PP307 - Does Eustachian Tube Massage Deliver on Its Promise?

Abstract:
Though Eustachian tube (ET) massage is recommended for treating ET dysfunction on websites such as WebMD and from the Cleveland clinic, there is a significant lack of peer-reviewed evidence supporting the practice. Further internet searches yielded numerous posts and threads on social media sites like Reddit lauding the practice and its effectiveness. The purpose of this study was to examine, via immittance testing, if ET massage causes an immediate opening of the ET in adults with and without ET dysfunction.

Summary:
Rationale
Eustachian tube dysfunction (ETD) is traditionally diagnosed by audiologists using tympanometry with a type C tympanogram being its hallmark finding. ET function testing can also be completed. Here, three tympanograms are run: at rest, following the Toynbee maneuver, and following the Valsalva maneuver. The tympanometric peak pressure (TPP) should move in the positive direction following the Valsalva and in the negative direction following the Toynbee. Findings are considered to be abnormal when the peak pressure does not change at least 15-20 daPa relative to the at-rest recording.

Interventions for ETD can be pharmacological, surgical, and mechanical. Additionally, there is ET massage. This has been recommended on several social media outlets, by medical facilities (e.g., Cleveland Clinic), and other websites (e.g., WebMD). Some massage suggestions are intraoral, but more commonly it is suggested that 1-2 fingers apply firm pressure, sliding from the mastoid process to the angle of the mandible to the collarbone. This process is repeated several times over many days. There is a lack of anatomical logic for this procedure to function the way it has been purported as the ET is housed within the temporal bone and in the deep tissues of the nasopharynx, but is apparently successful according to many online posters.

The purpose of this study is to explore if ET massage immediately opens the ET in adults, as measured via immittance testing.

Design
This ongoing study was approved by the IRB (#5641). So far, data have been collected for 20 adults aged 18-44 (mean:27.8) with and without ETD. Following consent and otoscopy, ET function testing was completed first on the right ear via a GSI TympStar Pro. ET massage was then performed. A tympanogram was run again to record the TPP. These procedures were then completed on the left ear.

Results
Preliminary analyses included repeated-measures ANOVA comparing the TPP of the last ET function tympanogram (Valsalva) to the post-ET massage tympanogram in both groups of participants. There were no significant differences between the right and left ears, so the data were collapsed. Thus far, there was no significant difference in TPP between the pre- and post-ET massage (F(1,38)=2.89, p=0.097). The average TPP for the ETD ears was -3 daPa (SE=1.82) and for the normal ET function ears was -1.71 daPa (SE=2.07). These values are below the accepted range to indicate a clinically significant difference in TPP, i.e., opening of the ET.

Conclusions
Preliminary results from the current study indicate that there is no immediate effect of ET massage on opening the ET. However, online descriptions of the procedure report that the massage is repeated several times per day for several days. This will be conducted in a future study. It is unlikely that continued massage will have the desired effect on the ET given the anatomy and physiology of the ET. Rather, the relief that is reported online could be due to the resolution of the ET dysfunction over several days and not the massage procedure itself.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is to describe the utility of eustachian tube massage for patients with eustachian tube dysfunction.

Assumptions
N/A
This session is fundamental as indicated above.