Cross-Cultural Adaptation, Validation, and Arabic Translation of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7)

Alkholaiwi, Feras; Alnatheer, Abdullah M.; Theyab, Rami Saud; Alyousef, Meshal; Aldrees, Turki; Dahmash, Abdulmajeed Bin; Alghonaim, Yazeed

doi:10.1055/s-0041-1740161

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International Archives of Otorhinolaryngology

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Original Research • iao 26 (4) • Oct-Dec 2022 • https://doi.org/10.1055/s-0041-1740161 copy

Cross-Cultural Adaptation, Validation, and Arabic Translation of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) scale is used to assess the effectiveness of the treatment and to determine the severity of the eustachian tube dysfunction (ETD). There is currently no validated Arabic version of the ETDQ-7.

Objectives

The aim of the present study is to test the validity and the reliability of a translated Arabic version of the ETDQ-7.

Methods

A multicenter prospective validation study was conducted in Riyadh, Saudi Arabia. The ETDQ-7 was adapted and translated into Arabic using a standard validation methodology. Fifty-one patients diagnosed with Eustachian tube dysfunction and 45 healthy individuals were enrolled in the study. The known-groups method was used in the validity analysis. The test-retest method, item-total score correlation, and internal consistency analysis were used for the reliability analyses.

Result

The overall internal consistency of the Arabic ETDQ items was measured using Cronbach α (Cronbach α = 0.803). The average and total ETDQ scores were significantly higher in the ETD group (17.6) than in the control group (9.87) (p < 0.001). The results indicate a good to excellent correlation (> 0.7). The area under the curve for the total ETDQ score was 88.6% (95% confidence interval [CI]: 80.3–96.8%)

Conclusion

The Arabic version of the ETDQ-7 scale is a valid instrument for evaluating ETD. It can also be used as an important tool for diagnosis, patient follow-up, and treatment management.

Keywords
eustachian tube; validation study; translation

Over the past 1 month, how much has each of the following been a problem for you?	No Problem		Moderate Problem			Severe Problem
1. Pressure in the ears?	1	2	3	4	5	6	7
2. Pain in the ears?	1	2	3	4	5	6	7
3. A feeling that your ears are clogged or “under water”?	1	2	3	4	5	6	7
4. Ear symptoms when you have a cold or sinusitis?	1	2	3	4	5	6	7
5. Crackling or popping sounds in the ears?	1	2	3	4	5	6	7
6. Ringing in the ears?	1	2	3	4	5	6	7
7. A feeling that your hearing is muffled?	1	2	3	4	5	6	7

	All	Case	Control	Overall p-value
	n = 96	n = 51	n=45	Overall p-value
Gender
Female	41 (42.7%)	22 (43.1%)	19 (42.2%)	1.000
Male	55 (57.3%)	29 (56.9%)	26 (57.8%)	1.000
Age (years old)	31.1 (9.30)	32.0 (9.26)	30.1 (9.33)	0.314
Location of the symptoms
Both ears	46 (47.9%)	33 (64.7%)	13 (28.9%)	< 0.001
Right ear	15 (15.6%)	7 (13.7%)	8 (17.8%)
Left ear	14 (14.6%)	11 (21.6%)	3 (6.67%)
No symptoms	21 (21.9%)	0 (0.00%)	21 (46.7%)

	[ALL]	Case	Control	p-value
	n = 96	n = 51	n = 45	p-value
Ear pressure	2.11 (1.29)	2.84	1.29	< 0.001
Ear pain	1.73 (1.14)	2.25	1.13	< 0.001
Ear clogged	2.41 (1.68)	3.10	1.62	< 0.001
Ear symptoms after cold or sinusitis	2.38 (1.62)	2.90	1.78	< 0.001
Crackling sound in ear	1.78 (1.23)	2.27	1.22	< 0.001
Ringing ears	1.96 (1.26)	2.51	1.33	< 0.001
Muffled hearing	1.60 (1.16)	1.71	1.49	0.356
Total score	14.0 (6.41)	17.6	9.87	< 0.001
Mean score	2.00 (0.92)	2.51	1.41	< 0.001

	Item 1	Item 2	Item 3	Item 4	Item 5	Item 6	Item 7
Ear pressure
Ear pain	0.474^* ***** p < 0.001.
Ear clogged	0.576^* ***** p < 0.001.	0.386^* ***** p < 0.001.
Ear symptoms after cold or sinusitis	0.478^* ***** p < 0.001.	0.408^* ***** p < 0.001.	0.470^* ***** p < 0.001.
Crackling sound in ear	0.503^* ***** p < 0.001.	0.453^* ***** p < 0.001.	0.367^* ***** p < 0.001.	0.230^* * p < 0.05.
Ringing ears	0.505^* ***** p < 0.001.	0.438^* ***** p < 0.001.	0.395^* ***** p < 0.001.	0.362^* ***** p < 0.001.	0.510^* ***** p < 0.001.
Muffled hearing	0.275**	0.162	0.331^* ***** p < 0.001.	0.227^* * p < 0.05.	0.158	0.228^* * p < 0.05.
Mean score	0.791^* ***** p < 0.001.	0.630^* ***** p < 0.001.	0.777^* ***** p < 0.001.	0.709^* ***** p < 0.001.	0.602^* ***** p < 0.001.	0.665^* ***** p < 0.001.	0.444^* ***** p < 0.001.

Item	ICC	95% CI	P
Ear pressure	0.93	0.87–0.96	< 0.001
Ear pain	0.87	0.78 - 0.92	< 0.001
Ear clogged	0.91	0.84 - 0.95	< 0.001
Ear symptoms after cold or sinusitis	0.91	0.85–0.95	< 0.001
Crackling sound in ear	0.90	0.83–0.94	< 0.001
Ringing ears	0.94	0.89 - 0.96	< 0.001
Muffled hearing	0.92	0.86–0.95	< 0.001
total	0.95	0.92 - 0.97	< 0.001

Cut-off value	Sensitivity	Specificity	PPV	NPV	Accuracy	AUC
≥ 13	71.4%	84.4%	83.3%	73.1%	77.9%	88.6% [80.3% - 96.8%]

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[1] Address for correspondence Abdullah Alnatheer, MBBS, College of Medicine, Imam Mohammed ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, Riyadh 13317-4233, Kingdom of Saudi Arabia (e-mail: a.anatheer@gmail.com).

	Item 1	Item 2	Item 3	Item 4	Item 5	Item 6	Item 7
Ear pressure
Ear pain	0.474^* ***** p < 0.001.
Ear clogged	0.576^* ***** p < 0.001.	0.386^* ***** p < 0.001.
Ear symptoms after cold or sinusitis	0.478^* ***** p < 0.001.	0.408^* ***** p < 0.001.	0.470^* ***** p < 0.001.
Crackling sound in ear	0.503^* ***** p < 0.001.	0.453^* ***** p < 0.001.	0.367^* ***** p < 0.001.	0.230^* * p < 0.05.
Ringing ears	0.505^* ***** p < 0.001.	0.438^* ***** p < 0.001.	0.395^* ***** p < 0.001.	0.362^* ***** p < 0.001.	0.510^* ***** p < 0.001.
Muffled hearing	0.275**	0.162	0.331^* ***** p < 0.001.	0.227^* * p < 0.05.	0.158	0.228^* * p < 0.05.
Mean score	0.791^* ***** p < 0.001.	0.630^* ***** p < 0.001.	0.777^* ***** p < 0.001.	0.709^* ***** p < 0.001.	0.602^* ***** p < 0.001.	0.665^* ***** p < 0.001.	0.444^* ***** p < 0.001.