Navigation-Assisted Balloon Eustachian Tuboplasty for Eustachian Tube Dilatory Dysfunction
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Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD.Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients' symptoms preoperatively and at the postoperative follow-up.Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient's final visit at 6 months post-procedure.Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.Keywords:
Eustachian tube
Balloon dilatation
Abstract Objective To evaluate the feasibility and safety of employing a Eustachian tube video endoscope with a supporting balloon as a viable treatment and examination option for patients with Eustachian tube dysfunction. Methods A study involving nine fresh human cadaver heads was conducted to investigate the potential of balloon dilatation Eustachian tuboplasty using a Eustachian tube video endoscope and a supporting balloon catheter. The Eustachian tube cavity was examined with the Eustachian tube video endoscope during the procedure, which involved the dilatation of the cartilaginous portion of the Eustachian tube with the supporting balloon catheter. Results The utilisation of the Eustachian tube video endoscope in conjunction with the supporting balloon catheter demonstrated technical ease during the procedure, with no observed damage to essential structures, particularly the Eustachian tube cavity. Conclusion This newly introduced method of dilatation and examination of the Eustachian tube cavity using a Eustachian tube video endoscope and the supporting balloon is a feasible, safe procedure.
Eustachian tube
Endoscope
Balloon catheter
Balloon dilatation
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When the Eustachian tube is dysfunctional, the external air cannot enter the middle ear, resulting in a negative pressure state in the middle ear, which can cause a series of pathological changes in the middle ear. In this paper, 13 patients with recurrence of otitis media after balloon dilatation of the Eustachian tube were treated with stenting in the Eustachian tube for Eustachian tube dysfunction with satisfactory results, and this method can provide a reference for the clinical treatment of Eustachian tube dysfunction.摘要: 咽鼓管出现功能障碍时外界空气不能进入中耳，导致中耳呈现负压状态进而可使中耳发生一系列病理变化。本文对13例行咽鼓管球囊扩张术治疗后复发的中耳炎患者，在咽鼓管内植入支架治疗咽鼓管功能障碍获得满意疗效，该方法可为咽鼓管功能障碍的临床治疗提供参考。.
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Balloon dilatation
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Abstract Objective: To investigate the evidence for balloon dilatation of the eustachian tube using a transtympanic approach. Methods: A systematic search of several databases was conducted (using the search terms ‘dilation’ or ‘dilatation’, and ‘balloon’ and ‘eustachian tube’). Only studies that used a transtympanic approach for the procedure were included. These studies were then assessed for risk of bias. Results: Three studies were included. Each of these studies was a limited case series, with two performed on human subjects and one on human cadavers. Results of safety and efficacy are conflicting. There is a high risk of bias overall. Conclusion: At present, there is a very narrow evidence base for transtympanic balloon dilatation of the eustachian tube. There are a number of advantages and disadvantages of the technique. Previously identified and theoretical safety concerns will need to be addressed thoroughly in future studies prior to wider clinical use.
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Balloon dilatation
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To explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction.A 10-question online survey was distributed to ENT consultants currently practising in the UK (July-September 2018).A total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years' experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty.The majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines.
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Myringoplasty
Eustachian tube
Balloon dilatation
Underlay
Perforation
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Objective Evaluate a new option for treatment of patients with Eustachian tube stenosis. Method Prospective surgical study. Three patients with unilateral intractable Eustachian tube stenosis (after surgical procedures) underwent retrograde illumination with Relieva Luma Sentry from middle ear to nasopharyngeal area and with endoscopic nasal approach to balloon dilatation to that area under general anesthesia. The procedures were done between 2010 and 2011. Results By following the light that was dissected through the stenosis tissue until we could have the Relieva Luma Sentry, we then inserted it retrograde inside a sphenoid balloon catheter and inserted the balloon inside a tubal lumen. After that, the balloon was inflated for 2 minutes with 10 atm to tubal dilatation. The approach to the middle ear was done transtympanically. Balloon catheters had success in dilatation in all cartilaginous Eustachian tubes. Balloon dilatation was not difficult to perform. Patients reported a very good improvement of hearing levels and a good dilatation comparing the tomography before and two months after the procedure. Conclusion Retrograde guided balloon dilatation of the nasopharyngeal Eustachian tube ostia showed good results. Larger studies are now needed to show the real role of this surgery.
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Balloon dilatation
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Lumen (anatomy)
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Eustachian tube
Balloon dilatation
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Abstract Objective: To determine the feasibility and safety of transtympanic balloon dilatation of the eustachian tube. Methods: Transtympanic eustachian tube dilatation was performed on six cadaver heads using balloon catheters. Catheters were placed in each eustachian tube and the head scanned by computed tomography. Randomised, blinded dilatation of one balloon in each head was performed, followed again by a second computed tomography scan. The scans were reviewed by a neurotologist and neuroradiologist who were blinded to previous treatment, and measurable dilatation and incidental damage noted. Results: There was adequate placement of the balloon catheter beyond the bony isthmus in 6 of 10 eustachian tubes. There was one insufficient catheter placement and three adverse placements (one into the petrous carotid canal and two into the vidian canal). Only one dilated tube showed a measurable increase in diameter. Conclusion: This experiment revealed serious safety issues with transtympanic eustachian tube dilatation. Therefore, this approach should not be considered feasible at this time.
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