General Discussion
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(7,346 posts)Based on estimates from surveys administered between 2001-2012 (Oehlandt, 2022; Shan, 2019), ETD affects 4-5% of adults. Medical management is frequently used for treatment of associated conditions, but success rates are limited. Established surgical approaches include myringotomy (creating a hole in the eardrum) and tympanostomy (small tubes implanted through a hole in the ear drum). (Tucci, 2019).
In 2019, the American Academy of OtolaryngologyHead and Neck Surgery (AAO-HNS) published a set of consensus statements regarding the use of BDET (Tucci, 2019). The published consensus statements were reached using the Delphi method. This involved the iterative consideration of statements by a panel representing a variety of medical specialty societies until consensus was reached. The target population for the statements was adults 18 years of age or older who had symptoms for 3 months or longer that significantly affected their quality of life or functional health status. The panel reached consensus on the following 18 statements regarding selection of candidates for BDET:
A comprehensive history and physical exam, including otoscopy, are essential parts of the diagnostic evaluation of a candidate for BDET.
Nasal endoscopy is an essential part of the diagnostic evaluation prior to BDET.
BDET is contraindicated for patients diagnosed as having a patulous ETD.
Nasal endoscopy in patients who are candidates for BDET is necessary for assessing the ET lumen and assessing the feasibility of transnasal access to the nasopharynx. A diagnosis of patulous ETD is suggested by symptoms of autophony of voice, audible respirations, pulsatile tinnitus, and/or aural fullness.
The benefit of repeat BDET after a prior ineffective BDET has not been determined.
Symptoms of obstructive ETD can include aural fullness, aural pressure, hearing loss, and otalgia.
Tympanometry is an essential part of the diagnostic evaluation prior to BDET. 8.50 0
Establishing a diagnosis of obstructive ETD requires ruling out other causes of aural fullness such as patulous ETD, temporomandibular joint disorders, extrinsic obstruction of the ET, superior semicircular canal dehiscence, and endolymphatic hydrops.
Patient-reported symptom scores alone are insufficient to establish a diagnosis of obstructive ETD.
Nasal endoscopy is necessary to rule out extrinsic causes of ETD.
Comprehensive audiometry is an essential part of the diagnostic evaluation prior to BDET.
BDET is appropriate in patients with obstructive ETD who have failed medical therapy for identified treatable causes.
Common causes of obstructive ETD that benefit from identification and management are allergic rhinitis, rhinosinusitis, and laryngopharyngeal reflux.
Medical management of known pathology that could affect nasal or ET function is appropriate to perform prior to BDET.
Patients with a history of recurrent baro-challenge, defined as uncomfortable pressure in the ear upon exposure to ambient pressure
changes that cannot be easily relieved, may improve following BDET.
There is no scientifically proven or standard medical therapy for ETD.
Pneumatic otoscopy can identify negative pressure in the middle ear space and can differentiate between adhesive and non-adhesive retractions of the tympanic membrane. . . . . . .
https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_e002209.html