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Møller MN, Berthelsen D, Svahn M. In-office Eustachian Tube Dilation Reduces Symptoms Among Patients With Barometric Challenges. Laryngoscope 2024. [PMID: 39215746 DOI: 10.1002/lary.31726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Balloon dilation of the eustachian tube has gained ground in the treatment of chronic dysfunction. A new indication for a larger group of patients has emerged, which is characterized by barochallenge only, which affects even more patients. Given the recent validation of the balloon dilation, we set out to explore if this procedure could be useful in treating this specific sub-group of patients in an in-office setting. METHODS Balloon dilation was performed using inly nasal cottonoids soaked in 2% tretracainephenylephrine combined with xylocaine nasal spray and lidocaine/prilocaine gel and a mild oral sedative. The effect of eustachian tube balloon dilation on the function of the eustachian tube was evaluated by using the eustachian tube dysfunction questionnaire-7 (ETDQ-7) and a VAS score. The questionnaires were completed beforehand and 3 months and 12 months postoperatively to determine subjective surgical success. RESULTS Two hundred and forty-six balloon dilation were performed in 132 participants. The results from the ETDQ-7 questionnaire and VAS scores showed a significant improvement in symptoms during pressurization after eustachian tube balloon dilation (p = 0.0001). A mean pain score during procedure in local anesthesia was 3.4 on a scale from 1 to 10. CONCLUSION Eustachian tube balloon dilation significantly reduced symptoms of eustachian tube dysfunction during non-physiological pressure, which was determined by ETDQ-7 and Vas scores. Additionally, we found that the procedure is well suited for private practice or the outpatient clinic, using local anesthetics and a mild sedative. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Martin Nue Møller
- Dept. of Oto-rhino-laryngology, Head and Neck Surgery & Audiology, Søernes Privathospital, Copenhagen, Denmark
| | - Debbie Berthelsen
- Dept. of Oto-rhino-laryngology, Head and Neck Surgery & Audiology, Søernes Privathospital, Copenhagen, Denmark
| | - Malene Svahn
- Dept. of Oto-rhino-laryngology, Head and Neck Surgery & Audiology, Søernes Privathospital, Copenhagen, Denmark
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Hsieh CY, Lin WC, Lin CC, Chou YF. Combined balloon Eustachian tuboplasty/endoscopic sinus surgery for patients with chronic rhinosinusitis and Eustachian tube dysfunction. Int Forum Allergy Rhinol 2024; 14:1327-1336. [PMID: 38465787 DOI: 10.1002/alr.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD. METHODS This randomized controlled trial conducted in a single-institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty-five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22, modified Lund-Kennedy score, Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and serial Eustachian tube function test results were analyzed 3 months postoperatively. RESULTS The improvement (12.60 ± 6.50) in the ETDQ-7 score in the BET group was significantly higher than that in the control group (6.60 ± 5.58). The ratio of improvement in the ETDQ-7 score was also significantly higher in the BET than in the control group (92% vs. 68%, p = 0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02-28.79, p = 0.048) and a low post-modified Lund-Kennedy score (OR: 0.15, 95% CI: 0.04-0.54, p = 0.004) were significantly associated with ETDQ-7 score improvement. CONCLUSION Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD.
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Affiliation(s)
- Cheng-Yu Hsieh
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Chieh Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chung-Ching Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Fan Chou
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Alghamdi AS, Aloufi BA, Almalki SM, Bosaeed KM. Effect of balloon dilatation among adult population with eustachian tube dysfunction: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08788-6. [PMID: 38977475 DOI: 10.1007/s00405-024-08788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This study aimed to assess the efficacy and safety of ballon dilation of the eustachian tube (BDET) in adult population suffering from Eustachian tube dysfunction (ETD). METHODS Following PRISMA criteria, a systematic review was conducted by searching PubMed, Cochrane, and Embase databases from January 2015 to March 2024. The primary outcomes included Eustachian Tube Score (ETS), tympanometry, and Valsalva maneuver. The quality of studies was assessed using the Quality in Prognostic Studies (QUIPS) instrument. RESULTS Overall, 11 studies were incorporated into the systematic review: two RCTs, three prospective investigations, and six retrospective studies. The balloon dilation in all investigations was performed using either Spiggle & Theis or Acclarent catheters for balloon dilation. There was heterogeneity across studies examining the effect of BDET on persistent ETD in terms of patient selection, period of follow-up, administration of conservative or surgical therapies, and use of assessment methods. Overall, the treatment yielded alleviation of symptoms, which either exhibited stability over time or demonstrated further improvement after an average duration of follow-up. Moreover, the incidence of complications was categorized as low and resolving spontaneously. The majority of the studies exhibited a high risk of bias related to confounding variables, and consequently, the overall risk of bias across most studies was considered high. CONCLUSION The findings suggest BDET holds promise for ETD treatment, reducing symptom severity with minimal complications. Nonetheless, there is a need for improved studies that adhere to established indications, methodologies, and outcomes to establish a more robust body of evidence.
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Affiliation(s)
- Abdullah S Alghamdi
- Department of Otorhinolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia.
| | - Bodoor A Aloufi
- Department of Otorhinolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Sultan M Almalki
- Department of Otorhinolaryngology, Head and Neck Surgery, Taif University, Taif, Saudi Arabia
| | - Khlood M Bosaeed
- Department of Otorhinolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
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Kang JM, Kim SH, Ryu DS, Park Y, Won DS, Kim JW, Park JK, Park HJ, Park JH. Sirolimus-coated Eustachian tube balloon dilatation for treating Eustachian tube dysfunction in a rat model. Sci Rep 2024; 14:8784. [PMID: 38627500 PMCID: PMC11021459 DOI: 10.1038/s41598-024-58869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
Eustachian tube balloon dilatation (ETBD) has shown promising results in the treatment of ET dysfunction (ETD); however, recurrent symptoms after ETBD frequently occur in patients with refractory ETD. The excessive pressure of balloon catheter during ETBD may induce the tissue hyperplasia and fibrotic changes around the injured mucosa. Sirolimus (SRL), an antiproliferative agent, inhibits tissue proliferation. An SRL-coated balloon catheter was fabricated using an ultrasonic spray coating technique with a coating solution composed of SRL, purified shellac, and vitamin E. This study aimed to investigate effectiveness of ETBD with a SRL-coated balloon catheter to prevent tissue proliferation in the rat ET after ETBD. In 21 Sprague-Dawley rats, the left ET was randomly divided into the control (drug-free ETBD; n = 9) and the SRL (n = 9) groups. All rats were sacrificed for histological examination immediately after and at 1 and 4 weeks after ETBD. Three rats were used to represent the normal ET. The SRL-coated ETBD significantly suppressed tissue proliferation caused by mechanical injuries compared with the control group. ETBD with SRL-coated balloon catheter was effective and safe to maintain ET luminal patency without tissue proliferation at the site of mechanical injuries for 4 weeks in a rat ET model.
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Affiliation(s)
- Jeon Min Kang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Song Hee Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Dae Sung Ryu
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yubeen Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Dong-Sung Won
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Ji Won Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jun-Kyu Park
- Department of Research and Development, JLinker Inc., 43-22, Nanosandan 5-Ro, Nam-Myeon, Jangseong, 57248, Republic of Korea.
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Borshchenko M, Eremeeva K, Svistushkin V. CT and MRI in the Preoperative Planning of Balloon Dilation of the Eustachian Tube: Literature Review. Indian J Radiol Imaging 2023; 33:489-495. [PMID: 37811176 PMCID: PMC10556335 DOI: 10.1055/s-0043-1769503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Balloon dilatation of the Eustachian tube (BET) is a surgical treatment method for Eustachian tube dysfunction (ETD), which relieves the symptoms in the majority of cases. However, there are potential intraoperative risks associated with BET; the decision-making process with regard to indications for BET is not standardized up to date. The objective of this study was to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the preoperative planning of BET. The literature review is based on a database search performed in August 2022. BET is classified into transtympanic and nasopharyngeal. CT of the temporal bone provides good visualization of the site of obstruction, which allows to choose the adequate approach. Transtympanic approach is associated with risks of internal carotid artery damage due to possible carotid canal anomalies. This risk can be prevented with preoperative CT scan of the temporal bone. In case of nasopharyngeal BET, there is no sufficient data considering risks of possible artery damage, although CT can provide accurate measurements of ET. MRI is useful for differential diagnosis of conditions imitating ETD, such as endolymphatic hydrops and nasopharyngeal carcinoma. Thus, it is feasible to perform CT and MRI before BET to personalize the management of ETD patients.
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Affiliation(s)
- Maria Borshchenko
- Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - Kseniya Eremeeva
- Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - Valery Svistushkin
- Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
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Kaderbay A, Karkas A, Schmitt D, Mura T, Lavieille JP, Venail F. Balloon dilation for persistent unilateral chronic obstructive Eustachian tube dysfunction is effective: a prospective multicentre study. Eur Arch Otorhinolaryngol 2023; 280:1101-1109. [PMID: 35932313 DOI: 10.1007/s00405-022-07578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Balloon dilatation of the Eustachian tube (BDET) is an option for treating chronic obstructive Eustachian tube dysfunction (COETD). In this prospective multicentric study, the main objective was to evaluate the results of BDET in unilateral COETD refractory to medical treatment. METHODS Adults with unilateral COETD whose Eustachian Tube Score (ETS) was less than 5 despite medical pressure therapy were included. The primary endpoint was the change in ETS measured at 2, 6, and 12 months after BDET. Secondary objectives were the evolution of clinical symptoms assessed by the Eustachian Tube Questionnaire (ETDQ-7), audiometry, tympanometry, and otoscopy changes after BDET. RESULTS Twenty-eight patients were included between May 2014 and December 2017 and were treated with BDET without adverse effects in three different referral centers. Population's median age was 52 (Q25; Q75: 24, 82) years. The median follow-up time was 381 (Q25; Q75: 364; 418) days. The median ETS was 2 (Q25; Q75: 1; 4) before BDET. There was a significant improvement in ETS at 2 and 6 months and 1 year after BDET (score at 1 year: 6 (Q25; Q75: 2; 8) (p < 0.0001)). There was a significant, sustained improvement in the ETDQ-7 with a score of 4.21 (Q25; Q75-3.50; 4.79) before BDET and 3.43 (Q25; Q75-2.43; 4.14) (p = 0.0012) at 1 year. There was a suggestive improvement in tympanometry results at 1 year (p = 0.025). CONCLUSION BDET provides an improvement in symptoms and objective measures assessed at 1 year in patients with COETD who have failed medical treatment. TRIAL REGISTRATION NCT02123277 (April 25, 2014).
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Affiliation(s)
- Akil Kaderbay
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - Alexandre Karkas
- Oto-Rhino-Laryngology, Head and Neck Surgery Department, Saint-Etienne University, Hôpital Nord, Saint Etienne, France
| | - David Schmitt
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Thibault Mura
- Medical Information Department, Montpellier University, CHU La Colombière, Montpellier, France
| | - Jean Pierre Lavieille
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Frédéric Venail
- Oto-Rhino-Laryngology-Head and Neck Surgery Department, Montpellier University, CHU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France.,Neurosciences Institute of Montpellier, INSERM U1298 and Montpellier University, Montpellier, France
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Bal R, Deshmukh P. Management of Eustachian Tube Dysfunction: A Review. Cureus 2022; 14:e31432. [DOI: 10.7759/cureus.31432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022] Open
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Goulioumis AK, Gkorpa M, Athanasopoulos M, Athanasopoulos I, Gyftopoulos K. The Eustachian Tube Dysfunction in Children: Anatomical Considerations and Current Trends in Invasive Therapeutic Approaches. Cureus 2022; 14:e27193. [PMID: 36039214 PMCID: PMC9395912 DOI: 10.7759/cureus.27193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/15/2022] Open
Abstract
The eustachian tube (ET) has a crucial role in the physiology of the middle ear. Thus, any condition that renders the tube dysfunctional is directly implicated with middle ear pathophysiology, like in the case of acute otitis media and otitis media with effusion. Children are more vulnerable to pathologies of the middle ear, primarily due to the immature development of their eustachian tubes. Otitis media with effusion, apart from being a burden for hearing, with direct consequences for speech development, may also be implicated in cholesteatoma formation. Medical therapy is not practically effective for the treatment of effusion. Moreover, the established surgical approaches, like grommets and adenoidectomy, deal only indirectly with the problem since they are not addressing the dysfunctional ET itself. An emerging interventional approach that intends to restore the function of the tube is the transnasal balloon dilation of the cartilaginous part of the ET. Growing international experience indicates that this promising technique is safe and effective. In the current review, we aim to provide background information on the anatomy, physiology, and pathophysiology of the ET and to present the progress of the balloon dilation technique with emphasis on pediatric patients.
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Patulous eustachian tube after balloon eustachian tuboplasty in a post-radiation patient. Am J Otolaryngol 2022; 43:103524. [PMID: 35672189 DOI: 10.1016/j.amjoto.2022.103524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Balloon eustachian tuboplasty (BET) is a minimally invasive surgical treatment that is effective and safe for obstructive eustachian tube dysfunction. However, BET complications include excessive widening of the eustachian tube, causing a patulous eustachian tube (PET). Herein, we report a case of PET following BET in a patient who underwent radiation therapy and reviewed the literature on considerations for reducing complications after BET. CASE PRESENTATION A 63-year-old woman complained of bilateral ear fullness after concurrent chemoradiation therapy for nasopharyngeal lymphoma. BET was performed on the left side because the left-sided serous otitis media persisted. A left-sided PET was performed two weeks after the BET, along with eustachian tube silicone plug insertion on the left side. The patient became asymptomatic immediately after the surgery, with no recurrence reported after a 12-month follow-up period. CONCLUSIONS To our knowledge, there has been no report of PET following BET in a post-radiation patient, and it was successfully treated via ET silicone plug insertion.
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Tang Y, Lou Z, Jin K, Sun J, Deng Y. Comparison of Electrocoagulation Tuboplasty and Continued Medical Therapy for Treating Persistent Eustachian Tube Dysfunction With Hypertrophic Mucosa Disease. Am J Rhinol Allergy 2021; 36:297-306. [PMID: 34796735 DOI: 10.1177/19458924211057353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this trial was to compare outcomes of electrocoagulation tuboplasty and continued medical therapy for treating persistent Eustachian tube dysfunction (ETD) with hypertrophic mucosa disease in the Eustachian tube (ET) orifice. STUDY DESIGN Prospective, case-control trial. MATERIAL AND METHODS Patients with persistent ETD were recruited and allocated to electrocoagulation tuboplasty and continued medical therapy groups. The ETD questionnaire-7 (ETDQ-7) score and objective parameters were compared between the groups at 6 and 12 months. RESULTS The proportion of patients with a decrease in ETDQ-7 scores was greater in the electrocoagulation group than in the medical therapy group at the 6-month follow-up (53.49% and 34.38%, respectively; p = .158), but the difference was not statistically significant. However, at the 12-month follow-up, there was a significantly higher proportion of patients with a decrease in ETDQ-7 scores in the electrocoagulation group (88.37% and 40.63%, respectively; p = .001). Additionally, a significant difference was observed between the groups in terms of the proportion of patients who improved 12 months after the treatment (tympanometry: 72.09% and 9.38%, respectively; p = .001; air-bone gap: 79.07% and 25.00%, respectively; p = .001; tympanic membrane status: 62.79% and 0.00%, respectively). In addition, the proportion of patients with improvements in the ET inflammation score was significantly different between the groups at 6-month (67.44% and 34.38%, respectively; p = .009) and 12-month (93.02% and 34.38%; p = .001) follow-ups. No device- or procedure-related serious adverse events were reported in any patients. CONCLUSIONS Electrocoagulation Eustachian tuboplasty appears to be a safe and feasible procedure for adult persistent ETD with hypertrophic mucosa disease in the ET orifice, and is superior to continued medical management alone. The improvements in ETDQ-7 and objective parameters persisted for 12 months.
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Affiliation(s)
- Yongmei Tang
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Zhengcai Lou
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Kangfeng Jin
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Junzhi Sun
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Yue Deng
- Changzheng Hospital, Naval Medical University Shanghai, Shanghai City, China
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Azadarmaki R, How A, Dean C, DeLorenzo K. In vivo study measuring middle ear pressure during various stages of Eustachian tube balloon dilation. Laryngoscope Investig Otolaryngol 2021; 6:1110-1115. [PMID: 34667855 PMCID: PMC8513449 DOI: 10.1002/lio2.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Documentation of middle ear pressure at different stages of balloon Eustachian tuboplasty and assessing risk of barotrauma with this procedure. MAIN OUTCOME MEASURES Middle ear pressure measurements in patients undergoing balloon Eustachian tuboplasty at the time of pre-insertion, catheter insertion, inflation, one minute post inflation, deflation, and catheter withdrawal, as well as documentation of pressure change in the middle ear between different stages. RESULTS A total of 24 patients and 45 Eustachian tubes, 11 females and 13 males, with an average age of 55.6 years were included in this study. Middle ear pressure values during the active stages of the procedure varied from -356 to +159 daPa. The overall greatest negative pressure change measured was -515 daPa from catheter insertion to immediately post balloon inflation. The overall greatest positive pressure change measured was +418 daPa from immediate catheter inflation to one minute post inflation. CONCLUSIONS There was no consistent pattern of middle ear pressure change noted during the different stages of balloon Eustachian tuboplasty as both positive and negative middle ear pressure changes were noted at the time of balloon dilation. Dangerous levels of middle ear pressure raising concern for barotrauma were not identified during the procedure. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Roya Azadarmaki
- Department of Otology‐NeurotologyWashington Ear AssociatesLeesburgVirginiaUSA
| | - Andrew How
- Department of Otology‐NeurotologyWashington Ear AssociatesLeesburgVirginiaUSA
| | - Colin Dean
- Department of Otology‐NeurotologyWashington Ear AssociatesLeesburgVirginiaUSA
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Saniasiaya J, Kulasegarah J, Narayanan P. Outcome of Eustachian Tube Balloon Dilation in Children: A Systematic Review. Ann Otol Rhinol Laryngol 2021; 131:797-804. [PMID: 34423675 DOI: 10.1177/00034894211041340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Eustachian tube dysfunction (ETD) is a chronic entity that has been historically managed with adenoidectomy and ventilation tube insertion. Recently, balloon dilation of the eustachian tube has shown promising results in recalcitrant eustachian tube dysfunction. We reviewed the literature to determine the outcome of eustachian tube balloon dilation in children. METHODS A literature search was conducted for the period from 1990 to 2020 by searching several databases over a 1-month period (January 2021) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews for Interventions. Primary outcome was defined as the success of the intervention determined by the resolution of symptoms, and secondary outcome was determined by revisions surgery and presence of complications. RESULTS Only 7 articles were identified based on our objectives and selection criteria. All studies included are retrospective cohort case series (Level IV) and 1 cohort of matched controls (Level III). A total of 284 patients were included in this review, with a mean age of 7.8 years. A total of 463 balloon dilation were performed either bilaterally or unilaterally. The most common finding of ETD is middle ear effusion in 5 studies. Balloon dilation of eustachian tube was second-line treatment in 6 studies and first-line treatment in 1 study. Improvement of symptoms was identified in all studies through various assessments performed. Revision surgery was performed in 1 study with no major complications reported. CONCLUSIONS Balloon dilation of the eustachian tube may be considered as an alternative procedure following failed standard treatment in children. The quality of evidence is inadequate to recommend widespread use of the technique until a better-quality study has been completed. Future randomized controlled studies with a large sample size are warranted to determine the efficacy of this procedure amongst children.
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Jeyanthi Kulasegarah
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Prepageran Narayanan
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Lou Z, Lou Z, Sun J, Chen Z, Yin S. Microwave ablation eustachian tuboplasty: a preliminary investigation with long-term follow-up. J Otolaryngol Head Neck Surg 2021; 50:39. [PMID: 34167591 PMCID: PMC8223355 DOI: 10.1186/s40463-021-00520-2] [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] [Received: 12/26/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to evaluate the efficacy of microwave ablation (MWA) eustachian tuboplasty for the treatment of patients with retracted tympanic membrane (TM) due to eustachian tube dysfunction (ETD). Methods This was a prospective study of 20 patients with ETD (middle ear atelectasis) who underwent MWA eustachian tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, audiometry results, tympanometry results, ETD Questionnaire (ETDQ-7) score, and TM status. Results Eighteen patients (18 ears) were included in this study. There were statistically and clinically significant improvements in the mean ETDQ-7 score at 6 months postoperatively (change in mean score of 16.7 ± 3.6, P < 0.001) and at 30 months postoperatively (change in mean score of 18.9 ± 2.9, P < 0.001). Type A tympanogram was obtained in 27.8% of patients (5/18) at 6 months postoperatively, and in 77.7% at 30 months postoperatively. A Valsalva maneuver was possible in 72.2% of patients at 6 months postoperatively and in 88.9% of patients at 30 months postoperatively. In addition, the ears of 13 patients (72.2%) showed both normal tympanograms and TM at 30 months postoperatively. Interestingly, 38.5% of patients (5/13) exhibited complete sclerosis of the pars tensa. None of the patients experienced severe MWA-related complications during follow-up. Conclusions MWA eustachian tuboplasty is a feasible alternative to conventional tuboplasty, and can improve subjective and objective outcomes in patients with ETD for up to 30 months following treatment. In addition, this study showed that the extent of sclerotic plaque increased over time, whereas the extents of atrophy and tensa retraction decreased following tuboplasty in most patients. Graphical abstract ![]()
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China. .,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
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Cheng H, Saxby A, Jufas N, Kong J, Patel N. Balloon dilation eustachian tuboplasty for dilatory dysfunction: Safety and efficacy analysis in an Australian cohort. ANZ J Surg 2021; 91:1480-1484. [PMID: 34075678 DOI: 10.1111/ans.16980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/19/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eustachian tube dysfunction (ETD) is a common clinical condition encountered by otolaryngologists. The severity and duration of symptoms range from the mild and transient to the chronic and severe along with secondary pathologies. Balloon dilation eustachian tuboplasty (BDET) as a treatment, was first described in 2010 and has been studied extensively. This study evaluates the efficacy and safety of BDET in an Australian cohort. METHODS Retrospective chart review on all patients who underwent BDET from September 2016 to March 2020 was performed. The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) was chosen as the primary outcome measure. Secondary outcome measures included subjective global assessment of presenting symptoms, ability to perform Valsalva maneuver and tympanometry. Any complications related to the procedures were reported. RESULTS One hundred and nineteen eustachian tube operations were included in this study. The patient cohort showed statistically significant improvement of mean EDTQ-7 score from 0.7 to 2.9. Improvement in EDTQ-7 was achieved in 83.9% of the cases. All patients in the baro-challenge-induced subgroup achieved improvement in ETDQ-7 score. Complete resolution of symptoms with an ETDQ <2.1 was achieved in 37.1% of the cohort. There were no adverse safety events associated with the procedures. CONCLUSION BDET resulted in improvement of the EDTQ-7 score in most of patients in this Australian cohort with no reported complications. BDET was most successful in baro-challenge-induced subgroup with universal improvement. Lower success rates were seen in patients with secondary pathology from their ETD.
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Affiliation(s)
- Horace Cheng
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
| | - Alex Saxby
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nicholas Jufas
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Kong
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nirmal Patel
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
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