Elsevier

American Journal of Otolaryngology

Volume 39, Issue 5, September–October 2018, Pages 603-608
American Journal of Otolaryngology

Prevalence and incidence of clinically significant patulous Eustachian tube: A population-based study using the Korean National Health Insurance Claims Database

https://doi.org/10.1016/j.amjoto.2018.07.010Get rights and content

Abstract

Objectives

The aim of this study is to estimate the entire population-based prevalence and incidence of Patulous Eustachian tube (PET) using the Korean National Health Insurance (NHI) claims database. The annual trends of prevalence and incidence of PET were also investigated.

Methods

Retrospective analysis of PET patients was performed between 2010 and 2016, from the NHI claims database. PET patients were defined as those who had at least one service claim with a primary diagnosis under an ICD-10-based PET code (H69.0).

Results

During the study period, there were 20,533 new PET patients in Korea. In 2016 there were 4482 incident cases, and the standardized annual incidence rate was 8.8 per 100,000 persons. The standardized annual prevalence rate increased significantly from 7.2 per 100,000 persons in 2010 to 10.3 per 100,000 persons in 2016. The prevalence increased significantly on annual basis, whereas the incidence rate fluctuated over time. Interestingly, the incidence and prevalence of PET in women was almost twice as high as that in men, and peaked in their 20s.

Conclusions

This study demonstrated the substantial annual increase of the NHI claims with PET code (H69.0) in Korea from 2010 to 2016. Statistical results based on the NHI claims, we confirmed the high prevalence and incidence rates of clinically significant PET in women than in men. This study only covered patient using the medical service for PET and missed PET sufferers not seeking medical service. However, this study can provide basic epidemiological information on clinically significant PET.

Introduction

The Eustachian tube (ET) is normally closed, but opens temporarily during swallowing [1]. Patulous Eustachian tube (PET) is a disease that affects patients with auditory symptoms such as aural fullness and autophony of breathing sounds due to persistent opening or inadequate closing of the ET [2]. PET patients also suffer from vestibular symptoms and hearing loss by transferring the movement of ossicles to the inner ear caused by excessive pressure changes in the middle ear [3]. The symptoms are alleviated with the change in position, such as lying down or having the head between the knees while sitting on a chair [4]. The diagnosis of PET can be confirmed by directly observing the inward and outward movement of the tympanic membrane at the same time as forced nasal breathing [2,4].

Since PET was first described by Jago [5] in 1858, little has been learned about its epidemiology. Although some studies have revealed that PET is associated with pregnancy [6], rapid weight loss [7], mucosal atrophy [8], or muscular dysfunction [9,10], there have been no national population-based epidemiological studies to estimate the incidence and prevalence of PET to date. The aim of this study was to investigate prevalence and the incidence of PET using the National Health Insurance (NHI) claims database. We also investigated the time trends in the prevalence and incidence of PET.

Section snippets

Data source and study population

The data used in this study were extracted from the Korean NHI claims database administrated by the government-affiliated agency under the Ministry of Health and Welfare that administers and supervises all medical activities in Korea. All Korean citizens and registered foreigners must be enrolled in the NHI system, either as an NHI beneficiary or Medical Aid recipient. It is mandatory for all types of healthcare institutions to submit all inpatient and outpatient data to the NHI. Nation-wide

Results

There were 20,533 new PET patients during the study period from 2012 through 2016. Both the crude and age- and gender-standardized annual prevalence rate of PET was 10.3 per 100,000 persons in 2016. The prevalence of PET was among men and women were 7.2 and 13.4 per 100,000 persons in 2016, respectively. The male and female ratio was 39.9% for males and 60.1% for females. The rates were higher among females during the study period. The analysis of prevalence rates revealed that this measure

Discussion

PET is a rare condition afflicting patients. PET patients may present with a variety of symptoms ranging from asymptomatic to severe disturbance in the quality of life [8]. Most patients can simply be relieved by reassurance. Symptoms can often be relieved by swallowing or yawning. When reassurance and medical treatments are not adequately effective for symptomatic patients, they may be offered various surgical procedures to partially obliterate the ET. Although these various treatments have

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