Search Results (42)

Background: Eustachian tube dysfunction (ETD) is associated with several common otologic conditions but lacks standardized diagnostic thresholds in Taiwan. This study aimed to evaluate the diagnostic performance of the GSI TympStar Pro pressure-swallow test and to identify a ROC-derived maximal peak pressure difference (MPD) cutoff for distinguishing clinically diagnosed obstructive Eustachian tube dysfunction (oETD) from healthy controls. Methods: A total of 152 subjects were enrolled, including 100 healthy controls and 52 patients with clinically diagnosed oETD, confirmed by otolaryngologist assessment and supported by ETDQ-7 symptom scoring. Tympanometry and tympanometry-based Eustachian tube function testing using the GSI TympStar Pro ETF–Intact pressure-swallow module, a modified three-tympanogram pressure-swallow protocol, were performed. Group comparisons were conducted using Mann–Whitney U and Chi-square tests. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: The median MPD was 11 daPa (IQR 6–17) in the control group, compared to 0 daPa (IQR 0–2) in the ETD group (p < 0.001). ROC analysis demonstrated that a cutoff value of ≤4 daPa yielded a sensitivity of 100.0% and specificity of 91.0% in the per-person analysis, and a sensitivity of 97.5% and specificity of 95.5% in the per-ear analysis. In the Type A-only per-ear analysis, MPD retained discriminatory performance, with an AUC of 0.978 (95% CI, 0.961–0.994). Conclusions: When interpreted in conjunction with ETDQ-7 symptom assessment and routine clinical evaluation, pressure-swallow testing may provide complementary objective information for the functional assessment of patients with suspected obstructive Eustachian tube dysfunction, particularly when resting tympanometry is unremarkable. In this single-center Taiwanese cohort, lower MPD values may serve as an adjunctive indicator of impaired Eustachian tube pressure equalization, and the ROC-derived cutoff of ≤4 daPa showed discriminatory value for differentiating symptomatic obstructive ETD from healthy controls. This cutoff should be interpreted as an exploratory, protocol-specific threshold and requires prospective validation in larger multicenter populations before broader clinical application. Full article

Background/Objectives: The modified inflation–deflation test (MIDT) is a physiological test used to evaluate eustachian tube function in patients with tympanic membrane perforation. However, the clinical characteristics and diagnostic value of MIDT have not been fully established. This study aimed to investigate the characteristics of MIDT findings in normal function and patients with Eustachian tube dysfunction (ETD) classified by sonotubometry. Methods: We retrospectively assessed 192 ears of 181 patients with tympanic membrane perforation who underwent sonotubometry and MIDT. Based on sonotubometry findings, 117 ears were classified into the normal function group and 75 ears into the ETD group. The MIDT parameters of the groups, including the first opening pressure (OP1), first closing pressure (CP1), residual pressure after three openings (RP3), and pressure difference between OP1 and CP1 were compared. Correlation and receiver-operating characteristic (ROC) analyses were performed. Results: The ETD group had significantly higher OP1, CP1, and RP3 levels than the normal function group (all p < 0.001). The pressure difference between OP1 and CP1 was significantly greater for the normal function group. Failure of Eustachian tube opening was observed in 46.7% and 3.4% of ears in the ETD and normal function groups, respectively. Eustachian tube opening duration measured by sonotubometry was negatively correlated with OP1, CP1, and RP3 but positively correlated with the OP1–CP1 difference. ROC analysis identified an optimal cutoff value of 112.50 daPa for the OP1–CP1 difference, yielding a sensitivity of 92.3% and a specificity of 58.7%. Conclusions: MIDT was significantly associated with sonotubometry findings and effectively differentiated ETD from normal Eustachian tube function. These findings support the clinical utility of the MIDT as a physiological tool for assessing Eustachian tube function in patients with tympanic membrane perforation. Full article

Background/Objectives: Children with normal newborn hearing screening results can develop hearing loss from various causes during their first years of life. Since 2016, a hearing and speech-language pathology screening has been conducted annually in kindergartens in Upper Austria in children aged 4 to 5 years. If an abnormal result is found, further evaluation is recommended. Methods: Data from the kindergarten hearing screening from 2018 to 2025 and hearing and speech screening from 2022/2023 were retrospectively analyzed. In addition, a prospective questionnaire survey was conducted with the parents of children who had an abnormal hearing screening result in 2024/2025. The survey asked whether the parents followed the recommendation for further evaluation and what the outcome of that evaluation was. Results: From 2018 to 2025, between 14,975 (2024) and 17,101 (2020) children were screened annually. The prevalence of abnormal hearing screening results ranged from 5.89% (2020) to 8.17% (2022). Abnormal grammar and articulation were found in 18.68% and 68.28% of the in-depth analyzed screenings of 4–5-year-old children in 2022, respectively. A total of 209 questionnaires were evaluated in the prospective questionnaire study. Approximately 70% of the participating parents reported having their child undergo the recommended evaluation by an ORL specialist. According to the parents, the most frequent cause of hearing impairment was middle ear effusion or Eustachian tube dysfunction. No new cases of sensorineural hearing loss were diagnosed in this population of 209 children, according to the parents surveyed. Conclusions: Nationwide screening in kindergartens allows for the early detection of hearing loss in early childhood, enabling children to receive evaluation and treatment. This is supported by the fact that, according to their parents, almost a quarter of the children with abnormal hearing screening results received a diagnosis requiring treatment from an ORL specialist. Full article

Treatment of cleft lip alveolus and/or palate includes surgical repair to treat communication-related outcomes such as velopharyngeal insufficiency and otological dysfunction. Robot-assisted surgery has recently evolved into a promising adjunct to conventional surgery, particularly for complex procedures such as transoral (reconstructive) surgery. This structured literature review aims to investigate whether robot-assisted transoral cleft palate repair enhances communication (i.e., speech and otological) outcomes compared to conventional manual cleft palate surgery. A literature search was performed using PubMed, Embase, the Cochrane Library and Google Scholar. Primary outcomes were the change in cleft speech characteristics and otological disease after robot-assisted cleft palate surgery versus manual cleft palate surgery. The available evidence on communication-related outcomes remains sparse. Six relevant articles were included. In only one study, transoral robotic cleft surgery (TORCS) significantly reduced otitis media with effusion (OME), need for ventilation tubes and hearing threshold within 2 years post-surgery. No postoperative speech or velopharyngeal outcomes were reported. In conclusion, transoral robotic cleft surgery (TORCS) appears safe and feasible for repair of a cleft palate. It provides superior intraoral view and improved surgeon ergonomics. Current drawbacks are the costs and the available tools, the extended surgical duration and the lack of haptic feedback, which limit the current clinical applicability of TORCS. Based on limited clinical evidence, TORCS may support faster recovery of Eustachian tube function and hearing, but no conclusions on speech outcomes can yet be drawn. Full article

Background and Objectives: Eustachian tube (ET) dysfunction links adenoidal disease to persistent middle ear dysfunction in children, yet the independent contribution of ET orifice obstruction grade to audiological outcomes and health-related quality of life remains unquantified after adjustment for anatomical and inflammatory confounders. Because conventional anatomical grading (e.g., the Cassano classification) does not directly characterize the degree of ET orifice compromise, it may underestimate the functional threat to middle ear ventilation; this study is the first to quantify the independent predictive value of endoscopic ET obstruction grade. This study aimed to evaluate ET obstruction grade as an independent determinant of hearing thresholds, middle ear pressure, and quality-of-life impairment in children with chronic adenoiditis and otitis media with effusion. Materials and Methods: A retrospective cohort of 236 children (aged 3–12 years) was analyzed. ET orifice obstruction was graded endoscopically as none, partial, or complete. Primary outcomes included pure tone average (PTA), middle ear pressure (MEP), and OSA-18 total score. Multivariate linear and logistic regression models were fitted, adjusting for age, sex, Cassano grade, neutrophil-to-lymphocyte ratio (NLR), allergic status, and acute otitis media frequency. The modifying role of mucosal appearance (edematous versus fibrotic/remodeling) on quality-of-life outcomes was also assessed. Results: ET obstruction was absent in 42 (17.8%), partial in 114 (48.3%), and complete in 80 (33.9%) children. PTA increased progressively across groups (22.2 ± 5.5 to 36.2 ± 6.7 dB; p < 0.001), as did OSA-18 scores (44.9 ± 7.9 to 80.4 ± 10.3; p < 0.001). In adjusted analysis, each obstruction increment independently predicted a 5.57 dB PTA increase (95% CI 4.37–6.77; p < 0.001), a 14.89-point OSA-18 increase (95% CI 12.87–16.92; p < 0.001), and 5.12-fold higher odds of PTA > 30 dB (95% CI 2.84–9.24; p < 0.001). Persistent middle ear dysfunction at six months occurred in 7.1%, 26.3%, and 61.3% across obstruction grades. Among children with complete obstruction, fibrotic mucosa was associated with higher OSA-18 scores than edematous mucosa (82.3 vs. 76.8; p = 0.02). Conclusions: ET obstruction grade independently determines audiological and quality-of-life outcomes in pediatric chronic adenoiditis. Mucosal remodeling further amplifies quality-of-life burden in complete obstruction. These findings support routine ET endoscopic grading in pediatric otorhinolaryngology risk stratification. Full article

Background: Otitis media with effusion (OME) is a common pediatric middle-ear disorder with multifactorial pathogenesis. Allergic rhinitis and allergic sensitization have been proposed as contributing factors, but previous evidence remains heterogeneous. This systematic review and meta-analysis aimed to clarify the association between allergic rhinitis, allergic sensitization, and pediatric OME, while separately considering Eustachian tube dysfunction (ETD) and middle-ear dysfunction. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, and the Cochrane Library. Observational studies evaluating allergic rhinitis, rhinitis, atopy, IgE sensitization, or allergy-related symptoms in relation to OME, ETD, abnormal tympanometry, or middle-ear dysfunction were considered eligible. Random-effects meta-analyses were performed separately for allergic rhinitis/rhinitis–OME and atopy/IgE sensitization–OME. ETD and middle-ear dysfunction outcomes were synthesized narratively because of methodological heterogeneity. Results: After removal of duplicates, 956 records were screened, 46 reports were assessed for eligibility, and 21 studies were included in the qualitative or narrative synthesis. Nine studies contributed to at least one pooled quantitative synthesis, while one additional birth-cohort study contributed adjusted estimates to the narrative sensitivity interpretation. Allergic rhinitis/rhinitis was significantly associated with OME in the primary meta-analysis (OR = 3.73, 95% CI 1.79–7.74, p < 0.001; I² = 69.7%). The association remained significant in an expanded sensitivity analysis including one additional community-based study (OR = 3.46, 95% CI 1.92–6.23, p < 0.001; I² = 63.7%). Atopy/IgE sensitization was also associated with OME (OR = 5.45, 95% CI 1.33–22.35, p = 0.018; I² = 86.0%), although this analysis included only two studies. Most pooled estimates were derived from crude data and should therefore be interpreted as associations rather than causal effects. Conclusions: Allergic rhinitis/rhinitis and allergic sensitization are associated with increased odds of pediatric OME. However, the available evidence is mainly observational and heterogeneous. Allergic disease should be considered a potential contributing factor in selected pediatric OME phenotypes, rather than a universal or isolated cause. A phenotype-based approach involving both otolaryngology and allergy/immunology may be clinically useful. Full article

Introduction: Teprotumumab (Tepezza^®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols. Full article

Eustachian tube dysfunction (ETD) and related pressure-mediated otologic disorders often present with fluctuating auditory, vestibular, and pressure-related symptoms that are difficult to explain using static structural or symptom-based diagnostic labels alone. This conceptual review proposes the Neuro–Vascular–Mechanical–Inflammatory–Autonomic (NVMIA) framework as a hypothesis-generating architecture for organizing such variability. Within this framework, middle ear pressure (MEP) is interpreted as a clinically measurable physiologic variable through which interacting neural, vascular, mechanical, inflammatory, and autonomic influences may become mechanically expressed and clinically observable. The framework does not present NVMIA-based patterns as validated diagnostic categories, clinical decision tools, or treatment algorithms. Rather, it proposes provisional regulatory patterns that may help generate testable hypotheses regarding pressure-regulatory instability, cross-axis coupling, symptom fluctuation, and physiologic reversibility. Mechanical impedance may function as an accessible reference plane for future empirical assessment, while neural, vascular, inflammatory, and autonomic domains are conceptualized as modulatory axes that may alter symptom expression and response variability. The review further outlines future validation needs, including dynamic MEP measurement, patient-reported outcome integration, longitudinal response assessment, and cautious computational modeling. By reframing ETD as a model of state-dependent regulatory instability, the NVMIA framework provides a conceptual basis for future studies in precision otology while emphasizing that prospective validation is required before clinical implementation. Full article

Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease traditionally defined and assessed by sinonasal symptoms such as nasal obstruction, rhinorrhea, facial pressure, and olfactory dysfunction. However, the burden of CRS extends beyond the sinonasal compartment, including a range of systemic and functional complaints that are not routinely addressed in standard rhinologic practice. Among these, vestibular symptoms, including dizziness, imbalance, and nonspecific disequilibrium, are frequently reported by patients with CRS, yet remain underrecognized and poorly integrated into current diagnostic frameworks and clinical guidelines, despite being captured as a single, psychometrically limited item within the 22-item Sinonasal Outcome Test (SNOT-22). Clinical observations and limited published data, mostly small observational studies and case reports, suggest that vestibular symptoms may fluctuate in parallel with CRS disease activity and may improve following effective medical or surgical control of sinonasal inflammation. Proposed mechanisms include Eustachian tube dysfunction, immune-mediated and neurogenic pathways, trigemino-vestibular interactions, and altered multisensory integration, although current evidence does not establish a causal relationship between CRS disease activity and measurable peripheral vestibular dysfunction. Comparative observations in allergic rhinitis and post-viral upper-airway inflammation situate CRS within a broader inflammatory upper-airway–vestibular interface. This Commentary highlights vestibular dysfunction as an underappreciated extra-sinonasal dimension of CRS with potential clinical and functional relevance. By drawing attention to this clinical blind spot, we aim to encourage more systematic symptom inquiry, interdisciplinary dialogue, and prospective research into the functional consequences of chronic upper-airway inflammation. Full article

Background: Eustachian Tube Dysfunction (ETD) presents significant diagnostic challenges, particularly in patients with chronic nasal disease, which often mimic or complicate ETD symptoms. Tubomanometry (TMM) is emerging as an objective tool for diagnosing ETD, but its application in patients with concurrent nasal pathologies remains underexplored. Methods: One hundred patients with concurrent ETD and chronic nasal disease were recruited. They were categorized into three groups: chronic rhinitis (35 patients, group A), nasal septal deviation (31 patients, group B) and chronic rhinosinusitis with polyps (34 patients, group C). Treatments included nasal irrigation, septoplasty, and nasal polypectomy with functional endoscopic sinus surgery, respectively. The TMM parameters (R, C2 and C2–C1 scores) were assessed before and after interventions. The patient reported outcome measures (ETDQ-7 and NOSE scores) were also recorded and statistically correlated with TMM measures. Results: Group A showed improvements in R, C2 and C2–C1 scores and mild post-treatment reductions in ETDQ-7 and NOSE scores. Similar improvements were observed in Group B, with significant symptom reduction post-septoplasty, particularly on the side of the nasal septal deviation. Group C demonstrated the greatest improvement, with significant improvements in TMM values and substantial reductions in both ETDQ-7 and NOSE scores. The statistical results revealed correlations between the treatment of nasal pathologies and ETDQ-7 and NOSE scores. Conclusions: All TMM parameters improved in each group following the nasal intervention. This study highlights the utility of TMM in evaluating ETD in the context of chronic nasal disease and suggests that treating underlying nasal conditions can significantly alleviate ETD symptoms. Full article

Objective: The aim was to evaluate cochlear implantation (CI) outcomes in children with Down syndrome (DS) with severe-to-profound sensorineural hearing loss (SNHL), addressing a literature gap and discussing challenges including anatomical abnormalities, cognitive deficits, and Eustachian tube dysfunction. Data Sources: Systematic searches were conducted in PubMed, Web of Science, Scopus, and Embase from inception through to June 2025. Review Methods: A systematic review adhering to PRISMA guidelines was performed. Included studies reported CI outcomes in DS patients receiving otolaryngologic care for SNHL. Extracted data included findings on ear anatomy, auditory performance, speech/language development, intelligibility, and duration of CI use. Results: A total of 149 abstracts were screened, yielding six studies with 26 patients that met the inclusion criteria. The review included pediatric DS patients with documented ages at implantation spanning from 11 months to 17.9 years. CI provided significant benefits for DS patients, including improved audiometric results, enhanced environmental awareness, and psychosocial gains. Optimal outcomes were associated with early implantation, thorough preoperative imaging (CT/MRI), and management of middle ear disease. Variability in outcomes often reflected cognitive limitations and anatomical challenges such as cochlear nerve hypoplasia and Eustachian tube dysfunction. Conclusions: CI can significantly improve quality of life and communication in children with DS when tailored to their unique needs. Preoperative imaging is essential to assess candidacy, and middle ear disease should be addressed prior to surgery. Clinicians should counsel families with individualized goals that emphasize functional hearing gains over normative speech benchmarks. Broader adoption of CI in this population may be supported by standardized, population-sensitive outcome measures and future prospective studies. Full article

Background/Objectives: Balloon eustachian tuboplasty (BET) is an effective surgical option for obstructive eustachian tube dysfunction (OETD). However, the feasibility of performing BET under local anesthesia (LA) using simplified analgesic protocols remains underexplored. We examined the feasibility of a streamlined LA-BET protocol. Methods: Fifty patients (sixty-four ears) diagnosed with primary OETD between March 2024 and December 2025 were enrolled. All patients underwent BET under LA using intramuscular ketorolac and topical lidocaine gel without sedation or nerve blocks. Pain scores, blood pressure changes, and patient acceptance were analyzed for each patient; Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores, tympanogram types, and Valsalva results were analyzed for each ear. All outcome measures were assessed 3 months postoperatively. Results: The mean ETDQ-7 score significantly improved from 24.9 ± 7.4 to 11.9 ± 5.4 (p < 0.001). The minimal clinically important difference (MCID ≥ 3.7) was achieved in 90.6% of ears, and normalization (ETDQ-7 ≤ 14.5) in 75.0%. The proportion of ears with positive Valsalva maneuvers increased from 39.1 to 76.6% (p < 0.01), and type A tympanograms improved from 64.1 to 84.4% (p = 0.018). Mean pain scores were 3.5 during insertion, 2.1 during balloon inflation, and 0.6 after deflation. All patients completed the procedure, and 96% would undergo LA again. Conclusions: LA-BET performed using intramuscular ketorolac and topical lidocaine gel is safe, tolerable, and effective. This protocol provides symptom relief and functional improvement without sedation or nerve block and offers a practical outpatient alternative for chronic OETD management. Full article

Background/Objectives: Eustachian Tube Dysfunction (ETD) is a prevalent condition affecting middle ear pressure regulation, yet nationwide epidemiological data in Saudi Arabia remain limited. This study aimed to assess the prevalence of ETD and identify its associated factors among Saudi adults using a validated screening tool. Methods: A nationwide cross-sectional study was conducted between June 2024 and March 2025 among 1124 Saudi adults (aged ≥ 18 years) across five geographic regions. ETD was assessed using the validated Arabic version of the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), with scores ≥ 14.5 indicating dysfunction. Data on demographic, anthropometric, clinical, and lifestyle characteristics were collected via an online questionnaire. Multiple linear regression analysis identified independent predictors of ETDQ-7 scores, with statistical significance set at p < 0.05. Results: The prevalence of ETD was 33.9% (95% CI: 31.1–36.8%), substantially higher than the 7% self-reported rate. Of affected participants, 29.6% had mild-to-moderate ETD and 4.3% had severe dysfunction. Multivariable regression analysis identified four significant independent predictors: higher body mass index (BMI) (β = 0.08; 95% CI: 0.03–0.16; p = 0.049), family history of hearing loss (β = 1.87; 95% CI: 0.90–2.83; p < 0.001), prior bariatric bypass surgery (β = 14.37; 95% CI: 3.33–25.41; p = 0.011), and allergies (β = 3.19; 95% CI: 2.30–4.07; p < 0.001). No significant associations were found with demographic factors, smoking, or other comorbidities. Conclusions: ETD affects approximately one-third of Saudi adults, with significant underdiagnosis. Obesity, genetic predisposition, bariatric surgery, and allergic conditions represent key modifiable and non-modifiable risk factors. These findings support implementing routine ETDQ-7 screening in primary care and targeted interventions for high-risk populations. Full article

Background/Objectives: Achondroplasia is linked to distinctive ear–nose–throat (ENT) morbidity, yet quantitative age-structured profiles and actionable correlates remain incompletely defined. This study mapped ENT phenotypes in a consecutive cohort and examined the achondroplasia subset for prevalence, co-occurrence, age dynamics, and parsimonious risk models. Methods: Retrospective observational analysis (1 February 2023–31 January 2025). Narrative “ENT complications” were dictionary-mapped to five non-exclusive categories: otitis media, adenotonsillar/apnea—obstructive sleep apnea (OSA), audiologic/Eustachian-tube dysfunction (ETD), nasopharyngeal/upper-respiratory (URT), and extra-ENT. Proportions used Wilson 95% confidence intervals (CIs). Pairwise associations used Fisher’s exact tests with Benjamini–Hochberg false discovery rate (BH-FDR). Age was summarized by a four-level age-class schema (AC-4: 0–2, 3–5, 6–12, ≥13 years) and a two-level sensitivity contrast (AC-2: ≤5 vs. >5 years). Results: Of 83 patients, 64 (77.1%) had achondroplasia. In achondroplasia, otitis media occurred in 51.6% and OSA in 28.1%; versus non-achondroplasia, ARDs were +35.8 and +28.1 percentage points (BH-FDR adjusted). Within achondroplasia, otitis media co-occurred with OSA (odds ratio [OR] 4.97; q = 0.012) and with ETD (OR 7.25; q = 0.012). OSA increased across AC-4 to school age (p-trend = 0.0548). In parsimonious models, otitis media independently predicted ETD and OSA. A five-item ENT-burden score discriminated otologic and adeno-tonsillar interventions (AUC 0.83–0.93). Conclusions: Achondroplasia shows a concentrated ENT burden dominated by otitis media and OSA, with large adjusted absolute differences versus non-achondroplasia. Otitis media functions as a practical clinical marker for both OSA and ETD, while a compact burden score may assist intervention triage. Full article

Hearing loss (HL) affects more than 1.5 billion people worldwide and remains a leading cause of disability across the lifespan. While genetic predispositions, otitis media (OM), and cholesteatoma are well-recognized contributors, Eustachian tube dysfunction (ETD) is an underappreciated but pivotal determinant of auditory morbidity. By impairing middle ear pressure (MEP) regulation, ETD drives conductive hearing loss (CHL) through stiffness and mass-loading effects, contributes to sensorineural hearing loss (SNHL) via altered window mechanics and vascular stress, and produces mixed hearing loss (MHL) when these pathways converge. A characteristic clinical trajectory emerges in which conductive deficits often resolve quickly with restored ventilation, whereas sensorineural impairment requires prolonged, physiology-restoring intervention, resulting in transient or persistent MHL. This review integrates mechanistic insights with clinical manifestations, diagnostic approaches, and therapeutic options. Diagnostic frameworks that combine patient-reported outcomes with objective biomarkers such as wideband absorbance, tympanometry, and advanced imaging enable reproducible identification of ETD-related morbidity. Conventional treatments, including tympanostomy tubes and balloon dilation, offer short-term benefit but rarely normalize tubal physiology. In contrast, Eustachian tube catheterization (ETC) has emerged as a promising, mechanism-based intervention capable of reestablishing dynamic tubal opening and MEP regulation. Looking forward, integration of physiology-based frameworks with personalized diagnostics and advanced tools such as artificial intelligence (AI) may help prevent progression from reversible conductive deficits to irreversible SNHL or MHL. Full article