Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction
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Keywords:
Valsalva maneuver
Balloon dilation
Interventional radiology
Eustachian tube
Balloon catheter
Abstract Objectives: There is no study in the literature that patients with clinically-proven PET were evaluated by Valsalva CT. We aimed to evaluate the merit of Valsalva computed tomography (CT) in patients who had clinically-proven patulous Eustachian tube (PET). Design: Case-series Setting and participants: We recruited patients with clinically-proven PET. Participants: Main outcome measures: All participants underwent temporal bone CTs while they were performing the Valsalva maneuver in the supine position. Standard axial plane CT images, along with multiplanar reconstruction and 3D Air volume rendering, were used to visualize the ET in its entirety. Results: Three patients (2 females, one male) with a total of 6 ears were included in the study. All patients had suggestive symptoms of PET, including aural fullness, aerophony, and autophony and underwent clinical examination and audiologic tests. In all ears, the whole Eustachian tube could be visualized with Valsalva CT. Conclusion: For the first time, we demonstrated the merit of Valsalva CT in visualization of the Eustachian tube in its entirety in patients with clinically diagnosed PET.
Valsalva maneuver
Eustachian tube
Supine position
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Abstract Background: Eustachian tube dysfunction is a disorder for which there are limited medical and surgical treatments. Recently, eustachian tube balloon dilation has been proposed as a potential solution. Method: A systematic literature review was performed. Abstracts were selected for relevance, and pooled data analysis and qualitative analysis was conducted. Results: Nine prospective studies, describing 713 eustachian tube balloon dilations in 474 patients (aged 18–86 years), were identified. Follow-up duration ranged from 1.5 to 18 months. Ability to perform a Valsalva manoeuvre improved from 20 to 177 out of 245 ears following eustachian tube balloon dilation and, where data were reported in terms of patient numbers, from 15 to 189 out of 210 patients. Tympanograms were classified as type A in 7 out of 141 ears pre-operatively and in 86 out of 141 ears post-operatively. Conclusion: Prospective case series can confirm the safety of eustachian tube balloon dilation. As a potential solution for chronic eustachian tube dysfunction, further investigations are warranted to establish a higher level of evidence of efficacy.
Eustachian tube
Balloon dilation
Valsalva maneuver
Dilation (metric space)
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Assess the feasibility of using the Valsalva maneuver to visualize the cartilaginous eustachian tube lumen with computed tomography (CT) in subjects with no ear disease.Prospective case series study.Thirty-eight consecutive patients undergoing CT of the sinuses for nose-related complaints with normal radiographic findings consented for a CT of the temporal bone while performing the Valsalva maneuver. Multiplanar reconstruction was performed along the axis of the tube. Images were assessed for visualization of the whole length of lumen of the tube, or partial visualization with ratio of visualized to nonvisualized segments.The Valsalva maneuver allowed visualization of the whole length of the tube in 27/76 (35%) ears examined. It consistently visualized the distal one-third of the cartilaginous tube in 71/76 (94%) ears. Paradoxical collapse of the eustachian tube was present in three ears along with evidence of poor Valsalva technique.Valsalva CT consistently allows visualization of the lumen of the distal one-third of the eustachian tube in a majority of patients with no eustachian tube-related complaints. This technique might be helpful in localizing eustachian tube pathology in patients with obstructive tube symptoms.
Eustachian tube
Valsalva maneuver
Lumen (anatomy)
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Eustachian tube dysfunction affects from 1% to 5% of adults. This study evaluates the effectiveness of balloon dilation of eustachian tube for treating nonselected patients with eustachian tube dysfunction in a long term.We evaluated all balloon dilation of eustachian tube operations at Turku University Hospital from 2013 to 2016. The data from 107 patients and 167 ears were collected retrospectively and a questionnaire was sent to these patients regarding their symptoms.An evident reduction of the symptoms was noticed. Aural fullness, otalgia, recurrent acute otitis media, or otitis media with effusion as well as symptoms from changes to ambient pressure and the ability to do the Valsalva maneuver were significantly improved. The mean followup time with the questionnaire was 33 months. Of patients, 80% (36/45) reported long-term reduction of symptoms.In our study, balloon dilation of eustachian tube seems to have reduced symptoms of eustachian tube dysfunction and the results appear to be long lasting.
Eustachian tube
Balloon dilation
Valsalva maneuver
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Not many imaging techniques have been reported in Eustachian tube imaging.To investigate the role of selective Eustachian tubography (SET) and Valsalva computed tomography (CT) in patients who underwent Eustachian tube balloon dilation (ETBD).Eligible patients were aged 18 years and older with chronic Eustachian tube dysfunction who had failed medical treatment. On the day of the procedure, Valsalva CT and SET were performed. Participants underwent fluoroscopic ETBD with a 6×20-mm balloon catheter. Clinical examinations to check for the ability to perform the Valsalva maneuver and ETDQ-7 score change were conducted at one week and then at one, two, and six months. Follow-up Valsalva CT was performed in the one-month follow-up.A total of 30 ears in 23 patients (16 right ears, 14 left ears; 10 women, 13 men) underwent ETBD from August 2018 to November 2019. Positive CT patency was higher in follow-up Valsalva CT than baseline Valsalva CT (40% and 23.3%, respectively) (P = 0.006). In SET, positive patency was observed in 13 of 25 ears. Response to balloon dilation was observed in 18 of 25 patients. Clinical success was achieved in 16 of 27 ears. Response to balloon dilation was the only significant predictor of clinical success (P = 0.012).SET depicted the lumen of the Eustachian tube; thereby, it could be a potentially valuable tool in ETBD. Valsalva CT provides additional information about the cartilaginous portion of the Eustachian tube.
Valsalva maneuver
Eustachian tube
Balloon dilation
Dilation (metric space)
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To assess the feasibility and safety of balloon dilation Eustachian tuboplasty (BET) as an option for treatment of patients with Eustachian tube dysfunction.A cadaveric study of 5 temporal human bones was performed. Each bone underwent transnasal balloon dilation Eustachian tuboplasty (BET) with computed tomography and post-dilation histology. The procedure involved the dilation of the cartilaginous and bony portion of the Eustachian tube with a balloon catheter.BET is technically easy to perform. No damage to essential structures, particularly the carotid canal, was found.This newly introduced method seems to be a feasible and safe procedure to dilate the Eustachian tube.
Eustachian tube
Balloon dilation
Dilation (metric space)
Cadaveric spasm
Balloon dilatation
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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.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.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.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.
Eustachian tube
Balloon dilation
Balloon dilatation
Balloon catheter
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This paper studied a simplified and quantified valsalva and reverse valsalva maneuver eustachian tube tympanometry with otoadmittance meter. In normal groups, the compliance changes were 0.57 +/- 0.23 ml with valsalva maneuver and 0.26 +/- 0.12 ml with reverse valsalva maneuver. Otherwise, the recordings were performed in various tympanic functions induced by various eustachian tube functions, and the results showed that this method was significant for the diagnosis of eustachian tube structure, obstruction or patency. The recording curves helped to determine the types and degrees of eustachian tube abnormality.
Tympanometry
Eustachian tube
Valsalva maneuver
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To assess Eustachian tube balloon dilation in the treatment of Eustachian tube dysfunction by objective analysis, especially tubomanometry.Retrospective cohort study.Tertiary referral hospital.Patients undergoing Eustachian tube balloon dilation for treatment of Eustachian tube dysfunction.Eustachian tube balloon dilation.Subjective improvement, otomicroscopic findings, tympanogram, air-bone gap in pure-tone audiogram, R-value in tubomanometry at three pressure measurements (30, 40, and 50 mbar) and the Eustachian Tube Score (ETS).Eustachian tube balloon dilation was performed in 21 patients. The Eustachian Tube Score including the R-values, tympanogram, and air-bone gap all showed a statistically positive outcome (p < 0.005) after Eustachian tube balloon dilation. Subjective improvement was seen in 76%. Normal R-values were achieved in 57%. Retraction processes of the tympanic membrane improved in 18% of patients. Only one minor bleeding complication occurred.Eustachian tube balloon dilation constitutes a safe and very promising treatment option for patients with Eustachian tube dysfunction based on early-outcome analysis. ETS and specifically tubomanometry appear promising as assessment tools but await validation for use in the diagnostic workup and outcome analysis after ETBD. The pathophysiologic mechanism of Eustachian tube balloon dilation remains unclear. Long-term analysis and stratification of patients are needed to better evaluate the definite value of Eustachian tube balloon dilation.
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Balloon dilation
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Eustachian tube
Valsalva maneuver
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