Endoscopic Evaluation of the Eustachian Tube: assessment of a novel tool for grading Eustachian tube inflammation

Int Forum Allergy Rhinol. 2019 Mar;9(3):305-310. doi: 10.1002/alr.22252. Epub 2018 Nov 28.


Background: Signs of inflammation are commonly encountered during endoscopic examination of the Eustachian tube (ET) region. The clinical applicability of these findings may be enhanced by use of a standardized assessment score.

Methods: Digital video recordings were obtained of 50 nasal endoscopy examinations of the nasopharyngeal portion of the ET. Four fellowship-trained rhinologists independently reviewed the videos with regard to specific physical findings: edema of the ET torus, erythema of the ET torus, exudate at the ET orifice, and presence of tubal tonsil. Scoring of this Endoscopic Evaluation of the Eustachian Tube (3ET) was reported using both 2-point and 3-point scales. Each reviewer repeated the scoring at a 10-day interval. Interrater and intrarater agreement were calculated for each item and the total scores.

Results: Interrater and intrarater agreement were greater for the 3-point scale than the 2-point scale. Interrater agreement for overall instrument using the 3-point scale was in the "acceptable" range for Krippendorff's alpha on both the first trial (0.6922) and second trial (0.7238). Intrarater agreement was generally "excellent" for individual items as well as the overall instrument.

Conclusion: The 3ET comprising these 4 physical findings has acceptable interrater and intrarater reliability, and may be applied to future clinical studies of ET function and disease.

Keywords: Eustachian tube; inflammation; interrater agreement; intrarater agreement; nasal endoscopy; nasopharynx; reliability.

MeSH terms

  • Adult
  • Aged
  • Capsule Endoscopy / methods*
  • Edema / pathology*
  • Eustachian Tube / diagnostic imaging
  • Eustachian Tube / immunology*
  • Female
  • Humans
  • Inflammation / diagnosis*
  • Male
  • Middle Aged
  • Nasopharynx / diagnostic imaging
  • Nasopharynx / pathology*
  • Observer Variation
  • Reproducibility of Results
  • Technology Assessment, Biomedical
  • Video Recording