(0330) Smoking Pack Years and Eustachian Tube Dysfunction

Introduction: The effect of smoking on obstructive eustachian tube dysfunction (ETD) is well established in clinical anecdotal practice; however, the quantitative relationship between smoking pack years (py) and ETD is poorly studied. In this retrospective cross-sectional study, we aim to determine the risk of developing ETD depending on smoking and smoking pack years.

Methods: All available data from the National Health and Nutrition Examination Survey (1999 to present) was analyzed. The primary outcome of ETD was defined as middle ear pressure less than –100 daPa. Non-smokers, current smokers, and those with tympanometry and symptom data were included. Patients under the age of 18 and with a BMI greater than 30 kg/m2, myringotomy tubes, or a sinus problem/earache/cold in the past 24 hours were excluded. The relative risks for developing ETD were calculated for non-smokers vs. smokers and those with greater vs. less than 1, 5, 20, and 30 py.

Results: A total of 6238 patients met our inclusion criteria (51% female, 73.6% non-Hispanic, mean age 41.9, 20.3% smokers). The relative risk of having ETD for smokers compared to non-smokers was 1.50 [95% CI 1.25-1.80]. The relative risk of having ETD for patients with 1+ py was 1.59 [95% CI 1.31-1.91], 5+ py was 1.77 [95% CI 1.43-2.20], 10+ py was 1.79 [95% CI 1.38-2.32], 20+ py was 2.08 [95% CI 1.50-2.87], and 30 py or greater was 2.13 [95% CI 1.39-3.25].

Conclusions: This study demonstrates that smoking significantly increases the risk of developing eustachian tube dysfunction, as represented by a negative middle ear pressure less than –100 daPa. A smoking history of 20 to 30 py more than doubled the risk of developing ETD. These results may be used to better counsel patients and identify patients to screen for ETD.