Eustachian tube balloon dilation in treatment of equalization problems of freediving spearfishermen

Giunta, Antonio Am; Liberati, Luca; Pellegrino, Cristina; Ricci, Giampietro; Rizzo, Santino

doi:10.28920/dhm49.1.9-15

Cited by 10 publications

(19 citation statements)

References 26 publications

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“…Balloon tuboplasty in free divers and spear fishermen was found to be effective. 16 To the best of our knowledge, this is the first report dedicated to the outcome balloon tuboplasty for ETD among SCUBA and closed-circuit rebreather (CCR) divers.…”

Section: Introductionmentioning

confidence: 98%

Outcome of Balloon Eustachian Tuboplasty in SCUBA Divers

et al. 2020

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Objectives: Good Eustachian tube (ET) function is necessary in order to equalize middle ear (ME) pressure with ambient pressures and avoid barotrauma among divers. Since placement of ventilation tubes is not compatible with diving, balloon eustachian tuboplasty is a potential surgical solution for divers with ET dysfunction (ETD). This is the first report of the outcome of balloon tuboplasty for ETD among divers. Methods: A retrospective analysis of medical records and clinical examinations of adult divers treated in a single tertiary medical center. Results: Four male divers (age range 21-71 years, 5 ETs) underwent balloon tuboplasty for ETD. None had identifiable risk factors for ETD. Symptom duration ranged from 2 to 5 years and was restricted to diving in 3 patients. The most common symptom was difficulties in equalizing air pressure during descent and ascent, followed by aural fullness and hearing loss. The validated Hebrew version of ETD-7 questionnaire (ETDQ-7H) results were normal in 3 ears and pathological (2.9 and 3.3) in 2 ears. The averaged postoperative ETDQ-7H score was 1.2 points, significantly better than the preoperative score ( P < .05). While diving, pressure-equalizing sensation improved in all ears. Conclusion: Balloon eustachian tuboplasty is a safe method for treating diving-induced baro-challenge ETD. This procedure can improve symptoms and enable the patient to resume diving.

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Section: Introductionmentioning

confidence: 98%

Outcome of Balloon Eustachian Tuboplasty in SCUBA Divers

et al. 2020

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“…A total of 12 publications underwent data extraction. One was ultimately excluded because of concern for duplication of outcomes reporting 31 . The authors were contacted, but unfortunately, confirmation was not achieved.…”

Section: Resultsmentioning

confidence: 99%

“…One was ultimately excluded because of concern for duplication of outcomes reporting. 31 The authors were contacted, but unfortunately, confirmation was not achieved. Ultimately, 11 publications were included in the systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…The EP score has similarly not been well studied in the assessment of BCETD. It was developed in 2019 and divides equalization efficiency into four different levels, aiming to connect each level to a specific risk of barotrauma 31,33 . Because it excludes assessment of symptoms that occur daily for patients with ETD, it is purported to be more relevant to divers, and possibly aviators, with BCETD than the ETDQ‐7.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Eustachian Tube Procedures for Baro‐challenge Eustachian Tube Dysfunction

et al. 2022

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Objective: To examine the effectiveness of Eustachian tube procedures for the treatment of baro-challenge Eustachian tube dysfunction.Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases, including PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and CINAHL (EBSCO), were searched for articles examining the effectiveness of Eustachian tube procedures for baro-challenge Eustachian tube dysfunction. Outcome measures included symptom resolution, ability to return to work, equalization problems (EP) scores, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and pressure chamber testing parameters. Pooled meta-analysis was performed for dichotomous measures and ETDQ-7 scores.Results: Eleven articles with 81 patients were included. Seventy-two patients from 10 articles underwent balloon Eustachian tube dilation; nine patients in 1 study underwent laser Eustachian tuboplasty (LET). All 81 patients were preoperatively symptomatic with barometric pressure change, and 26/30 (86.7%) were unable to work due to symptoms. On meta-analysis, after balloon dilation Eustachian tuboplasty (BDET), 82.5% (n = 30 [95% confidence interval: 42%-100%]) had improvement in ability to valsalva, 79.1% (n = 16 [57.9%-94.1%]) in ability to return to work, and 84.3% (n = 69 [69.8%-94.7%]) in any symptom. Of 25 patients with individual ETDQ-7 scores, 79.1% [51.4, 96.9] had improvements after BDET. For four case series with 36 patients, ETDQ-7 scores decreased by 1.2 [0.7, 1.7] (p < 0.00001). Of 20 patients with preoperative ETDQ-7 scores >2.0, there was a mean decrease of 2.1 [1.3, 2.8] (p < 0.00001).Conclusion: From the available evidence, Eustachian tube procedures appear to be effective at improving symptoms of baro-challenge Eustachian tube dysfunction. However, higher quality evidence is needed to support making definite recommendations for the use of balloon Eustachian tube dilation or LET for these patients.

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“…In all the studies, only two mild complications, one limited subcutaneous emphysema and one acute otitis, were reported (3%) (14).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Balloon Tuboplasty for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review and a Retrospective Cohort Study of 39 Patients

Oehlandt

Laakso

Lindfors

et al. 2022

Otology &Amp; Neurotology

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ObjectiveBaro-challenge-induced Eustachian tube dysfunction (ETD) manifests due to inadequate Eustachian tube (ET) function during rapid ambient pressure changes, although ET function may be normal in normobaric situations. This systematic review and retrospective cohort study aimed to evaluate the effectiveness of balloon Eustachian tuboplasty (BET) for the treatment of baro-challenge-induced ETD.Data SourcesPubMed, the Cochrane Library, Scopus, and Helsinki University Hospital cohort.MethodsA systematic literature search was conducted in November 2020 and resulted in 174 articles. Eight articles fulfilled the inclusion criteria. Data was available altogether from 74 adult baro-challenge-induced ETD patients. In addition, we retrospectively evaluated 39 BET operations at Helsinki University Hospital from 2011 to 2020. Data from these 39 patients were collected from medical charts, and a questionnaire was sent to the patients. Meta-analysis was used to evaluate subjective symptom improvement, changes in ETD Questionnaire-7 (ETDQ-7) scores, and Valsalva maneuver performance.ResultsIn the systematic review, the outcome parameters varied between studies. Improvement was reported in subjective symptoms, Valsalva maneuver, ETDQ-7, tubomanometry, and pressure chamber test. Response rate for the Helsinki University Hospital cohort study was 72% (28/39). Mean follow-up time from the BET to the questionnaire was 4 years 8 months (SD 26months). Of those patients 93% (26/28) found the operation beneficial. Meta-analysis including up to 113 patients showed improvement in Valsalva maneuver, ETDQ-7, and improvement in subjective symptoms. Overall improvement in symptoms was noted in 81% of the patients.ConclusionBET seems to be effective in the majority of patients with baro-challenge-induced ETD.

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Eustachian tube balloon dilation in treatment of equalization problems of freediving spearfishermen

Cited by 10 publications

References 26 publications

Outcome of Balloon Eustachian Tuboplasty in SCUBA Divers

Outcome of Balloon Eustachian Tuboplasty in SCUBA Divers

A Systematic Review of Eustachian Tube Procedures for Baro‐challenge Eustachian Tube Dysfunction

Efficacy of Balloon Tuboplasty for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review and a Retrospective Cohort Study of 39 Patients

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