Treatment of Eustachian tube dysfunction with balloon dilation: A systematic review

Abstract

Objective: Balloon dilation is a new entity in the therapeutic approach of Eustachian tube dysfunction. The aim of this systematic review is to evaluate the success of balloon dilation of the tuba auditiva in reducing symptoms in adult patients with Eustachian tube dysfunction.Data Sources: Embase, PubMed, and Cochrane Library. Review Methods: The systematic literature search was conducted independently by two authors based on title and abstracts, and resulted in 36 articles. These articles were screened as full text, 15 of them were eligible for critical appraisal. Data were extracted from selected studies and presented in this article. A meta-analysis was conducted for four subgroups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as a writing guideline for this systematic review.Results: All 15 included studies were case series. A total of 1,155 patients were treated with balloon dilation of the tuba auditiva. Outcome parameters were relief of symptoms, otoscopy, Valsalva maneuver or Toynbee test, audiometry, tympanometry, Eustachian tube dysfunction classification, and Eustachian tube score. All articles showed short-term improvement of original symptoms; some showed further improvement over time. Follow-up ranged from just after therapy to 50 months. Relatively mild and self-limiting complications were described in 36 patients.Conclusion: All current studies suggest that balloon dilation of the Eustachian tube can be a helpful treatment in patients with Eustachian tube dysfunction. However, placebo controlled trials are still warranted.

Fluoroscopic balloon diameter measurement at different pressures during Eustachian balloon dilation

“…In comparison, the Bielefeld system inflates the balloon at 10 atm for 2 minutes whereas the Acclarent system does so at 12 atm for between 30 seconds and 2 minutes . Complications of balloon ET dilation such as pain, emphysema, bleeding and increased tinnitus have been reported to be mild and self‐limiting, and might be related to a higher pressure and larger diameter of the balloon. Although damage to the internal carotid artery would be of clinical importance due to its proximity to the ET, it has not been described previously in relation to a balloon catheter procedure …”

“…However, the benefits of high‐pressure balloons have not been proved. In addition, complications such as subcutaneous emphysema and severe pain have been reported . Moreover, some authors reported that dilation of the bony canal should not be done because of risks of bony fracture and injury to the internal carotid artery .…”

The mechanism of balloon Eustachian tuboplasty: a biomechanical study

“…This study demonstrates that balloon size, inflation pressure and balloon insertion depth all impact on the changes induced in the ET during BET, and these are therefore likely to be important variables that determine the clinical effectiveness of the intervention. These technical details have typically been overlooked when comparing or combining BET clinical data, but they may underlie some of the variation seen in outcomes [2], and they will be important considerations during future development of the technique. Figure 4 demonstrates a significantly greater dissipation of energy during plastic deformation with the 6.0/6.5-mm balloons, a trend also seen in Fig.…”

“…Although clinical studies of BET have been of limited size and quality, BET appears to provide at least a short-term symptomatic improvement in patients with OETD [2]. Clinical data have also shown increased passive ET opening with Valsalva [12,15,16], a marked improvement in active ET opening with swallowing [17], and normalisation of tubomanometry R values [18,19].…”

“…Balloon Eustachian tuboplasty (BET) is a minimally invasive surgical procedure that is increasingly being adopted as a treatment for OETD. Early clinical results appear to indicate that the procedure is an effective means to reduce symptoms and normalise middle ear pressure [2], in a condition where other medical and surgical interventions have been found ineffective [3].…”