Auris, nasus, larynx · 2025
Possible patulous Eustachian tube: Clinical characteristics and diagnostic transition according to the Japan Otological Society criteria.
СтатьяНазвание и аннотация: Перевод в очереди
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Yoshida Marin, Oshima Hidetoshi, Shindo Hideshi, Hirai Ryoji, Oshima Takeshi
Аннотация
OBJECTIVE: The 2016 diagnostic criteria for patulous Eustachian tube (PET) proposed by the Japan Otological Society classify cases as "definite" or "possible." However, the clinical characteristics and natural course of possible cases remain unclear. This study aimed to clarify the clinical profiles and diagnostic transition of possible PET by subclassifying them into two groups.
METHODS: We retrospectively reviewed the records of 292 patients diagnosed as possible PET at their first visit to our specialized outpatient clinic between June 2019 and May 2025. Patients were categorized as group A (symptom relief with Eustachian tube-closing maneuvers but lacking objective findings) or group B (objective findings present but without symptom relief). Clinical features, symptom profiles, and diagnostic transitions were analyzed. Survival analyses using the Kaplan-Meier method, Cox proportional hazards model, Weibull parametric model, and restricted mean survival time (RMST) were conducted to evaluate transition to definite PET.
RESULTS: Voice autophony (81.8%¦vs. 59.9%) and breathing autophony (47.1%¦vs. 35.3%) were significantly more frequent in group A, whereas hearing loss was more common in group B (34.1%¦vs. 16.5%, p < 0.001). During follow-up, 30 patients (25 in group A, 5 in group B) progressed to definite PET. Kaplan-Meier analysis showed a significantly higher transition rate in group A (log-rank, p < 0.0001). Cox regression demonstrated a nearly five-fold higher hazard of progression in group A (HR = 4.95, 95% CI: 1.89-12.95, p = 0.001). RMST analysis indicated that group B required on average 1.5 more visits to reach diagnosis. Weibull analysis revealed that most group A patients were diagnosed by the third visit, whereas group B patients frequently remained undiagnosed.
CONCLUSION: Possible PET cases comprise heterogeneous conditions, with group A containing a higher proportion of true PET and group B including more non-PET cases with hearing loss. Careful follow-up and additional testing are warranted for group A, while differential diagnosis should be prioritized in group B. Subgroup-based evaluation may contribute to a more precise and practical diagnostic process for PET.
METHODS: We retrospectively reviewed the records of 292 patients diagnosed as possible PET at their first visit to our specialized outpatient clinic between June 2019 and May 2025. Patients were categorized as group A (symptom relief with Eustachian tube-closing maneuvers but lacking objective findings) or group B (objective findings present but without symptom relief). Clinical features, symptom profiles, and diagnostic transitions were analyzed. Survival analyses using the Kaplan-Meier method, Cox proportional hazards model, Weibull parametric model, and restricted mean survival time (RMST) were conducted to evaluate transition to definite PET.
RESULTS: Voice autophony (81.8%¦vs. 59.9%) and breathing autophony (47.1%¦vs. 35.3%) were significantly more frequent in group A, whereas hearing loss was more common in group B (34.1%¦vs. 16.5%, p < 0.001). During follow-up, 30 patients (25 in group A, 5 in group B) progressed to definite PET. Kaplan-Meier analysis showed a significantly higher transition rate in group A (log-rank, p < 0.0001). Cox regression demonstrated a nearly five-fold higher hazard of progression in group A (HR = 4.95, 95% CI: 1.89-12.95, p = 0.001). RMST analysis indicated that group B required on average 1.5 more visits to reach diagnosis. Weibull analysis revealed that most group A patients were diagnosed by the third visit, whereas group B patients frequently remained undiagnosed.
CONCLUSION: Possible PET cases comprise heterogeneous conditions, with group A containing a higher proportion of true PET and group B including more non-PET cases with hearing loss. Careful follow-up and additional testing are warranted for group A, while differential diagnosis should be prioritized in group B. Subgroup-based evaluation may contribute to a more precise and practical diagnostic process for PET.