Table 3.

ET Function testing—obstructed ETD

Paper	Imaging modality	Route Contrast/ isotope	Cohort: patients (ears)	ET function tested Patient action	Non-imaging comparator		Key findings
Direct
Parisier1970 [49]	Spot and cine x-ray	Intratympanic Sodium diatrozoate	10 perforations and -ve fluorescein clearance test	Patency/clearance Swallowing, Valsalva, Toynbee	Fluorescein clearance test	• Can visualise ET lumen and identify narrowings in the bony, junctional or cartilaginous portion
			34 controls with TM perforations
Bluestone 1971 [50] part A	Spot and cine x-ray	Intratympanic Iophendylate	24 Unrepaired CP 42 MEE 7 controls	Patency/clearance VTs inserted, at rest	None	• In repaired CP and unrepaired CP contrast failed to clear, or enter aural end of ET in most
						• Contrast entry improved in all 2 weeks after VT insertion
Bluestone 1971 [50] part B	Spot and cine x-ray	Nasopharynx Sodium diatrozoate	14 unrepaired CP 6 repaired CP 12 MEE and normal palate 5 healthy	Reflux protection Swallowing	None	• Contrast entered the ET and was ejected in healthy ears, but would not enter in unrepaired CP, and would often enter less far in repaired CP and MEE (blockage at the nasopharyngeal end)
Gaafar 1988 [51]	Spot x-ray	Intratympanic Lipiodol	20 (32) Symptomatic ETD	Patency/clearance	Flexible endoscopy of nasopharyngeal orifice only	• The site of obstruction can be indicated in some, in others ET completely non-patent
				At rest and swallowing
Paludetti 1992 [52]	Scintigraphy	Intratympanic 77m TC-labelled albumin	16 COM with TM perforations 2 controls	Patency/clearance At rest	Opening pressure manometry	• Slower ET passage of isotope in COM
Brenner 1997 [53]	Scintigraphy	Nasopharynx and intratympanic 133 Xe gas	10 abnormal tympanogram 18 controls	Ventilation Valsalva	Tympanogram	• Lower median uptake and longer clearance half life in ETD
Karasen 1999 [54]	Scintigraphy	Nasopharynx 133 Xe gas	16 ETD 13 controls	Ventilation Valsalva	Tympanogram	• Reduced isotope uptake in ears with ETD
Celen 1999 [55]	Scintigraphy	Intratympanic 99m albumin	32 MEE children with VTs 10 controls with dry perforations	Patency/clearance At rest	Tympanogram	• Passage of isotope in 16 % cases with MEE and 100 % controls • Longer to reach the ET and nasopharynx in cases
Indirect
Shim 2010 [56]	CT	None	80 COM 100 controls	Post-operative middle ear aeration	Otoscopy and tympanometry 1 year after surgery		• Cross-sectional area of the aerated bony ET may be useful for predicting the post-operative results
	(supine and prone)

CP cleft palate, TM tympanic membrane, COM chronic otitis media (infection or inflammation of the middle ear), VT ventilation tube (grommet), MEE middle ear effusion