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Obstruction of the Eustachian tube is a common condition that is unpleasant and might lead to various middle ear disorders.
This study aimed to estimate the prevalence of Eustachian tube dysfunction (ETD) among the public in Jeddah, Saudi Arabia.
This cross-sectional survey-based study was conducted in Jeddah during August 2018 by distributing an electronic survey form to participants from different districts of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study.
A total of 2372 participants (female, 1535/2372, 64.71%; male, 837/2372, 35.28%; mean age 31.31 years, SD 11.85 years) agreed to contribute to our study. Upon analysis of their answers to the questionnaire, the overall prevalence of ETD in our sample was found to be 42.49% (1008/2372). The prevalence was higher among participants who reported a previous diagnosis of ETD and hearing loss (1897/2372, 80.00% and 1902/2372, 80.21%, respectively). Additionally, participants with a family history of hearing loss had a significantly higher prevalence (1136/2372, 47.92%) of ETD than those with no family history of hearing loss. Our analysis also showed that females were at a greater risk of developing ETD than males (
As per our prevalence data, ETD is a common disease in Jeddah, pointing to the need for more attention, awareness, and research.
The Eustachian tube is a thin tube that links the middle ear with the nasopharynx. It is responsible for ventilation and pressure equalization in the middle ear [
The prevalence of ETD among the adult general population is approximately 1% [
Patients with ETD complain of ear fullness, pain, muffled hearing, “popping” sounds, or tinnitus [
Knowledge of the prevalence of a disease within a population is of value in establishing possible current and future community service requirements. To the best of our knowledge, no study in Saudi Arabia has assessed the prevalence of ETD in the community to date. This study aims to evaluate the prevalence of ETD in Jeddah, Saudi Arabia, by using the ETDQ-7 instrument.
This study was approved by the institutional review board of King Abdulaziz University Hospital, Saudi Arabia. This cross-sectional survey-based study was conducted by distributing an electronic questionnaire among the general population of Jeddah during August 2018. The electronic questionnaire only accepted a one-time response per participant so that there would be no instances of multiple responses from the same person. Jeddah, an urban metropolis and one of the biggest cities in Saudi Arabia, is located in the western region of the country and has a population of approximately 3.5 million.
This study aimed to estimate the prevalence of ETD in all areas of Jeddah. An electronic survey form was distributed by trained medical students to the participants. Randomly distributed city districts were selected for the study in order to obtain a realistic representative sample of the population of Jeddah, taking into account the more densely populated northern and southern regions of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study. The purpose of the study was disclosed to the participants, and written consent was obtained before they could fill out the questionnaire.
The ETDQ-7, designed by McCoul et al [
The ETDQ-7 is a valid measure [
To avoid recall bias, the participants were instructed to answer the questions of the ETDQ-7 based on the symptoms they had experienced in the past month [
The data were organized in an Excel sheet and transferred to Statistical Package for Social Sciences (SPSS) software (version 24; IBM Corp.) for further analysis. Categorical variables were described using a frequency table, whereas continuous variables were described using the mean and SD. The data were then processed for determining statistical significance using the Chi-square test. For all statistical tests,
A total of 2372 participants agreed to contribute to our study, resulting in a response rate of 78.00% (2372/3041). The study population comprised 64.71% (1534/2732) female and 35.28% (837/2732) male participants, with a mean age of 31.31 (SD 11.85) years. The largest age group comprised 45.06% (1070/2372) of our total sample and included participants aged 19-29 years. Data on the past medical history of our sample showed that only 3.37% (80/2372) and 5.52% (130/2372) of the participants had been diagnosed with ETD and hearing loss, respectively. Among the total sample, 37.48% (889/2372) reported a positive family history of hearing loss. Other demographic characteristics of the population are presented in
The results of our analysis of the participants’ responses to the ETDQ-7 demonstrated that the overall prevalence of ETD in our sample was 42.49% (1008/2372). The fourth question—regarding “the presence of ear symptoms when having a cold or sinusitis”—recorded the highest mean score of the entire questionnaire. The mean scores of all the questions in the ETDQ-7 are shown in
Demographic characteristics of the sample and mean results of the ETDQ-7 (N=2372).
Variables | Values |
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Age, mean (SD) | 31.31 (11.85) |
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≤18 | 181 (7.63) |
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19-29 | 1069 (45.06) |
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30-39 | 486 (20.48) |
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≥40 | 636 (26.81) |
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Male | 837 (35.28) |
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Female | 1535 (64.71) |
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Saudi | 2137 (90.09) |
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Non-Saudi | 235 (9.90) |
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Yes | 80 (3.37) |
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No | 2292 (96.62) |
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Yes | 131 (5.52) |
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No | 2241 (94.47) |
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Yes | 889 (37.47) |
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No | 1483 (62.52) |
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Yes | 332 (13.99) | ||
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No | 2040 (86.00) | ||
Overall prevalence of ETD according to the ETDQ-7b, n (%) | 1008 (42.49) |
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1- Pressure in the ears? | 1.961 (1.44) |
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2- Pain in the ears? | 2.046 (1.47) |
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3- A feeling that your ears are clogged or ‘under water’? | 2.280 (1.68) |
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4- Ear symptoms when you have a cold or sinusitis? | 2.417 (1.81) |
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5- Crackling or popping sounds in the ears? | 1.972 (1.59) |
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6- Ringing in the ears? | 2.066 (1. 62) |
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7- A feeling that your hearing is muffled? | 2.172 (1.72) |
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aETD: Eustachian tube dysfunction.
bETDQ-7: 7-question Eustachian tube dysfunction questionnaire.
Upon comparison of the prevalence of ETD on the basis of the demographic and clinical features of our sample, the condition was found to be most prevalent among participants aged 18 years or younger (45.3%), and its prevalence was similar in the groups aged 19-29 and 30-39 years (41.8% and 41.2%, respectively). In this study sample, ETD was more prevalent among females compared to males and among Saudi participants compared to non-Saudi participants. The prevalence of ETD was significantly higher among participants who had reported a previous diagnosis of ETD and hearing loss (1897/2372, 80% and 1902/2372, 80.2%, respectively;
Multivariate regression revealed that a diagnosis of hearing loss, family history of hearing loss, diagnosis of ETD, gender, and smoking were associated with the prevalence of ETD. These data are presented in
Prevalence of ETD according to the ETDQ-7 (N=2372).
Variables | ETDa | ||
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.65 | ||
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≤18 | 82 (45.30) |
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19-29 | 447 (41.81) |
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30-39 | 200 (41.23) |
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≥40 | 279 (43.92) |
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.01 | ||
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Male | 326 (38.91) |
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Female | 682 (44.39) |
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.61 | ||
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Saudi | 904 (42.30) |
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Non-Saudi | 104 (44.34) |
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<.001 | ||
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Yes | 64 (80.00) |
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No | 944 (41.23) |
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<.001 | ||
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Yes | 105 (80.21) |
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No | 903 (40.33) |
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<.001 | ||
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Yes | 426 (47.92) |
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No | 582 (39.22) |
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.17 | ||
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Yes | 153 (46.09) |
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No | 855 (41.91) |
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aETD: Eustachian tube dysfunction.
b
Prevalence of ETD according to the ETDQ-7, based on multivariate analyses (N=2372).
Variables | R | Confidence interval | |
Diagnosed with hearing loss | 0.349 | 0.263 to 0.436 | <.001 |
Diagnosed with ETDa | 0.308 | 0.199 to 0.417 | <.001 |
Family history of hearing loss | 0.063 | 0.023 to 0.103 | .002 |
Gender | –0.073 | –0.117 to –0.030 | .001 |
Smoking | 0.064 | –0.004 to 0.124 | .04 |
aETD: Eustachian tube dysfunction.
The aim of this study was to estimate the prevalence of ETD among the public in Saudi Arabia—which, to our knowledge, has not been measured before—using the ETDQ-7 instrument. ETD negatively affects the outcomes of middle ear surgery and is highly associated with OME and cholesteatoma [
In this study, a family history of hearing loss was significantly correlated with the presence of ETD (
Among participants below the age of 18 years, 45% (1067/2372) were diagnosed with ETD, making them the age group with the highest prevalence of ETD in this study. This finding is similar to that of a German study, which found that least 40% of all German children are affected by ETD [
An unexpected finding was that females were at a greater risk of developing ETD than males (
Multiple recent diagnostic evaluations have helped improve the understanding of the human anatomy; examples include the dynamic functions of the eustachian tube orifice via simple nasal endoscopy and other research-related diagnostic tests such as sonotubometry, tubomanometry, the pressure chamber test, and inflation deflation test [
A major limitation of this research related to our inability to include people of all socioeconomic sections of society in Jeddah or ensure that our study covered all residential regions of the city. Future studies should consider different environmental risk factors when collecting data and attempt to identify an association between hearing loss and ETD. They should also evaluate the prevalence of ETD in all regions and neighborhoods of the city and consider the extent of noise exposure in each region. Another suggestion for future investigations would be to analyze the prevalence of ETD among vulnerable population groups such as those exposed to occupational and environmental risk factors. Our study design can be applied to larger studies on a national or an international scale, which will help compare the prevalence of ETD among different cultures and identify more specific risk factors for the condition. Given the high prevalence of ETD in our study, more research and awareness on ETD in the community are needed.
In conclusion, this study aimed to determine the prevalence of ETD among the public in Saudi Arabia by using the ETDQ-7. Our results showed that ETD is a common disease in Jeddah. The prevalence of ETD was significantly higher among participants who had reported a previous diagnosis of ETD and hearing loss. Therefore, this condition needs more attention, awareness, and research (particularly the use of advanced statistical analysis). In addition, since smoking has a significant impact on ETD and tends to cluster in families, the potential role of smoking in family history of ETD should be examined.
Eustachian tube dysfunction
7-item Eustachian Tube Dysfunction Questionnaire
Otitis media
Otitis media with effusion
We are grateful to Shahad Ali Aleiidi, Ahmed Habib Alshaikh, Ohoud Muqbil Almutairi, Sultan Sameer Alrabghi, and Meshal ldhubabian for participating in the data collection for this research. We would also like to acknowledge Mohammed Al-Shmrani for reviewing the statistical analysis.
All authors contributed equally during the preparation of this paper. The final proofreading of the manuscript was completed by KA.
None declared.