Vol 71, No 3 (2020)
Original article
Published online: 2020-09-28

open access

Page views 1529
Article views/downloads 1670
Get Citation

Connect on Social Media

Connect on Social Media

Eustachian tube function test as a predictor of middle ear barotrauma

Konstantin Petrov Georgiev1, Nikola Georgiev Shopov2
Pubmed: 33001432
IMH 2020;71(3):195-200.


Background: Most of the cases of middle ear barotrauma in divers are due to the impassability of the Eustachian tube. The aim of our study is to compare the results of tympanometry and Valsalva part of Eustachian Tube Function test (ЕТF-test) with the ability of divers to compensate for the change in ambient pressure in a hyperbaric chamber.
Material and methods: The study included 35 professional divers undergoing annual medical examination. For all subjects is measured first intratympanal pressure at rest, then after the maneuver of Valsalva with impedancemeter. Then a barofunction test (BFT) was performed to assess the diving fitness and the passability of the Eustachian tubes. It consists of divers compressing and decompressing in a hyperbaric chamber to a pressure of 2.2 ATA for 1 minute. Based on results from previous studies we are using a 20 DaPa cutoff point on the ETF test to predict Eustachian tube passability and a successful barofunction test.
Results: In the current study 24 divers have ETF test results higher than 20 DaPa. 3 divers have ETF test values lower than 20 DaPa in both ears, but none of them displayed difficulties in the BFT. 8 divers have ETF values lower than 20 DaPa in one ear and higher than 20 DaPa in the other. 7 of the last group displayed difficulties with the BFT in the ear with poor ETF result.
Conclusions: We consider that the ETF test can be used to assess diving fitness as a screening method before performing a BFT, as values above 20 DaPa guarantee Eustachian tube function sufficient for diving activities. Values of 20 DaPa and less are not a definite predictor of the BFT results. The results of the ETF test can also be used in the usual work of an otorhinolaryngologist to evaluate Eustachian function in cases of unilateral disease of middle ear.

Article available in PDF format

View PDF Download PDF file


  1. Taylor D. The Valsalva Manoeuvre: A critical review. South Pacific Underwater Medicine Society J. 1996; 26(1).
  2. Kay E. Prevention of middle Ear Barotrauma. http://www.divingdoc.com/MEbaro.html.
  3. Doyle WJ, Swarts JD, Banks J, et al. Sensitivity and specificity of eustachian tube function tests in adults. JAMA Otolaryngol Head Neck Surg. 2013; 139(7): 719–727.
  4. Beck DL, Spiedel DP, Prairie E, et al. Tympanometry and Acoustic Reflex: Innovation, Reviewand Application, Hearing Review, 3 April 2009.
  5. Shupak A, Sharoni Z, Ostfeld E, et al. Pressure chamber tympanometry in diving candidates. Ann Otol Rhinol Laryngol. 1991; 100(8): 658–660.
  6. Georgiev K. Unilateral Eustachian Impasability - cutoff points for ETF test. Laryngorhinootologie. 2020; 99(S02): S314.
  7. http://mlwiki.org/index.php/ROC_Analysis.
  8. Shopov N, Georgiev K, Vazharov Iv, Bozov Hr. Evaluation of Eustachian tubes function in divers. Congress paper 23 congress BMMR, TurkeyAntalya 11-14 May 2018.
  9. Kitajima N, Sugita-Kitajima A, Kitajima S. [A study of the Eustachian tube function in patients with a scuba diving accident]. Nihon Jibiinkoka Gakkai Kaiho. 2012; 115(12): 1029–1036.
  10. Tailor BV, Smith ME, Hutchinson PJA, et al. Outcome measures for baro-challenge-induced eustachian tube dysfunction: a systematic review. Otol Neurotol. 2018; 39(2): 138–149.
  11. Uzun C, Adali MK, Tas A, et al. Use of the nine-step inflation/deflation test as a predictor of middle ear barotrauma in sports scuba divers. Br J Audiol. 2000; 34(3): 153–163.