Eustachian Tube Dysfunction (ETD) is defined by symptoms and signs of pressure dysregulation in the middle ear. Vertigo associated with ETD is caused in most (and perhaps all) instances by unilateral Eustachian tube obstruction or by more complete obstruction one side than the other. Vertigo due to unilateral ETD was first defined as “alternobaric vertigo” (or ‘vertigo altenobarica’), by Dr. Claes Lundgren who coined the term in 1965 to describe vertigo in deep-sea divers. Alterno Baric Vertigo (ABV) results from unequal pressure between the middle ears and is usually caused by bilateral middle ear pressures changing at different rates, causing the brain to erroneously perceive the difference as movement. The fundamental mechanism of ABV is asymmetrical middle ear pressures. This diagnosis can also be applied to cases at ground level, no matter how minute the difference in pressure is. Persistent ABV at ground level is associated with abnormal vestibular function test results. ABV should be differentiated from any condition conferring active risk of vertigo or severe disequilibrium. This includes peripheral causes such as menière’s disease, benign paroxysmal positional vertigo, and vertebrogenic dizziness, as well as central disorder. Vestibular organ dysfunction is caused by poorly regulated pressure in the middle ears. Vestibular organs are dependent variable organs. Every clinical test currently used to assess vestibular function should ideally be performed in a state where pressures in the middle ear cavities are well within normal range, and perfectly balanced between the ears. Taking these points into consideration, I would like to (1) propose that ABV be included in the ETD Consensus Statement as an official symptom of ETD, (2) reiterate that eustachian tube function should be tested before vestibular function, and (3) call for case studies and research into cases of vertigo where eustachian tube function was assessed before vestibular function.

Hee-Young Kim is a respected otolaryngologist and president of Kim Ear, Nose and Throat Clinic, Seoul, Republic of Korea. He received his doctor of medicine, master of science, and PhD in pathology from Chung-Ang University, South Korea. His area of academic interest is eustachian tube disfunction and he has published on topics such as Alternobaric Vertigo (ABV): Eustachian tube function should be assessed before vestibular function, Eustachian tube catheterization: fundamental skill for competent otolaryngologists, eustachian tube catheterization, vertigo due to eustachian tube obstruction, the history of eustachian tube catheterization, and the reciprocal causal relationship between laryngopharyngeal reflux and eustachian tube obstruction in peer reviewed journals. He was awarded the Albert Nelson Marquis Lifetime Achievement Award. Since 2016, he has served as the editor-in-chief of the Journal of Otolaryngology-ENT Research.