PSYCHOLOGICAL STATUS OF PATIENTS WITH PATULOUS EUSTACHIAN TUBE
Introduction
Patients with a patulous eustachian tube (PET) often complain of various symptoms, including autophonia, impaired hearing, ear fullness, tinnitus, dizziness, headache, and psychological symptoms. When treating PET patients, it is important to consider the patient’s psychological state because they suffer from a variety of symptoms that may be long lasting and may affect, or be affected by, their mental state. This study focused on the psychological status of PET patients and compared these patients with healthy subjects.
We assessed the psychological status of PET patients using questionnaires that evaluated anxiety and depression, autonomic nerve imbalance, the degree of PET symptoms, and whether these symptoms interfered with daily life. We compared PET patients with healthy controls.
Materials and methods
We reviewed the medical records of 27 PET patients (ten males, 17 females; age 18–87 years, mean age 52.1) who visited our department between April 2010 and May 2012. Twenty healthy subjects were enrolled as controls (eight males, 12 females; age 24–67 years, mean age 48.0). To assess their psychological state and autonomic dystonia, all of the subjects completed the Hospital Anxiety and Depression Scale (HADS)1 and Toho Medical Index (TMI), which evaluates autonomic nervous system symptoms and psychiatric symptoms.2 The HADS consists of an anxiety score (HADS-A) and a depression score (HADS-D). Each item in the HADS is scored from 0–3, and the total score ranges from 0 to 21. A score ≥ 8 suggests the presence of a mood disorder such as an anxiety or depressive disorder.3 The TMI score ranges from 0 to 33.2 A score ≥ 8 indicates autonomic nerve imbalance. Additionally, in the 27 PET patients, we assessed the degree of each patient’s symptoms and whether the symptoms interfered with daily life using a face scale ranging from 0 to 10 points (Fig. 1).
Fig. 1. Degree of the patients’ symptoms and symptom interference with daily life.
Correlations between the HADS scores and the degree of the patients’ symptoms and whether the symptoms interfered with daily life were analyzed using Pearson’s product-moment correlation coefficient. The PET patients and normal subjects were compared using a chi-square test.
Comparisons of the HADS and TMI scores of PET patients and normal subjects
Fig. 2.1. Comparison of positive HADS-A scores in PET patients and controls.
Fig. 2.2. Comparison of positive HADS-D scores in PET patients and controls.
Seven of the 27 (25.9%) PET patients had positive HADS-A scores for anxiety (Fig. 2.1); significantly more PET patients than controls had high HADS-A scores (P = 0.04). Four of the 27 (14.8%) PET patients had positive HADS-D scores for depression (Fig. 2.2); there was no significant difference in the HADS-D scores between the PET patients and controls. Eight of the 27 (29.6%) patients had positive TMI tests (Fig. 2.3); there was no significant difference in the number of PET patients and controls with positive TMI scores.
Fig. 2.3. Comparison of positive TMI scores in PET patients and controls.
Degree of symptoms and symptom interference with daily life in PET patients
The level of patients’ symptoms was 6.1 ± 2.0 (mean ± SD). Of the 27 patients, 18 (66.7%) experienced severe symptoms, i.e., higher than level 6. The mean score for symptom interference with daily life was 5.7 ± 2.1. Of the 27 patients, 18 (66.7%) experienced severe symptom interference with daily life, higher than level 6.
Correlations between HADS scores and degree of symptoms/symptom interference with daily life in PET patients
In PET patients, neither anxiety nor depressive disorder was significantly correlated with the degree of symptoms or symptom interference with daily life (Figs. 3.1 and 3.2).
Fig. 3.1. Correlation between the HADS score and the degree of the PET patients’ symptoms.
Fig. 3.2. Correlation between the HADS score and symptom interference with daily life in PET patients.
A previous study found PET patients had tendency lacking in agreeableness than normal controls, and they scored lower on measures of though expression and neurotic tendencies, although these scores were not related to the duration of the disorder.4
In our series, around 70% of the PET patients experienced severe symptoms and symptom interference with daily life. Our PET patients were more prone to anxiety than the healthy subjects. No significant correlations were found between scores for anxiety and depression among the PET patients and the degree of symptoms or symptom interference with daily life. These results suggest that PET patients tend to develop anxiety, but the severity of their anxiety does not affect the severity of their symptoms or symptom interference with daily life. It is more likely that the anxiety preceded PET and is independent of their PET symptoms. Nevertheless, awareness of the mental state of PET patients is very helpful when treating these patients.
Conclusions
Patulous eustachian tube patients tend to be anxious, but the severity of their anxiety does not appear to affect the severity of their symptoms or symptom interference with daily life. Rather, it is their baseline personality character.
References
1.Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370, 1983
2.Fujii Y, Nomura S. A prospective study of the psychobehavioral factors responsible for a change from non-patient irritable bowel syndrome to IBS patient status. Biopsychosoc Med 2:16, 2008
3.Ingvar B, Alv AD, Tone TH, Dag N. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research 52(2):69–77, 2002
4.Yamamoto-Fukuda T, Imamura A, Tanaka F, Kumagami H, Takahashi H. Psychosomatic analysis of patients with patulous eustachina tube using psychological tests. Otology Japan 17(2):113–117, 2007
Adress for correspondence: Dr. Momoko Ise, 1–1-1 Honjo, Kumamoto City, 860–8556, Japan. momonga-momo-momok@hotmail.co.jp
Cholesteatoma and Ear Surgery – An Update, pp. 471–474
Edited by Haruo Takahashi
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