Author(s)
Sarah M. Adams, BS
Armo Derbarsegian, BS
Ahmad R. Sedaghat, MD PhD
Katie M. Phillips, MD
Affiliation(s)
University of Cincinnati College of Medicine;
Abstract:
Introduction: Chronic rhinosinusitis (CRS) is a prevalent condition that involves sinonasal inflammation leading to chronic sinonasal symptomatology. Eustachian tube dysfunction (ETD), characterized by bothersome ear symptoms such as ear pressure, tinnitus, hearing loss, ear fullness, and pain, is a common comorbidity of CRS. Along with controlling nasal symptoms, proper management of patients’ ETD is a key component in the treatment of CRS and improving overall quality of life. Our study sought to determine the prevalence and medical responsiveness of ETD in CRS in a real-world setting.
Methods: A total of 175 adult patients with CRS presenting to University of Cincinnati rhinology clinics for initial treatment were recruited. All participants completed the 22-item Sinonasal Outcome Test (SNOT-22) and the 7-item ETD questionnaire (ETDQ-7) to assess their current CRS and ETD symptoms, respectively, at each office visit. ETD prevalence and improvement was evaluated using ETDQ-7 scores recorded at initial presentation and at least 4 weeks following initiation of topical corticosteroids and nasal irrigation, the standard of care therapy for CRS patients. Regression analysis was used to evaluate factors associated with improvement of eustachian tube symptoms through medical management of CRS.
Results: At presentation, participants had a mean SNOT-22 score of 49.3, mean ETDQ-7 score of 21.3, with 65.7% having ETD (defined by ETDQ-7>14.5). After at least 4 weeks of treatment with intranasal corticosteroids and saline irrigations, the SNOT-22 score dropped by a mean 11.6 points, ETDQ-7 score dropped by a mean 3.1 points and 51.4% of participants still met criteria for ETD. Amongst participants who started with ETD, the ETDQ-7 score dropped by a mean 5.1 points. The change in ETDQ-7 score was associated with the initial ETDQ-7 score (b=-0.34, 95%CI: -0.45 to -0.22, p<0.001)—indicating greater improvement in ETDQ-7 score associated with worse initial symptoms—but no other clinical or disease characteristics. Amongst participants starting with ETD, however, higher ETDQ-7 score was associated with lower likelihood of not having ETD after treatment (OR=0.86, 95%CI: 0.79 – 0.93, p<0.001). Having ETDQ-7 score >21 before treatment was predictive (sensitivity: 68.8%, specificity: 83.1%) of having ETD after treatment as well.
Conclusion: ETD is a common and difficult-to-treat comorbidity in CRS. In a real-world setting, standard approaches to appropriate medical management may be limited in their ability to improve, or resolve, ETD.
Educational Objectives: At the end of this presentation, the participant will be able to1) understand the burden of Eustachian tube dysfunction in chronic rhinosinusitis, 2) describe the efficacy of standard medical management for chronic rhinosinusitis on improving symptoms of Eustachian tube dysfunction, 3) describe predictors of success in treatment Eustachian tube dysfunction with medical management of chronic rhinosinusitis and 4) use this information to counsel patients in their practice and inform the overall treatment of chronic rhinosinusitis.