Table 1.
Tests of ET opening assessed, including manoeuvres used and number of repeats.
Fig 1.
Flow chart demonstrating the data collection process and generation of a reference standard, with subsequent analysis to assess test accuracy.
Table 2.
Summary of test results for ETD, with different interpretation methods.
Table 3.
Demographic and clinical characteristics of 116 participants.
Fig 2.
Flow chart for the expert panel diagnostic process.
Rules were set to assign a diagnosis in the event of disagreement between panels A&B: 1. Diagnoses made via individual agreement were assigned over those with initial disagreement; 2. Diagnoses made at discussion via consensus were assigned over those made by a 2:1 vote; 3. If rule 1 or 2 could not be applied, the diagnosis was recorded as indeterminate.
Table 4.
Principle component analysis matrix.
Table 5.
Table 6.
The coefficients (= log odds ratio) can be used to calculate a patient’s risk of having OETD.
As continuous, raw data were used, tympanogram middle ear pressure and nine step pressure change have a negative predictive effect.
Table 7.
Discriminatory ability of diagnostic models for OETD.
Table 8.
All test latent class model: the panel diagnosis included as an index test alongside the tests of ET opening and PROMs.
Table 9.
Time to complete each test and patient-reported difficulty/discomfort.
Fig 3.
Proposed diagnostic pathway for ETD.
a, b While clinical assessment of a patient’s history and conventional examination may not be diagnostic of ETD, they are nonetheless an important means to identify suitable patients for investigation. c Effort should be made during assessment of the clinical history to identify habitual sniffing, as a negative middle ear pressure in these individuals may not indicate OETD, and further testing should be undertaken. d Described diagnostic thresholds are based on the equipment and protocols used in our study, but may require adjustment if alternative methods are used e TTAG is recommended if a tympanic membrane perforation is present. f A simple provocation test for use in clinic is asking the patient to exercise (jog on the spot or climb a flight of stairs) prior to testing. g Consider repeating tests on a separate occasion to improve sensitivity in patients with variable ET function. Patients with baro-challenge induced OETD may present in this group.