Prevalence and Population Estimates of Obstructive Eustachian Tube Dysfunction in US Adolescents

Abstract

This cross-sectional cohort study uses census data to approximate population estimates of obstructive eustachian tube dysfunction among US adolescents.

Obstructive eustachian tube dysfunction (OETD) affects over 11 million adults in the US, and is associated with chronic suppurative otitis media, middle ear atelectasis, and tympanic membrane perforation.^1,2 Compared with adults, children have a higher risk for obstruction and reflux of nasopharyngeal secretions and pathogens, resulting in increased rates of cholesteatoma reoccurrence and poorer hearing results after surgery.² Though OETD is thought of as more common among children than adults, there are no population estimates of OETD in US adolescents. To further understand the burden of OETD over the life course, a nationally representative cross-sectional sample was combined with census data to approximate population estimates of OETD among US adolescents.

Methods

We analyzed 3147 adolescents aged 12 to 19 years from the 2005 to 2010 cycles of the National Health and Nutrition Examination Survey (NHANES; https://www.cdc.gov/nchs/nhanes/index.htm), an ongoing cross-sectional study of a representative sample of the noninstitutionalized US population. Participants completed tympanometry assessments and surveys for demographic and health information. Obstructive eustachian tube dysfunction was defined as peak middle ear pressure lower than −100 dekapascals in either ear in the absence of a “cold, sinus problem, or earache” in the past 24 hours and a “head cold or chest cold” in the past 30 days. Population prevalence was estimated employing sample weights using STATA statistical software (version 15.1, StataCorp), and prevalence data were applied to the 2017 to 2018 American Community Survey data to determine population estimates. NHANES was approved by the institutional review board of the National Center for Health Statistics and all participants provided written informed consent. Data were analyzed between January and February 2020.

Results

In a nationally representative sample of 3147 US adolescents aged 12 to 19 years, the overall prevalence of OETD was estimated to be 4.4%, corresponding to a total of 1.48 million adolescents (Table). Prevalence was higher among younger adolescents, males, and Mexican Americans.

Table. Prevalence and Population Estimates of OETD in US Adolescents^a,b.

Characteristic	OETD prevalence, % (95% CI)	OETD No., millionsc
Overall	4.39 (3.31-5.48)	1.48
Age, y
12-15	5.04 (3.23-6.86)	0.84
16-19	3.72 (2.49-4.95)	0.64
Sex
Male	5.12 (3.67-6.57)	0.88
Female	3.59 (2.28-4.89)	0.59
Race/ethnicity
Non-Hispanic white	4.20 (2.64-5.78)	0.74
Non-Hispanic black	4.34 (2.93-5.74)	0.20
Mexican American	5.77 (3.63-7.91)	0.31
Other	4.00 (1.96-6.03)	0.25

Abbreviation: OETD, obstructive eustachian tube dysfunction.

^aNational Health and Nutritional Examination Surveys 2005 to 2010 (n = 3147; https://www.cdc.gov/nchs/nhanes/index.htm).

^bOETD was defined as peak middle ear pressurelower than −100 dekapascals in either ear in the absence of a “cold, sinus problem, or earache” in the past 24 hours and a “head cold or chest cold” in the past 30 days.

^cdata from the US Census Bureau, 2017 to 2018 American Community Survey (https://www.census.gov/programs-surveys/acs).

Discussion

Obstructive eustachian tube dysfunction was found to have a prevalence of 4.4% among US adolescents from the present study, totaling 1.48 million adolescents in the United States, similar to the prevalence of 4.6% in adults. This is comparable to findings of a recent study³ that found a prevalence of 6.1% among adolescents, though our study removed those with a head or chest cold to further exclude acute cases of eustachian tube dysfunction (ETD) and did not exclude for multiple covariates of interest pertaining to tobacco smoke exposure. Older adolescents were less likely to have OETD, potentially secondary to improved muscular opening function with age.⁴ The contribution of demographic factors, such as sex and race/ethnicity, may follow other middle ear conditions, such as chronic suppurative otitis media, which are more common among males and minorities.⁵

This study likely underestimates the true population estimate of ETD in the adolescent population because patients younger than 12 years were not provided tympanometry assessments in NHANES. The diagnosis of OETD was also limited to tympanometry, which does not capture patulous ETD and barochallenge-induced ETD. A 2015 clinical consensus recommended diagnosis of OETD should be based on clinical history, otoscopy, tympanometry, nasopharyngoscopy, and other clinical assessments.⁶ Therefore, the use of tympanometry alone is likely to provide a conservative estimate of OETD in this population.

Despite these limitations, this is the first nationally representative population estimate of OETD among US adolescents. Our estimates provide evidence that OETD prevalence is similar to adults and further characterizes the epidemiology of OETD over the life course. Longitudinal studies are needed to better understand the potential long-term effects of OETD.