EUSTACHIAN TUBE FUNCTION AND TYMPANIC MEMBRANE RETRACTION
Quantitative and qualitative studies on variability and on related symptoms
Marie Bunne
Department of Otorhinolaryngology, Sunderby Hospital, 971 80 Luleå, and Department of Clinical
Science, Otorhinolaryngology, Umeå University, 901 85 Umeå, Sweden
Abstract
Impaired opening function of the Eustachian tube and subsequent negative middle ear pressure are
regarded as important pathogenic factors in secretory otitis media and in persistent tympanic
membrane retractions. These conditions are characterized by a fluctuating course of disease and by
various types of impaired sound perception. A first aim of the present study was to investigate and
compare the variability of the tubal opening and closing functions in ears with retraction disease and
in healthy ears. The middle ear pressure was directly recorded during the performance of tubal
function tests on two test days with 3 to 4 months in-between. On each test day, two identical test
procedures were performed with 30 minutes in-between. A second aim was to investigate the
character and consequences of transient episodes of distorted sound in ears with retraction, focusing
both the patients’ perspective and the pathogenic relevance of the symptoms. This evaluation was
based on interviews, which were analyzed by a qualitative method.
In the short- as well as long-term perspective, a considerable individual variability of test responses
was found, most notably in diseased ears whereas healthy ears showed less variability. For the groups
there were no differences with regard to resistance to passive tubal opening at increased middle ear
pressure, whereas the capacity to equalize a positive or negative middle ear pressure and to inflate the
ear by Valsalva’s maneuver was significantly reduced in diseased ears compared to healthy ears.
Female gender, retraction pockets, and serous effusion (in contrast to mucoid) tended to be related to
poorer tubal opening function.
In subjects who experienced sensations of distorted sound quality, two patterns emerged at the
qualitative analysis: 1. Sounds becoming too loud and piercing, or one’s own voice being perceived
as extremely strong (autophony), could be very disturbing and cause loss of control of speech with
subsequent social isolation. Such disturbances appeared spontaneously or were elicited by swallowing
or Valsalva’s inflation. They were often eliminated by evacuation of the middle ear by sniffing. 2.
Episodes of weaker sound were less distressing and were eliminated by Valsalva’s maneuver when
possible.
It is concluded that Eustachian tube opening and closing functions are dynamic, not static, and that
this applies for both diseased and healthy ears. The pronounced variability over time in diseased ears
shows that single tubal function tests in individual ears have little prognostic value. Relationships
between gender and type of effusion deserve further investigation. Experiences of too loud and
piercing sound can be related to Eustachian tube closing failure rather than to opening failure, and
should be recognized as possible risk factors for the development of retractions when combined with
sniffing. Adequate information and training can help patients take control of disturbances and stop
sniffing.
From a methodological point of view, the introduction of a qualitative research method has proven
fruitful for studying patients’ experiences and coping strategies for ear symptoms. Since
otorhinolaryngology involves various sensory functions, there is a potential for using qualitative
research methods as a complement to quantitative methods when focusing the patient’s perception of
symptoms and coping with diseases in this field.