Measuring the health utility of chronic eustachian tube dysfunction

Objective: To assess the health utility of chronic Eustachian tube dysfunction (ETD). Methods: This is a prospective study of 53 patients with chronic ETD recruited from a tertiary clinic from April 2017 to July 2018. The 7-Item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was administered, and health utility was evaluated using the EuroQol-5 Dimensions-3 Level Instrument (EQ-5D-3L), the visual analogue scale (VAS), time tradeoff (TTO), and standard gamble (SG). Participants were grouped into medical or procedural management groups. One-week follow-up included repeated health utility measures and ETDQ-7. Results: Fifty-three patients were included in the final analysis. Of those, 34 were managed medically, and 19 received myringotomies ± PE tubes. The mean baseline ETDQ-7 was 4.26 ± 1.31; whereas health utility measures were different depending on the method utilized: EQ-5D-3L 0.90 ± 0.11; VAS 0.76 ± 0.21; TTO 0.85 ± 0.23; and SG 0.94 ± 0.11 (P <.001). There was a significant change in ETDQ-7 (P =.001) and TTO (P =.011) scores posttreatment. On the ETDQ-7, question 2 (pain in the ears) was significantly associated with VAS (P =.032), and question 4 (ear symptoms during a cold or sinusitis) was significantly associated with TTO (P =.006). Conclusion: Chronic ETD has a significant burden on quality of life, with a health utility similar to gastroesophageal reflux disease and moderate asthma. Although treatment-related changes are measurable using disease-specific quality-of-life measures, only TTO was significantly changed after treatment. Health utility seemed to depend on the method of measurement but provided a benchmark for evaluating cost-effectiveness of innovations to manage ETD. Level of Evidence: 2 Laryngoscope, 130:E39–E44, 2020.