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Ahluwalia J, Babu S, Haupert M, Thottam P. Outcomes of Concurrent Balloon Eustachian Tuboplasty and Tympanostomy Tube Placement in Children. Laryngoscope 2024. [PMID: 38872456 DOI: 10.1002/lary.31572] [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: 03/11/2024] [Revised: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Balloon dilation eustachian tuboplasty (BDET) has been proven to be a safe treatment option for children with eustachian tube dysfunction (ETD). This study aims to analyze the long-term outcomes of children who underwent concurrent BDET and tympanostomy tube (TT) placement. We hypothesize that patients who underwent simultaneous therapy have experienced a low overall rate of middle ear pathology and have consistent hearing quality at subsequent office visits. METHODS Retrospective chart review of 19 pediatric patients (36 ears) who previously underwent concurrent BDET and TT placement. Patient charts within the extended postoperative period were reviewed. Specific data points included need for reoperation, rates of middle ear pathology, audiological outcomes, and number of previous TT placements. RESULTS Pediatric patients who underwent concurrent BDET and TT placement had long-term success in 34/36 ears (94.4%). All postoperative tympanograms and audiograms (100%) were normal when performed within 12 months after the procedure. Notably, 34/36 ears (94.4%) had history of tube placement in the past. Patients had an average of three sets of tympanostomy tubes prior to undergoing concurrent BDET and TT. CONCLUSION Concurrent BDET and TT placement may be an effective treatment option for pediatric patients with persistent eustachian tube dysfunction. Specifically, BDET may be a useful adjunct tool in pediatric patients with refractory ETD despite having multiple sets of tympanostomy tubes. This study aims to strengthen the argument of performing multimodal therapy in pediatric patients with recurrent middle ear disease. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Jatin Ahluwalia
- Department of Otolaryngology-Head and Neck Surgery, Ascension St. John Hospital, Detroit, Michigan, U.S.A
| | - Seilesh Babu
- Department of Otology-Neurotology, Michigan Ear Institute, Farmington Hills, Michigan, U.S.A
| | - Michael Haupert
- Department of Otolaryngology-Head and Neck Surgery, Ascension St. John Hospital, Detroit, Michigan, U.S.A
- Department of Pediatric Otolaryngology, Michigan Pediatric Ear, Nose, and Throat Associates, West Bloomfield, Michigan, U.S.A
| | - Prasad Thottam
- Department of Otolaryngology-Head and Neck Surgery, Ascension St. John Hospital, Detroit, Michigan, U.S.A
- Department of Pediatric Otolaryngology, Michigan Pediatric Ear, Nose, and Throat Associates, West Bloomfield, Michigan, U.S.A
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Standring RT, O'Malley EM, Greene JB, Russell JL, McCoul ED. Balloon dilation of the Eustachian tube with a seeker-based device: A registry of 169 patients. Laryngoscope Investig Otolaryngol 2021; 6:975-982. [PMID: 34667839 PMCID: PMC8513429 DOI: 10.1002/lio2.652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To collect real-world data on the safety and effectiveness of balloon dilation of the Eustachian tube using a seeker-based device in patients with persistent/chronic symptoms of Eustachian tube dysfunction. METHODS A multicenter, prospective, single-arm registry was conducted from June 2018 through August 2020 at 10 US centers, including tertiary care and private practices. Primary endpoints included mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and the serious related adverse event rate. Secondary endpoints include changes in middle ear assessments, surgical intervention rate, and changes in Sino-Nasal Outcome Test and Work and Activity Impairment (WPAI) questionnaires. RESULTS A total of 169 participants were treated with balloon dilation of the Eustachian tube, with 166 and 154 participants completing the 6-week and 6-month follow-ups, respectively. Repeated measures analysis of the change in ETDQ-7 scores indicated statistically significant improvement (-2.1; 95% CI -2.40, -1.84; P < .0001) at 6-month follow-up. The minimum clinically important difference of improvement was achieved by 85% of participants at 6 months. Four nonserious adverse events were reported. Middle ear functional assessments were improved in the majority of participants with abnormal baseline findings. There were no statistically significant differences in the change from baseline ETDQ-7 scores between participants who had concurrent procedures and those who did not. WPAI scores demonstrated significant improvement. CONCLUSION Real-world evidence supports the clinical studies demonstrating that balloon dilation of the Eustachian tube with a seeker-based device is a safe and effective procedure to treat ETD symptoms. LEVEL OF EVIDENCE 3.
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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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The impact of bariatric surgery on eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2020; 278:689-693. [PMID: 32556787 DOI: 10.1007/s00405-020-06128-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE We aimed to evaluate the relationship between acute loss of weight after 6 months of bariatric surgery and the occurrence of tubal dysfunction symptoms METHODS: We recruited 76 patients who had undergone bariatric surgery between 2018 and 2019. It was planned to see if the change in Body Mass Index (BMI) caused changes in the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores of individuals. Regardless of the questionnaire, patients were also asked for 3 symptoms (autophony, fullness in the ear, hearing their own breath in the ear) before and 6 months after bariatric surgery. RESULTS The mean age of the study group was 39.32 ± 11.09 years and 80.3% percent of the patients were female. The mean weight loss of the patients at the 6th month was 44.67 ± 13.10 kg, and mean weight loss rate was % 35.06 ± 8.01. The incidence of hearing their own breath, autophony and fullness of the ear were 25%, 22.4% and 11.8%, respectively. The proportion of those experiencing any of these three complaints was 30.3% (n = 23). The ETDQ scores of the cases ranged from 7 to 27, with an average of 9.38 ± 4.28. There are 10.5% (n = 8) paints with a score of ≥ 14.5 as regarded as patients with Eustachian tube dysfunction (ETD). The mean age of patients with ETD was significantly higher (p < 0.05) than patients without ETD. Gender distributions, weight loss rates, smoking, previous operation and additional disease distributions do not show statistically significant differences between patients with and without ETD (p > 0.05). CONCLUSION Present study indicated a 10.5% ETD incidence after bariatric surgery. ETDQ questionnaire can be used for ETD screening in patients who underwent bariatric surgery, which will be an overlooked complication in this group of subjects.
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Savenko IV, Boboshko MY. [The patulous Eustachian tube syndrome: the current state-of-the-art and an original clinical observation. Second communication]. Vestn Otorinolaringol 2018; 83:77-81. [PMID: 29953063 DOI: 10.17116/otorino201883377] [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
The choice of the treatment strategy for the patients presenting with the patulous Eustachian tube syndrome constitutes a serious challenge for an otorhinolaryngologist. Despite the considerable progress achieved during the past years in the development of modern pharmacotherapy and functional endoscopic surgery, the specialists often encounter difficulties in the management of the patients suffering from this disease. The present article (continuing the previous communication) contains information concerning the historical and modern approaches to the treatment of the patients with the patulous Eustachian tube syndrome. The authors describe the conservative and surgical methods employed for the treatment of this condition and the approaches to the choice of the treatment strategies depending on the etiology, pathogenesis, and severity of the disorder being considered, its duration, and the character of the morphological changes identified during the diagnostic procedures. The authors emphasize the importance of the wait-and-see strategy for the treatment of the patients presenting with the patulous Eustachian tube syndrome. In conclusion, they present the concrete results of four original observations of such patients.
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Affiliation(s)
- I V Savenko
- Laboratory of Hearing and Speech, Academician I.P. Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia, 197022
| | - M Yu Boboshko
- Laboratory of Hearing and Speech, Academician I.P. Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia, 197022; Otorhinolaryngology Department, I.I. Mechnikov North-Western State Medical University, , Saint-Petersburg, Russia, 191015
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Savenko IV, Boboshko MY. [The patulous Eustachian tube syndrome: the current state of the problem and our own clinical observation. Part 1]. Vestn Otorinolaringol 2018; 83:56-62. [PMID: 29697658 DOI: 10.17116/otorino201883256-62] [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: 11/18/2022]
Abstract
The patulous Eustachian tube syndrome was described more than 150 years ago, but up to the present time some of its aspects continue to be a challenge for both fundamental and clinical medicine. Certain issues of etiology and pathogenesis of this condition have until recently remained unclear which probably accounts for the failure of choosing the adequate methods for its medical correction. Despite the seemingly broad spectrum of the modern tools for the purpose including first and foremost the endoscopic and radiological techniques, verification of the patulous Eustachian tube may encounter difficulties for the specialists. In connection with this, we have undertaken to summarize the views and opinions as regards the syndrome of interest available in the relevant world literature. In the first part of this communication, the authors discuss the modern concepts of etiology and pathogenesis of the patulous Eustachian tube syndrome with special reference to its clinical manifestations and methods of diagnostics.
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Affiliation(s)
- I V Savenko
- Laboratory of Hearing and Speech, Academician I.P. Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia, 197022
| | - M Yu Boboshko
- Laboratory of Hearing and Speech, Academician I.P. Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia, 197022; Otorhinolaryngology Department, I.I. Mechnikov North-Western State Medical University, Saint-Petersburg, Russia, 191015
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