Endoscopy Guided Eustachian Tube Balloon Dilation: Our Experiences

Document Type: Original

Authors

1 Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University (Deemed to be), K8, Kalinga Nagar, Bhubaneswar-751003, Odisha, India.

2 Kerala ENT Research Foundation, Kollam, Kerala, India.

3 Medical Research Laboratory, IMS and SUM Hospital, Siksha “O” Anusandhan University (Deemed to be), K8, Kalinga Nagar, Bhubaneswar-751003, Odisha, India.

10.22038/ijorl.2019.41623.2359

Abstract

Introduction:
Eustachian tube (ET) dysfunction is a common clinical entity but its treatment is still challenging to Otorhinolaryngologists. This study is done to know the effectiveness of transnasal endoscopic balloon dilatation of eustachian tube for treatment of chronic eustachian tube dysfunction.
 
Materials and Methods:
It is a retrospective observational study conducted between May 2018 to June 2019 at IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India. Twenty one patients were identified with diagnosis of ET dysfunction and assigned to this study. The transnasal endoscopic procedure was done to dilate the cartilaginous part of the eustachian tube with a balloon catheter. Preoperative computed tomography was done in all cases. All patients were post-operatively assessed in 1st, 2nd and 8th weeks after the procedure.
 
Result:
Balloon dilatation of the eustachian tube was easily performed in all cases of this study. No abnormality including carotid canal was seen before this procedure. All except 2 cases revealed significant improvement in the ET functions. There was no damage to any vital structures like internal carotid artery in this study.
 
Conclusion:
The majority of the patients participated in this study showed positive outcome after balloon dilation of eustachian tube. It is a feasible and safe procedure for dilating the eustachian tube. This treatment is a very promising and requires more research on this aspect.

Keywords


  1. Hopf J, Linnarz M, Gundlach P, Schafer E, Leege N, Scherer H, et al. Microendoscopy of the Eustachian tube and the middle ear. Indications and clinical application. Laryngorhinootologie. 1991; 70: 391-4.
  2. McCoul ED, Lucente FE, Anand VK: Evolution of Eustachian tube surgery. Laryngoscope. 2011; 121: 661-6.
  3. Browning GG, Gatehouse S. The prevalence of middle ear disease in the adult British population. ClinOtolaryngol Allied Sci. 1992;17:317-21.
  4. Ward BK, Chao WC, Abiola G, Kawai K, Ashry Y, Rasooly T, et al. Tweleve month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction.  The Laryngoscope. 2019;129(1): 222-8.
  5. Cummings CW, Fredrickson JM, Harker LA. Otolaryngology: head and neck surgery. 4th. St. Louis, MO: Mosby. 2005.
  6. Swain SK, Samal R, Pani SK. Effect of smoking on outcome of tympanoplasty. Indian Journal of Otology. 2011;17(3):120.
  7. Poe DS, Abou-Halawa A, Abdel-Razek O. Analysis of the dysfunctional eustachian tube by video endoscopy. Otology &neurotology. 2001; 22(5):590-5.
  8. Yamashita K. Pneumatic endoscopy of the Eustachian tube. Endoscopy. 1983;15:257–259.
  9. Adil E, Poe D. What is the full range of medical and surgical treatments available for patients with eustachian tube dysfunction? CurrOpinOtolaryngol Head Neck Surg. 2014;22:8-15.
  10. Norman G, Llewellyn A, Harden M, Coatesworth A, Kimberling D, Schilder A, et al. Systematic review of the limited evidence base for treatments of eustachian tube dysfunction:a health technology assessment. ClinOtolaryngol. 2014; 39: 6-21.
  11. Martino E, Di Thaden R, Krombach GA, Westhofen M. Function tests for the eustachian tube. Current knowledge [in German]. HNO. 2004; 52:1029-39; quiz 1040.
  12. Lukens A, DiMartino E, Gunther RW, Krombach GA. Functional MR imaging of the eustachian tube in patients with clinically proven dysfunction: Correlation with lesions detected on MR images. Europian radiology 2012;22(3):533-8.
  13. Gluth MB, McDonald DR, Weaver AL, Bauch CD, Beatty CW, Orvidas LJ. Management of eustachian tube dysfunction with nasal steroid spray: a prospective, randomized, placebo-controlled trial. Arch Otolaryngol Head Neck Surg. 2011;137: 449-55.
  14. Poe DS, Hanna BM. Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model. Am J Otolaryngol.2011;32:115-23.
  15. Kivekas I, Chao WC, Faquin W, Hollowell M, Silvola J, Rasooly T, et al. Histopathology of balloon-dilation eustachiantuboplasty. Laryngoscope. 2015; 125: 436-41.
  16. Williams B, Taylor BA, Clifton N,Bance M. Balloon dilation of the eustachian tube: a tympanometric outcomes analysis. Journal of Otolaryngology - Head and Neck Surgery. 2016; 45:13.
  17. Ockermann T, Reineke U, Upile T, Ebmeyer J, Sudhoff HH. Balloon dilatation eustachiantuboplasty: a clinical study.Laryngoscope. 2010; 120(7):1411-6.
  18. Schroder S, Reineke U, Lehmann M, Ebmeyer J, Sudhoff H. Chronic obstructive eustachian tube dysfunction in adults: long-term results of balloon eustachiantuboplasty [in German]. HNO. 2013; 61: 142–51.
  19. Wanscher JH, Svane-Knudsen V. Promising results after balloon dilatation of the eustachian tube for obstructive dysfunction. Dan Med J. 2014; 61:A4818.
  20. Busby DR, Slemmons DH, Miller TF Jr. Fatal epistaxis via carotid aneurysm and Eustachian tube. Arch Otolaryngol. 1968;87: 295-8.
  21. Hwang SY, Kok S, Walton J. Balloon dilation for eustachian tube dysfunction: systematic review. The Journal of Laryngology & Otology. 2016; 130(4):2-6.
  22. Abdel-Aziz T, Schroder S, Lehmann M, Gehl HB, Ebmeyer J, Sudhoff H. Computed tomography before balloon eustachiantuboplasty–a true necessity? OtolNeurotol. 2014; 35:635-8.
  23. Jurkiewicz D, Bien´D, Szczygielski K,KantorI. Clinical evaluation of balloon dilation Eustachian tuboplasty in the Eustachian tube dysfunctionEur Arch Otorhinolaryngol.2013; 270:1157-60.