Eustachian Tube Balloon Dilation - for the 1st time in India, performed at Dr Rao's ENT Super Speciality International Hospital

Dr Rao’s ENT Super Speciality Hospital is proud to be the first ENT Hospital in India to offer Eustachian Tube Balloon Dilation procedure which is widely used globally to treat Eustachian Tube Dysfunction. In our constant quest to bring the best global ENT practices and standards to India, we have recently started offering the surgical procedure at our state of the art international super speciality ENT hospital.

Dr GVK Chaitanya Rao, our Managing Director and member of American Rhinologic Society (ARS) and European Rhinologic Society (ERS) explains what is Eustachian Tube Dysfunction, what is the procedure for Balloon Dilation and other details about the surgery.

What is Eustachian Tube

The eustachian tube, also known as the pharyngotympanic tube, is an anatomical structure 3-4 cm long that extends from the middle ear to the nasopharynx region. The main functions of the eustachian tube are –

  1. To ventilate the middle ear,
  2. Facilitate the drainage of secretions produced in the middle ear, and
  3. Prevent the reflux of nasopharyngeal secretions into the middle ear.

What is Eustachian Tube Dysfunction?

The eustachian tube, also known as the pharyngotympanic tube, is an anatomical structure 3-4 cm long that extends from the middle ear to the nasopharynx region. The main functions of the eustachian tube are –

  1. To ventilate the middle ear,
  2. Facilitate the drainage of secretions produced in the middle ear, and
  3. Prevent the reflux of nasopharyngeal secretions into the middle ear.
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How is Tubal Dysfunction diagnosed?

There are several tests to evaluate the functionality of the eustachian tube; however, there are still no defined criteria for the diagnosis of tubal dysfunction. Tympanometry and Sonotubometry are the most commonly used tests.

Tympanometry evaluates the ability of the tympanic membrane to transmit sound energy through the middle ear. After examining the external ear with an otoscope to ensure that the path to the eardrum is clean and that there is no perforation in the eardrum, the test is performed by inserting an instrument (tympanometer) into the ear canal. The device changes the pressure in the ear, generates a pure tone and measures the responses of the eardrum to sound at different pressures. This procedure generates a series of data which is plotted on a computer. The resulting graph is cataloged as one of the following 3 groups: normal, low, or excessive.

Sonotubometry is based on the application of a sound source in the nostrils with the placement of a microphone in the external auditory canal to measure the sound transmitted when the eustachian tube opens and closes. This diagnostic test has the advantage of allowing the assessment of eustachian tube regardless of the condition of the tympanic membrane.

What are the indicators of Eustachian Tube Dysfunction?

Many of the chronic pathologies of the middle ear are caused because of improper functioning of the eustachian tube leading to reduced ventilation of the middle ear. Balloon dilatation of eustachian tube improves the patency of cartilaginous part of eustachian tube and acquires great value in the treatment and prognosis of serous otitis media, tympanic membrane perforation, chronic otitis media, and cholesteatoma.

What is the procedure for Eustachian Tube Balloon Dilation?

Balloon dilatation of the eustachian tube can be performed under general or local anesthesia. This procedure involves the introduction of an inflatable catheter into the eustachian tube through the nasopharynx. Once the catheter is inserted, the balloon at its distal end is inflated by the introduction of saline solution, up to a pressure of 10 atmospheric pressure. The balloon is kept inflated at this pressure for two minutes. Then, the balloon is deflated and the catheter is removed under endoscopic vision. The postoperative period is practically painless, allowing patients to return to their normal lives within a few hours.

This procedure is based on the idea that temporary dilatation of the eustachian tube can improve symptoms (loss of hearing, pain and auditory fullness, otorrhea, tinnitus, and dizziness) of patients with tubal dysfunction.

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What is the clinical effectiveness of Eustachian Tube Balloon Dilation?

The data on the effectiveness of balloon dilation are based on several comparative studies. In all the studies an improvement was observed in the evaluated variables (tympanometry, mucosal inflammation, improvement of general symptomatology, quality of life).

The proportion of patients whose tympanogram results were classified as A (normal) after the intervention varied between 90-97% (1) (2). The duration of follow-up ranged between 2 months and 4.2 years.

With regards to the findings obtained with the otoscope, it was evidenced that 100% of the patients who presented with retractions of the tympanic membrane before the procedure were free of them after the intervention (2).

To evaluate the improvement of symptoms, a group of German researchers used a composite scale whose values ​​ranged from 0 to 10; Values ​​above 5 indicated functional Eustachian tubes. The mean preoperative value was 2.71 and the postoperative value at 2, 12 and 24 months of follow-up was 5.46; 6.07; and 6.14, respectively (3) (4). In the studies that used this scale, 78% of the eustachian tube balloon dilatation treated patients showed an improvement at 2 months of follow-up.

Several studies have evaluated the inflammation of the middle ear mucosa on a scale of 1 (normal) to 4 (severe), obtaining a pre-surgical mean of 2.8 and 1.4 after the eustachian tube balloon dilatation intervention, evidencing an improvement in the inflammation after surgery in more than 80% of patients (1).

Regarding long-term results, 87% of the population showed persistent improvement of symptoms at 34 months of follow-up (5). The need to repeat the procedure was similar in different studies (2) (5) (6), within a range of 8-10%.

After the eustachian tube balloon dilatation intervention, the quality of life of patients improved both in general health and specifically in relation to the disease. In a study using the Glasgow Benefit Inventory (GBI) questionnaire, a statistically significant improvement was obtained in the global score, in the “general health” subscale and in the “physical health” subscale (7).

What are the risks involved?

Based on the available studies, the safety and tolerability of balloon dilation in adults is good, presenting with mild adverse effects in very few cases. These effects are usually self-limiting or can be treated with local decongestants.

The most frequent adverse event has been the appearance of slight bleeding in the nasopharyngeal region. Otitis media and emphysema have also been observed in the facial area in some cases.

References

  1. Silvola J, Kivekas I, Poe DS. Balloon Dilation of the cartilaginous portion of the Eustachian tube. Otolaryngol Head Neck Surg. 2014;151:125-30.
  2. McCoul ED, Anand VK. Eustachian tube balloon dilation surgery. Int Forum Allergy Rhinol. 2012;2:191-8
  3. Schröder S, Reineke U, Lehmann M, Ebmeyer J, Sudhoff H. Chronic obstructive eustachian tube dysfunction in adults: long-term results of balloon eustachian tuboplasty. HNO. 2013;61:142-51.
  4. Sudhoff H, Schröder S, Reineke U, Lehmann M, Korbmacher D, Ebmeyer J. Therapy of chronic obstructive eustachian tube dysfunction: evolution of applied therapies. HNO. 2013;61:477-82.
  5. Catalano PJ, Jonnalagadda S, Yu VM. Balloon catheter dilatation of Eustachian tube: a preliminary study. Otol Neurotol. 2012;33:1549-52.
  6. Poe DS, Silvola J, Pyykko I. Balloon dilation of the cartilaginous eustachian tube. Otolaryngol Head Neck Surg. 2011;144:563-93.
  7. Bast F, Frank A, Schrom T. Balloon dilatation of the Eustachian tube: postoperative validation of patient satisfaction. ORL J Otorhinolaryngol Relat Spec. 2013;75:361-5.