the variable clinical course of diseases related to Eust achian tube function, the variability of tubal function has been less focus ed than outcomes of single tests. This study aimed to compare the passive a nd active tubal function and its variability in children with secretory oti tis media (SOM) at tube insertion and at follow-up. Method: Thirty-eight ea rs in 19 children aged 4-10 years (mean 7.0 years) with long-standing SOM w ere examined 4-6 h after tube insertion, at 4 months and at 9 months. The p ressure in the middle ear and the nasopharynx were recorded while performin g (1) forced opening test, (2) equalization of + 100 and - 100 daPa, (3) Va lsalva test, and (4) sniff test. The procedure was repeated after 30 min. R elationships were analyzed by uni- and multi-variate analysis of variance. Results: From tube insertion to 4 months, the mean forced opening pressure increased from 282 +/- 128 to 355 +/- 153 daPa (P < 0.01), and the mean clo sing pressure from 91 +/- 51 to 126 +/- 82 daPa (P ( 0.01). There was no fu rther change at 9 months. Female gender, serous effusion (in contrast to mu coid), and more than three previous episodes of acute otitis media were rel ated to higher opening and closing pressures. At tube insertion, 60% and 16 % equalized + 100 and - 100 daPa, respectively, and 28% succeeded in perfor ming Valsalva inflation. The sniff test was positive in 32%, indicating a c losing failure. These rates did not change significantly over time. For ind ividual ears, outcomes of all tests varied considerably when retested after 30 min; P-o changed by +/- 12% and P-c by +/- 26%, and 9-29% of the ears c hanged from a positive to negative response, or vice versa, in the equaliza tion, Valsalva, and sniff tests. Conclusions: The unexpected finding of wea ker closing forces at the day of tube insertion and increased tubal resista nce at follow-up might be ascribed to changes in the muco-adhesive forces r elated to the disease and tube treatment. The pronounced intra-individual v ariability of test outcomes indicates that tubal function is dynamic and va riable in ears prone to SOM, which emphasizes that results of single tubal function tests have very low prognostic value. (C) 2000 Elsevier Science Ir eland Ltd. All rights reserved.