1
|
Hubbell RD, Toivonen J, Kawai K, Kim HJ, Nieman CL, Ward BK, Poe DS. Patulous Eustachian Tube Dysfunction Symptoms Following Balloon Dilation. Laryngoscope 2023; 133:3152-3157. [PMID: 36929856 DOI: 10.1002/lary.30659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/01/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management. Reported complications have been limited and include patulous Eustachian tube dysfunction (PETD). This multicenter study investigates the incidence of PETD and associated factors. METHODS Consecutive patients at three academic centers undergoing BDET (January 2014-November 2019) for OETD refractory to medical therapy were included. PETD was diagnosed by patient-reported symptoms of autophony of voice and/or breathing. Associated factors studied include age, sex, comorbidities, balloon size, duration of inflation, repeat BDET, and adjunctive procedures. RESULTS BDET procedures (n = 295 Eustachian tubes) were performed on 182 patients. Mean age was 38.4 years (SD 21.0; range 7-78) and 41.2% were female. Twenty cases of PETD (6.8% of procedures; 9.3% of patients) occurred following BDET. Risk of PETD did not vary by institution, comorbidities, or adjunctive procedure. Age ≤18 years (adjusted risk ratio [RR] = 3.26; 95% confidence interval [CI]: 1.24, 8.54; p = 0.02), repeat BDET (RR = 3.26; 95% CI: 2.15, 4.96; p < 0.001), and severe preoperative Eustachian tube inflammation (RR = 2.83; 95% CI: 1.10, 7.28; p = 0.03) were associated with increased risk of developing PETD in the multivariable model. Most symptoms were reported as mild or intermittent. CONCLUSION BDET caused PETD symptoms in approximately 7% of dilated Eustachian tubes in this study with increased risk for younger patients and those with severe inflammation or undergoing repeat dilations. Although most cases were self-limited, symptoms can persist. Awareness of risk factors may aid clinicians in limiting this complication. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3152-3157, 2023.
Collapse
Affiliation(s)
- Richard D Hubbell
- Department of Otolaryngology-Head and Neck Surgery, Loyola Stritch School of Medicine, 23 West Chicago Avenue, Apt 3606, Chicago, Illinois, 60654, USA
| | - Joonas Toivonen
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - H Jeffrey Kim
- Department of Otolaryngology-Head and Neck surgery, Georgetown University Medical Center, Washington, D.C., USA
| | - Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dennis S Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Oppel N, Ezzat M, Krüger P, Schmitt K, Napp A, Pohl F, Bleich A, Lenarz T, Stein T, Paasche G, Schuon R. Development of an In Vivo Model for Eustachian Tube Dysfunction. Bioengineering (Basel) 2022; 9:317. [PMID: 35877368 PMCID: PMC9311709 DOI: 10.3390/bioengineering9070317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
Otitis media is often connected to Eustachian tube dysfunction (ETD). Until now, there was no large animal model available for the examination of new treatment methods such as stents for the Eustachian tube (ET). Thus, the aim of the study was to develop a method to reproducibly induce ETD by injection of fillers and without permanent closure of the ET. Tools for safe injection of hyaluronic acid (HA) in the surrounding of the ET were developed. In ex vivo experiments, HA mixed with Imeron® was injected close to the nasopharyngeal orifice of the ET of blackface sheep. The established depot was visualized using cone beam computer tomography and magnetic resonance imaging, and stents could be placed into the ET. A reliable position of the HA depot was achieved. This method was transferred to in vivo, and middle ear ventilation was investigated by tympanometry. ETD was achieved with amounts of 2.5 mL HA or higher. None of the animals showed any sign of discomfort or complications. The induced ETD lasted for 3 to 13 (maximum observation period) weeks and was also combined with middle ear effusion. A model of ETD based on injection of HA next to the ET was successfully established and is now available to test novel treatment options for ET functionality.
Collapse
Affiliation(s)
- Niels Oppel
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
| | - Malena Ezzat
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
| | - Philipp Krüger
- bess pro GmbH, Gustav-Krone-Str. 7, 14167 Berlin, Germany; (P.K.); (T.S.)
| | - Katharina Schmitt
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
| | - Alexandra Napp
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
| | - Friederike Pohl
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
| | - Andre Bleich
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
- Cluster of Excellence Hearing4all, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Tobias Stein
- bess pro GmbH, Gustav-Krone-Str. 7, 14167 Berlin, Germany; (P.K.); (T.S.)
| | - Gerrit Paasche
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
- Cluster of Excellence Hearing4all, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Robert Schuon
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (N.O.); (M.E.); (K.S.); (A.N.); (F.P.); (T.L.); (R.S.)
| |
Collapse
|
3
|
Kryukov AI, Kunelskaya NL, Ivoylov AY, Garov EV, Bodrova IV, Sudarev PA, Yanovsky VV, Morozova ZN. [Two-year experience in the balloon dilatation treatment of children with persistent auditory tube dysfunction]. Vestn Otorinolaringol 2021; 86:54-57. [PMID: 34783474 DOI: 10.17116/otorino20218605154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Is to study the effectiveness of the of balloon dilatation of the auditory tube in children with persistent dysfunction of the auditory tube. Examination and treatment of 28 children aged 5 to 16 years with persistent dysfunction of the auditory tube was performed. To diagnose and objectify the results of the treatment, taking of complaints and medical history of the patient, examination of ENT organs, endoscopic examination of the nose, nasopharynx and otoendoscopy, functional multispiral computed tomography of the auditory tubes, audiological examination (tympanometry, tonal threshold audiometry) were performed. Treatment included balloon dilatation of the auditory tubes. In 25 (89.3%) children, upon repeated examination after 2, 6, 12 months, the clinical, radiological, and audiological parameters were normal.
Collapse
Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - N L Kunelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - A Yu Ivoylov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia.,Speransky Pediatric Municipal Clinical Hospital No. 9, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - I V Bodrova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - P A Sudarev
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V V Yanovsky
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Z N Morozova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| |
Collapse
|
4
|
[Evaluation of standardized questionnaires for diagnosis and differentiation of obstructive and patulous Eustachian tube dysfunction]. HNO 2021; 69:198-205. [PMID: 32885310 PMCID: PMC8241754 DOI: 10.1007/s00106-020-00931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hintergrund Eine klaffende Tube kann insbesondere durch Autophonie, Druckgefühl und gestörten Höreindruck zu einer Einschränkung der Lebensqualität führen. Bei fehlenden spezifischen Symptomen kann die Diagnose der klaffenden Tube schwierig sein. Insbesondere die Abgrenzung zur chronisch obstruktiven Tubenfunktionsstörung stellt eine Herausforderung dar. Da derzeit kaum standardisierte Diagnostik- und Therapieoptionen zur Verfügung stehen, ist eine strukturierte Untersuchung zur sicheren Diagnostik und wissenschaftlichen Aufarbeitung dieser Erkrankung erforderlich. Für die Diagnostik der chronisch obstruktiven Tubenfunktionsstörung wurde 2012 bereits der „Eustachian Tube Dysfunction Questionnaire“ (ETDQ-7-Fragebogen) nach McCoul entwickelt. Für die klaffende Tube existiert seit 2017 der PHI-10-Fragebogen („patulous Eustachian tube handicap inventory“) nach Kobayashi. Material und Methoden Der PHI-10-Fragebogen wurde ins Deutsche übersetzt und an 41 Gesunden, 13 Patienten mit Tinnitus auris, 11 Patienten mit klaffender Tube und 18 Patienten mit chronisch obstruktiver Tubenventilationsstörung getestet. Zusätzlich erfolgte im Vergleich die Auswertung des ETDQ‑7 nach McCoul. Ergebnisse Es erfolgt die Präsentation der deutschen Übersetzung des PHI-10 und der Ergebnisse von PHI-10 und ETDQ‑7 in allen Patientengruppen. Der ETDQ‑7 hat das Risiko falsch-positiver Ergebnisse bei Patienten mit klaffender Tube und der PHI-10 bei Patienten mit obstruktiver Tubenfunktionsstörung. Beide untersuchten Fragebögen sind falsch-positiv bei Tinnituspatienten. Schlussfolgerung Der PHI-10 (deutsch) und ETDQ‑7 (deutsch) sind eine nützliche Unterstützung der Anamnese bezüglich Tubenfunktionsstörungen. Sie unterscheiden jedoch nur unzureichend zwischen klaffenden und obstruktiven Tubenfunktionsstörungen und eignen sich nicht für Patienten mit Tinnitus. Die Stärke der Fragebögen ist in der Verlaufskontrolle und dem Monitoring von Therapieergebnissen zu sehen.
Collapse
|
5
|
Swain SK, Janardan S, Mohanty JN. Endoscopy Guided Eustachian Tube Balloon Dilation: Our Experiences. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2020; 32:287-294. [PMID: 33014905 PMCID: PMC7515618 DOI: 10.22038/ijorl.2019.41623.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: 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. Materials and Methods: 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. Result: 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. Conclusion: 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.
Collapse
Affiliation(s)
- Santosh-Kumar Swain
- Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha "O" Anusandhan University (Deemed to be), K8, Kalinga Nagar, Bhubaneswar-751003, Odisha, India
| | | | - Jatindra-Nath Mohanty
- Medical Research Laboratory, IMS and SUM Hospital, Siksha "O" Anusandhan University (Deemed to be), K8, Kalinga Nagar, Bhubaneswar-751003, Odisha, India
| |
Collapse
|
6
|
Tympanoplasty With or Without Balloon Eustachian Tuboplasty for Chronic Suppurative Otitis Media With Obstructive Eustachian Tube Dysfunction. Otol Neurotol 2020; 41:1077-1083. [DOI: 10.1097/mao.0000000000002730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Plaza G, Navarro JJ, Alfaro J, Sandoval M, Marco J. Consensus on Treatment of Obstructive Eustachian Tube Dysfunction With Balloon Eustachian Tuboplasty. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.otoeng.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
8
|
Subjective and Objective Effectiveness of Eustachian Tube Balloon Dilatation for Patients With Eustachian Tube Dysfunction-Evaluation in a Pressure Chamber. Otol Neurotol 2020; 41:795-801. [PMID: 32282784 DOI: 10.1097/mao.0000000000002648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Eustachian tube plays a crucial role in pressure equalization between the middle ear and ambient pressure for fast and large pressure differences. In patients with chronic Eustachian tube dysfunction, Eustachian tube balloon dilatation is increasingly used as surgical therapy. Subjectively, many patients report an improvement of the symptoms postoperatively. Hence, there is a need to objectively measure this effect. METHODS The objectivity of Eustachian tube balloon dilatation was evaluated using a precise method of measuring Eustachian tube function. In a hypo/hyperbaric pressure chamber, 23 ears in 13 patients were exposed to a standardized profile of compression and decompression before Eustachian tube balloon dilatation and 4 weeks afterwards. Standardized parameters of Eustachian tube function were determined and statistically compared before and 4 weeks after intervention. In addition, an Eustachian Tube Dysfunction Questionnaire-7 (ETDQ7) questionnaire was completed beforehand and 4 weeks postoperatively to determine subjective surgical success. RESULTS The results from the ETDQ7 questionnaire showed a significant improvement in symptoms after Eustachian tube balloon dilatation (p = 0.0002). Objective measurements results showed a significant reduction of the Eustachian tube opening pressure during pressure decrease 4 weeks after intervention (p = 0.0012). CONCLUSION Eustachian tube balloon dilatation significantly reduced Eustachian tube opening pressure, in addition to subjective improvement of symptoms determined by ETDQ7.
Collapse
|
9
|
A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma. Curr Med Sci 2020; 40:9-17. [PMID: 32166660 DOI: 10.1007/s11596-020-2141-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/10/2019] [Indexed: 10/24/2022]
Abstract
This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear cholesteatoma. We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear cholesteatoma. Middle ear cholesteatoma surgeries were divided into four types and two special types as follows: type I, attic retraction pocket, which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction; type II, cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions, including type II a, requiring only use of a curette, and type II b, requiring use of an electric drill or chisel; type III, cholesteatoma not limited to the attic, in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions, requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and "Canal Wall Up" mastoidectomy; type IV, extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications, removal of which can only be performed under a microscope for "Canal Wall Down" mastoidectomy. In addition, there were two special types: "difficult external auditory canal" and congenital cholesteatoma in children. In our system, type I and type II middle ear cholesteatoma surgery was completely performed under an endoscope alone. However, estimating the extent of the lesions, determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear cholesteatoma. The classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.
Collapse
|
10
|
Li YQ, Chen YB, Yin GD, Zeng XL. Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media. Eur Arch Otorhinolaryngol 2019; 276:2715-2720. [PMID: 31197531 DOI: 10.1007/s00405-019-05512-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). MATERIALS AND METHODS A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24 months. The scores of eustachian tube (ET) function preoperation, 1 month, 6 months, 12 months, and 24 months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. RESULTS The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6 months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. CONCLUSION BET combined with TTI surgery is an effective therapy for patients with CRSOM.
Collapse
Affiliation(s)
- Yong-Qi Li
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Yu-Bin Chen
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Gen-di Yin
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiang-Li Zeng
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| |
Collapse
|
11
|
Plaza G, Navarro JJ, Alfaro J, Sandoval M, Marco J. Consensus on treatment of obstructive Eustachian tube dysfunction with balloon Eustachian tuboplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:181-189. [PMID: 31133274 DOI: 10.1016/j.otorri.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/28/2018] [Accepted: 01/28/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a great variability in diagnosis of obstructive Eustachian tube dysfunction and its treatment by balloon Eustachian tuboplasty (BET). The aim of this paper was to present a consensus on indications, contraindications, methodology, complications and results after BET. MATERIAL AND METHODS We obtained a consensus on BET, after a systematic review of the literature on BET from 1966 to November 2018, using MESH terms «Eustachian tube and (dilation or dysfunction)», including a total of 1.943 papers in Spanish, English, German and French. We selected 139 papers with a relevant abstract, including two international consensuses, seven systematic revisions, and two randomised control trials on BET. RESULTS The indications for BET are barotrauma, serous otitis media, adhesive otitis, atelectatic middle ear and failure after tympanoplasty, once obstructive Eustachian tube dysfunction is confirmed. BET is more effective in barotrauma and serous otitis media. There are high- evidence reports on BET showing good results that persist long-term, as compared to conservative medical treatment. CONCLUSIONS BET is a surgical, minimally invasive treatment that has shown its effectiveness and safety in obstructive Eustachian tube dysfunction in adults and children. It is most effective in barotrauma and serous otitis media.
Collapse
Affiliation(s)
- Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - Juan José Navarro
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, España
| | - Jorge Alfaro
- Servicio de Otorrinolaringología. Hospital Quirón Salud, Zaragoza, España
| | - Marta Sandoval
- Servicio de Otorrinolaringología, Hospital Sant Joan Despi-Moisés Broggi, Barcelona, España
| | - Jaime Marco
- Servicio de Otorrinolaringología, Hospital Clínico de Valencia, Universidad de Valencia, Valencia, España
| |
Collapse
|
12
|
Yin G, Tan J, Li P. Balloon dilation of Eustachian tube combined with tympanostomy tube insertion and middle ear pressure equalization therapy for recurrent secretory otitis media. J Otol 2019; 14:101-105. [PMID: 31467507 PMCID: PMC6712345 DOI: 10.1016/j.joto.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022] Open
Abstract
Objective to report outcomes of balloon dilation Eustachian tuboplasty combined with tympanostomy tube insertion and middle ear pressure equalization therapy in treatment of recurrent secretory otitis media. Methods Fifty one patients with recurrent secretory otitis media (62 ears) underwent balloon dilation of Eustachian tube and tympanic tube insertion under general anesthesia, followed by long term middle ear pressure equalization therapies. The Eustachian tube score (ETS) and Eustachian tube function questionnaire (ETDQ-7) were used for pre- and postoperative (up to 12 months) evaluation of Eustachian tube functions. Results The mean ETS score was 2.34 ± 0.97 preoperatively, and 6.17 ± 1.54, 7.23 ± 1.62, 8.24 ± 1.97, and 7.63 ± 1.86 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). The ETDQ-7 score was 4.82 ± 1.07 preoperatively, and 2.20 ± 0.54, 2.32 ± 0.68, 2.53 ± 0.79, and 2.67 ± 0.76 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). Conclusion Balloon dilation of Eustachian tube combined with tympanostomy and catheterization resulted in significant improvement of subjective symptoms and objective evaluation of Eustachian tube functions in most patients with recurrent secretory otitis media, as indicated by the ETS and ETDQ-7 scores, demonstrating high levels of efficacy and patient satisfaction.
Collapse
Affiliation(s)
- Gendi Yin
- Department of Otolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jingqian Tan
- Department of Otolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peng Li
- Department of Otolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
13
|
Giunta AA, Liberati L, Pellegrino C, Ricci G, Rizzo S. Eustachian tube balloon dilation in treatment of equalization problems of freediving spearfishermen. Diving Hyperb Med 2019; 49:9-15. [PMID: 30856662 DOI: 10.28920/dhm49.1.9-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Eustachian tube balloon dilation is a minimally invasive surgical procedure used to treat Eustachian tube dysfunction which is not responsive to conventional therapies. METHODS In this cohort intervention series we report the results of balloon dilation in treating refractory equalization problems in 20 freediving spearfishermen; in 19 cases the problem was unilateral and in one case bilateral. All the patients had already received medical and insufflation therapy and four patients had also had nasal surgery. None of these treatments or procedures had achieved improvement. We used a 20 mm x 3 mm disposable balloon catheter inserted through a 70-degree guide catheter and inflated up to 12 ATM three times at three different depths of insertion within the Eustachian tube. Every inflation lasted 120 seconds. RESULTS Fifteen out of 20 patients improved. Ten patients reported a complete resolution of equalization problems, five showed improvement with persistence of a slight equalization delay on the treated side. Five patients did not report any improvement. Two complications occurred: subcutaneous emphysema of the parotid region in one case; and a mild high frequency (4-8 KHz) sensorineural hearing loss in another patient. CONCLUSION Balloon dilation of the Eustachian tube is an effective therapy in the treatment of equalization problems with a good success rate.
Collapse
Affiliation(s)
- Antonio Am Giunta
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy.,Corresponding author: Antonio Alberto Maria Giunta, ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy,
| | - Luca Liberati
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| | - Cristina Pellegrino
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| | - Giampietro Ricci
- ENT Department of Santa Maria della Misericordia of Perugia, Piazza Menghini 1, Perugia, Italy
| | - Santino Rizzo
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| |
Collapse
|
14
|
Alper CM, Teixeira MS, Richert BC, Douglas Swarts J. Presentation and eustachian tube function test results in children evaluated at a specialty clinic. Laryngoscope 2018; 129:1218-1228. [PMID: 30474114 DOI: 10.1002/lary.27545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET-specific or sinus balloons around the world and off-label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children. STUDY DESIGN Retrospective cross-sectional study. METHODS This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable. RESULTS Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%). CONCLUSIONS ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1218-1228, 2019.
Collapse
Affiliation(s)
- Cuneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Beverly C Richert
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
15
|
Tisch M, Maier H, Sudhoff H. Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:509-512. [PMID: 29327736 PMCID: PMC5782429 DOI: 10.14639/0392-100x-1690] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022]
Abstract
Balloon dilation of the Eustachian tube has been recently introduced as a novel and minimally invasive method for treating chronic obstructive Eustachian tube dysfunction. For the first time worldwide, we assessed the role of this technique in the treatment of children with Eustachian tube dysfunction who did not respond to other treatments. We retrospectively analysed the medical records of 60 children (mean age: 6.3 years, range: 28 months to 12 years) who underwent balloon dilation of the Eustachian tube using the Bielefeld balloon catheter. In addition, the parents of a further 66 children who underwent balloon dilation (mean age: 8 years, range: 4 to 13 years) were asked to complete a standardised written questionnaire and were interviewed by telephone about the postoperative course of their children. There were no complications during surgery. Clinical symptoms improved in more than 80% of patients. No patient reported a deterioration of symptoms. Of the participating parents, 81.3% were very satisfied or satisfied with the outcome of treatment. Balloon dilation is a rapid, simple and safe method for the treatment of both adults and children with Eustachian tube dysfunction that does not respond to other treatments. Further studies, ideally multicentre studies, are required in order to optimise the definition of existing and potential new indications for this treatment approach and to establish this treatment in the management of children with refractory chronic Eustachian tube dysfunction.
Collapse
Affiliation(s)
- M Tisch
- Department of Otolaryngology, Head and Neck Surgery, German Armed Forces Hospital of Ulm, Germany; Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - H Maier
- Department of Otolaryngology, Head and Neck Surgery, German Armed Forces Hospital of Ulm, Germany; Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - H Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, German Armed Forces Hospital of Ulm, Germany; Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| |
Collapse
|
16
|
Micucci S, Keschner DB, Liang J. Eustachian Tube Balloon Dilation: Emerging Practice Patterns for a Novel Procedure. Ann Otol Rhinol Laryngol 2018; 127:848-855. [PMID: 30227726 DOI: 10.1177/0003489418798858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review the role of eustachian tube balloon dilation (ETBD) in the setting of chronic Eustachian tube dysfunction (ETD) and ascertain how ETBD is currently being used in practice today. METHODS An online survey included 20 questions designed by 3 investigators to examine how otolaryngologists utilize ETBD in the management of ETD. The survey was distributed to the members of the American Rhinologic Society (ARS), American Otological Society (AOS), and American Neurotology Society (ANS) in their respective annual electronic mailings in April and May of 2017. RESULTS A total of 1105 and 633 surveys were sent to ARS and AOS/ANS members, respectively. Of those, 157 surveys were returned (126 from ARS and 31 from AOS/ANS). Of those returning the survey, 72 (50%) had not performed ETBD and were excluded from subsequent analysis. Forty-four (66%) respondents consider ETBD after failure of medical management; conversely, 18 (27%) and 26 (39%) consider ETBD after failure of 1 or more trial of myringotomy tube placement. Routine testing for ETBD includes audiogram with tympanometry 64 (96%) and preoperative computer tomography (CT) 38 (57%). Fifty-three (80%) practitioners only perform ETBD in adults 18 years and older. Thirty-four (53%) respondents describe ETBD as "great" or "good," while 27 (42%) were unsure, and only 3 (5%) did not like ETBD. CONCLUSIONS Eustachian tube balloon dilation is a novel technique for the treatment of chronic ETD, and its role continues to evolve and develop. Current practice patterns demonstrate wide variability in the assessment of ETD, heterogeneity in the timing of ETBD, and controversy in preoperative CT screening.
Collapse
Affiliation(s)
- Steven Micucci
- 1 Kaiser Permanente Oakland Medical Center, Oakland, Caliornia, USA
| | | | - Jonathan Liang
- 1 Kaiser Permanente Oakland Medical Center, Oakland, Caliornia, USA
| |
Collapse
|
17
|
Abstract
The Eustachian tube protects against secretion, germs and sound pressure from the nasopharynx, it acts as a drain, and serves pressure equalization in both directions so that the ear drum and sound-conducting apparatus can vibrate optimally. The incidence of Eustachian tube dysfunction in adults is about 1%, in children almost 40%. Symptoms are often unspecific. For diagnosis, the Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum. Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children. Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter. The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated.
Collapse
Affiliation(s)
- S Schröder
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - J Ebmeyer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
| |
Collapse
|
18
|
Alper CM, Luntz M, Takahashi H, Ghadiali SN, Swarts JD, Teixeira MS, Csákányi Z, Yehudai N, Kania R, Poe DS. Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis). Otolaryngol Head Neck Surg 2017; 156:S22-S40. [PMID: 28372527 DOI: 10.1177/0194599816647959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
Collapse
Affiliation(s)
- Cuneyt M Alper
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,3 Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michal Luntz
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Haruo Takahashi
- 5 Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Samir N Ghadiali
- 6 Department of Biomedical Engineering, Ohio University, Columbus, Ohio, USA.,7 Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio University, Columbus, Ohio, USA
| | - J Douglas Swarts
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Miriam S Teixeira
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zsuzsanna Csákányi
- 8 Department of Pediatric Otorhinolaryngology, Heim Pal Children's Hospital, Budapest, Hungary
| | - Noam Yehudai
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Romain Kania
- 9 Department of Otorhinolaryngology-Head and Neck Surgery, Lariboisière Hospital, Diderot University, University Paris Sorbonne, Paris, France
| | - Dennis S Poe
- 10 Department of Otology and Laryngology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,11 Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
19
|
Leichtle A, Hollfelder D, Wollenberg B, Bruchhage KL. Balloon Eustachian Tuboplasty in children. Eur Arch Otorhinolaryngol 2017; 274:2411-2419. [PMID: 28283791 DOI: 10.1007/s00405-017-4517-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
Endonasal ballon dilatation of the Eustachian tube (BET) is a promising treatment for Eustachian tube dysfunction with encouraging results over the last years in adults. In addition, in children, single studies demonstrated promising results, but revealed the necessity for broader and additional studies. Our retrospective analysis presents outcomes with BET in children with chronic obstructive dysfunction of the Eustachian tube, showing resistance to the conventional therapy after adenotomy with paracentesis or grommets (ventilation tubes). The data of 52 children, having undergone BET from April 2011 to April 2016, were retrospectively evaluated. Most children in our study presented middle ear effusion (47%), adhesive (21%), chronic otitis media (13%), or recurrent acute otitis media (11%). In 24 (37%) children, we combined BET with a paracentesis, in 5 (8%) patients with a tympanoplasty type I and in 3 (5%) patients with a type III. All children were assessed using an audiogram, tympanometry, and tubomanometry (50 mbar) before and after BET. In addition, we evaluated the results of the Lübecker questionnaire, which we performed before and after BET. The childrens' ear-related and quality of life-related symptoms, such as pressure equalization, ear pressure, hearing loss, pain and limitation in daily life, and satisfaction pre- and postoperatively, were analyzed. In the majority of patients, we could see an improvement in the ear pressure, hearing loss, limitation in daily life, and satisfaction with recurrent inflammations, underlined by better outcomes in the tubomanometry and the tympanogram. BET in children is a safe, efficient, and promising method to treat chronic tube dysfunction, especially as a second line treatment, when adenotomy, paracentesis, or grommets failed before.
Collapse
Affiliation(s)
- A Leichtle
- Department of Otolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - D Hollfelder
- Department of Otolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - B Wollenberg
- Department of Otolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - K-L Bruchhage
- Department of Otolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| |
Collapse
|
20
|
Van Roeyen S, Van de Heyning P, Van Rompaey V. Delayed-Start Study Design for Balloon Dilation of the Eustachian Tube: Alternative for a Randomized Controlled Trial. Front Surg 2017; 4:10. [PMID: 28265561 PMCID: PMC5316550 DOI: 10.3389/fsurg.2017.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shari Van Roeyen
- Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| |
Collapse
|
21
|
Luukkainen V, Kivekäs I, Hammarén-Malmi S, Rautiainen M, Pöyhönen L, Aarnisalo AA, Jero J, Sinkkonen ST. Balloon Eustachian tuboplasty under local anesthesia: Is it feasible? Laryngoscope 2017; 127:1021-1025. [PMID: 28409844 DOI: 10.1002/lary.26488] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study whether balloon Eustachian tuboplasty (BET) is a feasible and safe procedure under local anesthesia. STUDY DESIGN Prospective multicenter case-control study. METHODS Patients undergoing either BET (n = 13) or endoscopic sinus surgery (ESS) (n = 12) under local anesthesia, with the possibility of sedation and analgesia, were monitored during the procedure and recovery period for possible adverse effects. After the procedure, the patients responded to a questionnaire assessing their experience. RESULTS No adverse effects were detected in the BET group. Patients in the BET group reported similar Visual Analog Scale scores for pain during the operation as the ESS group (5.0 ± 0.7 vs. 3.2 ± 0.7, mean ± standard error of the mean). However, patients in the BET group experienced more discomfort (4.2 ± 0.6 vs. 2.5 ± 0.3, respectively, P = 0.049). Seventy-seven and 92% of the patients in the BET and ESS groups, respectively, considered the anesthesia and pain relief to be sufficient. Patients from both the BET and ESS groups were almost devoid of pain 1 to 2 hours postoperatively (0.8 ± 0.2 and 1.4 ± 0.3, respectively). In total, 12 of 13 patients in the BET group, and all 12 patients in the ESS group, would choose local anesthesia with sedation and analgesia if they needed to undergo the same procedure again. CONCLUSION BET is a safe and feasible procedure under monitored anesthesia care, including local anesthesia along with sedation and analgesia. There is need for further methodological improvement to reduce pain and discomfort during the operation. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1021-1025, 2017.
Collapse
Affiliation(s)
- Veera Luukkainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Sari Hammarén-Malmi
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Leena Pöyhönen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Antti A Aarnisalo
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
22
|
COMPARATIVE CLINICAL AND AUDIOLOGICAL CHARACTERISTICS OF THE AUDITORY ANALYZER CONDITION IN PATIENTS WITH CHRONIC TUBOTYMPANIC OTITIS MEDIA. WORLD OF MEDICINE AND BIOLOGY 2017. [DOI: 10.26724/2079-8334-2017-4-62-17-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
23
|
Teschner M. Evidence and evidence gaps in the treatment of Eustachian tube dysfunction and otitis media. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc05. [PMID: 28025605 PMCID: PMC5169078 DOI: 10.3205/cto000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Evidence-based medicine is an approach to medical treatment intended to optimize patient-oriented decision-making on the basis of empirically proven effectiveness. For this purpose, a classification system has been established to categorize studies - and hence therapy options - in respect of associated evidence according to defined criteria. The Eustachian tube connects the nasopharynx with the middle ear cavity. Its key function is to ensure middle ear ventilation. Compromised ventilation results in inflammatory middle ear disorders. Numerous evidence-based therapy options are available for the treatment of impaired middle ear ventilation and otitis media, the main therapeutic approach being antibiotic treatment. More recent procedures such as balloon dilation of the Eustachian tube have also shown initial success but must undergo further evaluation with regard to evidence. There is, as yet, no evidence for some of the other long-established procedures. Owing to the multitude of variables, the classification of evidence levels for various treatment approaches calls for highly diversified assessment. Numerous evidence-based studies are therefore necessary in order to evaluate the evidence pertaining to existing and future therapy solutions for impaired middle ear ventilation and otitis media. If this need is addressed, a wealth of implications can be expected for therapeutic approaches in the years to come.
Collapse
Affiliation(s)
- Magnus Teschner
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
24
|
[Does balloon dilatation represent a breakthrough for Eustachian tube disorders – even in children?]. HNO 2016; 63:681-2, 684-5. [PMID: 26385899 DOI: 10.1007/s00106-015-0047-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Balloon dilatation is a promising new treatment for Eustachian tube dysfunction which is becoming more and more popular in Germany. There are a number of single publications and even meta-analyses on this topic, which demonstrate good results but also reveal the need for better studies. Initially tube dilatation was applied only in adults with tube dysfunctions but recently some centers even recommend it for children with long-lasting or frequently recurring middle ear effusion, which is resistant to conventional therapy. This article provides a critical appraisal based on the current literature and emphasizes the need for controlled studies. Due to the poor definition of tube dysfunctions it may be difficult to establish informative studies but in terms of evidence-based medicine there is need for a precise definition of indications and inclusion criteria. Most important is that such studies must include control groups, which has so far not been the case. Moreover, there should be a consensus about the criteria for defining success. Although all publications claim that balloon tuboplasty is a safe method, the question whether or not preoperative computed tomography (CT) scans are needed should be considered in each individual case. Nevertheless, balloon dilatation is a very promising method offering a new approach to the problem of Eustachian tube dysfunction.
Collapse
|
25
|
Schröder S, Abdel-Aziz T, Lehmann M, Ebmeyer J, Sudhoff H. [Bacteriologic investigation of the Eustachian tube and the implications of perioperative antibiotics before balloon dilation]. HNO 2016; 63:629-33. [PMID: 26303520 DOI: 10.1007/s00106-015-0048-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Balloon Eustachian Tuboplasty (BET) is a new minimally invasive treatment for chronic Eustachian tube dysfunction (ETD). Initially, perioperative prophylactic antibiotic therapy with ciprofloxacin 2 × 500 mg p.o. for 5 days was administered. This study aimed to characterize the bacterial flora in the ET, nose, and pharynx in patients with chronic obstructive ETD. Additionally, we investigated the necessity of perioperative antibiotic prophylaxis in BET patients. PATIENTS AND METHODS We examined 40 patients undergoing BET: 20 patients with and 20 patients without perioperative antibiotic prophylaxis. All patients were followed-up for clinical signs and symptoms of local infection for at least 2 weeks after surgery. Following BET, the tips of 35 balloon catheters, as well as swabs from the nose and pharynx were sent for microbiologic analysis. RESULTS None of these 40 patients had postoperative signs of infection. Of the swabs of the balloon catheters, 46% were sterile and 23% showed standard flora. The remaining 31% of swaps revealed specific bacteria. However, none of the nasal or nasopharyngeal swaps were sterile. CONCLUSION Due to the lack of signs of postoperative infection in either investigated group, the authors no longer favor use of perioperative antibiotic prophylaxis in patients undergoing BET. The relevance of biofilms and pathogen colonization to ET function has recently been intensively discussed, and should be further investigated in future studies.
Collapse
Affiliation(s)
- S Schröder
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Klinikum Bielefeld, Akademisches Lehrkrankenhaus der Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland,
| | | | | | | | | |
Collapse
|
26
|
Schröder S, Lehmann M, Ebmeyer J, Upile T, Sudhoff H. Balloon Eustachian tuboplasty: a retrospective cohort study. Clin Otolaryngol 2015; 40:629-38. [DOI: 10.1111/coa.12429] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Schröder
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - M. Lehmann
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - J. Ebmeyer
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - T. Upile
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| | - H. Sudhoff
- Department of Otolaryngology, Head and Neck Surgery; Bielefeld Academic Teaching Hospital; Münster University; Bielefeld Germany
| |
Collapse
|
27
|
Maier S, Tisch M, Maier H. Einsatz der Ballondilatation der Eustachischen Röhre bei chronisch obstruktiven Tubenventilationsstörungen im Kindesalter. HNO 2015; 63:686-8, 690-4, 696-7. [DOI: 10.1007/s00106-015-0050-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
First results of Endonasal dilatation of the Eustachian tube (EET) in patients with chronic obstructive tube dysfunction. Eur Arch Otorhinolaryngol 2015; 273:607-13. [DOI: 10.1007/s00405-015-3602-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
|
29
|
Abstract
Objective A systematic review and meta-analysis of the evidence on balloon Eustachian tuboplasty (BET) as a treatment modality for Eustachian tube dysfunction (ETD). We followed the PRISMA guideline and registered with PROSPERO No. CRD42014009461. Data Sources We searched 12 databases including PubMed and Embase from January 1, 2010, to April 7, 2014, for studies of BET. Endpoints: change in symptoms, middle ear pathology, eardrum status, Eustachian tube function tests, hearing, adverse events, complications, and health-related quality of life. Review Methods Study quality was assessed using the modified Delphi technique quality appraisal tool for case series studies. Risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Results Nine case series studies with 443 patients (642 tubes) were included. Population size n = 4 (7 tubes) to n = 210 (320 tubes). All studies were of poor quality and featured a high risk of bias. We found reduction of patient symptoms in ETD questionnaire ( P < .001), postoperative normalization of the tympanic membrane, conversion of type B or type C into type A tympanograms, reduced mucosal inflammation, increased number of positive Valsalva test and Swallowing tests, improvement in Eustachian tube score, reduction in Sino-Nasal Outcome Test (SNOT)-22 score ( P = .001), and increased quality of life ( P = .001). No serious adverse events were found. Conclusion The evidence of BET is poor and biased. No firm conclusions can be made to identify patients who will benefit from the procedure or to accurately predict surgical results. Randomized controlled trials or case-control trials are needed.
Collapse
Affiliation(s)
- Thomas Skov Randrup
- Department of ENT, Head and Neck Surgery, Aarhus University Hospital, Århus C, Denmark
| | - Therese Ovesen
- Department of ENT, Head and Neck Surgery, Aarhus University Hospital, Århus C, Denmark
| |
Collapse
|
30
|
Jenckel F, Kappo N, Gliese A, Loewenthal M, Lörincz BB, Knecht R, Dalchow CV. Endonasal dilatation of the Eustachian tube (EET) in children: feasibility and the role of tubomanometry (Estève) in outcomes measurement. Eur Arch Otorhinolaryngol 2014; 272:3677-83. [DOI: 10.1007/s00405-014-3443-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/10/2014] [Indexed: 11/28/2022]
|
31
|
Miller F, Burghard A, Salcher R, Scheper V, Leibold W, Lenarz T, Paasche G. Treatment of middle ear ventilation disorders: sheep as animal model for stenting the human Eustachian tube--a cadaver study. PLoS One 2014; 9:e113906. [PMID: 25419714 PMCID: PMC4242708 DOI: 10.1371/journal.pone.0113906] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/02/2014] [Indexed: 11/18/2022] Open
Abstract
Eustachian tube disorders can lead to chronic otitis media with consecutive conductive hearing loss. To improve treatment and to develop new types of implants such as stents, an adequate experimental animal model is required. As the middle ear of sheep is known to be comparable to the human middle ear, the dimensions of the Eustachian tube in two strains of sheep were investigated. The Eustachian tube and middle ear of half heads of heathland and blackface sheep were filled with silicone rubber, blended with barium sulfate to induce X-ray visibility. Images were taken by digital volume tomography. The tubes were segmented, and a three-dimensional model of every Eustachian tube was generated. The lengths, diameters and shapes were determined. Additionally, the feasibility of endoscopic stent implantation and fixation was tested in cadaver experiments. The length of the tube between ostium pharyngeum and the isthmus and the diameters were comparable to published values for the human tube. The tube was easily accessible through the nose, and then stents could be implanted and fixed at the isthmus. The sheep appears to be a promising model for testing new stent treatments for middle ear ventilation disorders.
Collapse
Affiliation(s)
- Felicitas Miller
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Alice Burghard
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Rolf Salcher
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Verena Scheper
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - Wolfgang Leibold
- Department of Immunology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - Gerrit Paasche
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany
- * E-mail:
| |
Collapse
|
32
|
Schröder S, Lehmann M, Sauzet O, Ebmeyer J, Sudhoff H. A novel diagnostic tool for chronic obstructive eustachian tube Dysfunction-The eustachian tube score. Laryngoscope 2014; 125:703-8. [DOI: 10.1002/lary.24922] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/26/2014] [Accepted: 08/18/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Stefanie Schröder
- Department of Otorhinolaryngology-Head and Neck Surgery; Bielefeld Clinical Center, Academic Teaching Hospital, University of Münster; Bielefeld
| | - Martin Lehmann
- Department of Otorhinolaryngology-Head and Neck Surgery; Bielefeld Clinical Center, Academic Teaching Hospital, University of Münster; Bielefeld
| | - Odile Sauzet
- Department of Epidemiology and International Public Health; Faculty of Health Sciences; Bielefeld University; Bielefeld Germany
| | - Jörg Ebmeyer
- Department of Otorhinolaryngology-Head and Neck Surgery; Bielefeld Clinical Center, Academic Teaching Hospital, University of Münster; Bielefeld
| | - Holger Sudhoff
- Department of Otorhinolaryngology-Head and Neck Surgery; Bielefeld Clinical Center, Academic Teaching Hospital, University of Münster; Bielefeld
| |
Collapse
|
33
|
Silvola J, Kivekäs I, Poe DS. Balloon Dilation of the Cartilaginous Portion of the Eustachian Tube. Otolaryngol Head Neck Surg 2014; 151:125-30. [DOI: 10.1177/0194599814529538] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
Abstract
Objective Studies of balloon Eustachian tuboplasty (BET) have shown encouraging results in small series with short follow-ups. Our pilot study suggested that patients with protracted otitis media with effusion (OME) or atelectasis of the tympanic membrane (TM) could benefit from BET. Study Design A prospective study where subjects act as their own controls. Patients from the pilot study and additional cases were enrolled in this cohort with long-term follow-up. Setting Regional Academic Center. Subjects and Methods Out of 80 patients who underwent BET, 41 consecutive Eustachian tube (ET) operations were included. Subjects’ inclusion criteria were OME and/or TM atelectasis, type B or C tympanograms, and inability to inflate their middle ears by Valsalva maneuver. All patients had longstanding ET dysfunction relieved only by repeated tympanostomies. Outcomes included ability to perform a Valsalva maneuver, audiometry, tympanometry, videoendoscopy of the ET with mucosal inflammation rating scores, and otomicroscopy. Results All cases were dilated successfully, without significant complications. Mean follow-up was 2.5 years (range, 1.5-4.2 years). Eighty percent (33/41) could do a Valsalva maneuver postoperatively; none of these ears required new tympanostomy tubes and subjective symptoms were relieved. Tympanometry results showed overall improvement. Nine patients had persistent perforations and 3 declined removal of the tube. Subjective symptoms were not relieved for 10% (4/41). Conclusion The results show that BET can effectively improve ET function in ears with OME or atelectasis. The procedure is well tolerated and without significant complications. The follow-up continues and we are investigating possible reasons for failures.
Collapse
Affiliation(s)
- Juha Silvola
- Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland
- Department of Otolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ilkka Kivekäs
- Department of Otolaryngology and Communication Enhancement Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Otorhinolaryngology, Tampere University Hospital and the University of Tampere, Tampere, Finland
| | - Dennis S. Poe
- Department of Otolaryngology and Communication Enhancement Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
34
|
Miller BJ, Elhassan HA. Balloon dilatation of the Eustachian tube: an evidence-based review of case series for those considering its use. Clin Otolaryngol 2013; 38:525-32. [DOI: 10.1111/coa.12195] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2013] [Indexed: 01/07/2023]
Affiliation(s)
- B. J. Miller
- College of Medicine; Swansea University; Swansea UK
| | - H. A. Elhassan
- Department of Otolaryngology; Singleton Hospital; Swansea UK
| |
Collapse
|
35
|
Schröder S, Lehmann M, Sudhoff H, Ebmeyer J. Beurteilung der chronisch-obstruktiven Tubenfunktionsstörung. HNO 2013; 62:160, 162-4. [DOI: 10.1007/s00106-013-2764-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
36
|
|
37
|
Euteneuer S. [Chronic dysfunction of the eustachian tube: diagnosis and results of balloon dilatation of the eustachian tube]. HNO 2013; 61:460-1. [PMID: 23670680 DOI: 10.1007/s00106-013-2714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Bast F, Frank A, Schrom T. Balloon Dilatation of the Eustachian Tube: Postoperative Validation of Patient Satisfaction. ACTA ACUST UNITED AC 2013; 75:361-5. [DOI: 10.1159/000358254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022]
|