{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T20:50:39Z","timestamp":1783630239181,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100008005","name":"Yonsei University College of Medicine","doi-asserted-by":"publisher","award":["6\u20102022\u20100112"],"award-info":[{"award-number":["6\u20102022\u20100112"]}],"id":[{"id":"10.13039\/501100008005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008005","name":"Yonsei University College of Medicine","doi-asserted-by":"publisher","award":["2024\u201032\u20100064"],"award-info":[{"award-number":["2024\u201032\u20100064"]}],"id":[{"id":"10.13039\/501100008005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The modified nine\u2010step test is a classical method for evaluating Eustachian tube function. However, clinical interpretation of the increased maximal difference in middle ear pressure (mdMEP) in the modified nine\u2010step test is unknown. We hypothesised that the different reservoir effects of the mastoid cavity can bias the results of the modified nine\u2010step test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 108 consecutive participants (216 ears) were retrospectively screened. Of these, 55 participants (82 ears) who met the inclusion\/exclusion criteria were enrolled. The volumetric results of the mastoid cavity, parameters of the modified nine\u2010step test (mdMEP, middle ear pressure, tympanic membrane compliance), and demographic data were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A significant negative correlation was found between mdMEP and mastoid cavity volume (<jats:italic>R<\/jats:italic>\u2009=\u2009.467, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Ears with mdMEP &gt;70\u2009daPa showed poor pneumatization in the mastoid cavity, with volumes less than 3000\u2009mm<jats:sup>3<\/jats:sup> (10th percentile of all ears analysed). Ears with mastoid cavity volumes lower than the 25th percentile showed a significantly higher mdMEP (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Patients with mastoid cavity volumes higher than the 75th percentile were significantly younger (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Multivariate regression analysis for mdMEP showed a good fit (<jats:italic>R<\/jats:italic>\u2009=\u2009.854) using factors including middle ear pressure, admittance and, most importantly, the reciprocal of mastoid volume (Beta\u2009=\u20090.752, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The mdMEP, the main parameter of the modified nine\u2010step test, was negatively correlated with the mastoid cavity volume. Therefore, the results of the modified nine\u2010step test should be interpreted with consideration of mastoid cavity volume.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.14175","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:23:44Z","timestamp":1715127824000},"page":"588-594","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Interpretation of the nine\u2010step test for <scp>Eustachian<\/scp> tube function should consider mastoid cavity volume"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-6279","authenticated-orcid":false,"given":"Jun Yup","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Hanyang University Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5196-8482","authenticated-orcid":false,"given":"Dachan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3951-5074","authenticated-orcid":false,"given":"In Seok","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1633-9805","authenticated-orcid":false,"given":"Ji Hyuk","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9243-9392","authenticated-orcid":false,"given":"Seong Hoon","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Yonsei University College of Medicine, Gangnam Severance Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348948109000608"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198806000-00015"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12428"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12030732"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206946"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mao.0000169765.00798.cd"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130808701210"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215106001095"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1983.00800200010004"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489309126169"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000001666"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348947508400309"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0091-6749(83)90027-1"},{"key":"e_1_2_12_15_1","unstructured":"CasaleJ 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