In Vivo Measurement of Middle Ear Pressure Changes during Balloon Eustachian Tuboplasty

Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review

Objective

To report a novel technique in Balloon Dilation of Eustachian Tube (BDET) using an endovascular balloon (EVB), in a prospective cohort. The results are compared with reported outcomes using standard balloons.

Methods

Demographic information and clinical parameters were collected prospectively fora series of patients with obstructive eustachian tube dysfunction (OETD). Balloon dilation Eustachian tuboplasty was performed under local anesthesia in a tertiary referral center, using the EVB. Systematic literature review was used for comparison, using Medline via "PubMed", "Embase", and "Web of Science".

Results

Eight OETD candidates (12 ears) were enrolled; 5 males and 3 females. Average age was 48 (range -23 to 63) years. The most common presenting symptom was aural fullness (9/12), followed by ear pressure (7/12), hearing loss (5/12) and tinnitus (4/12). Otoscopically, tympanic membrane retraction was evident in 10/12 ears, the majority of which was class II-Sade classification. Pre-operative tympanogram was type B and C in 7 and 5 ears, respectively. All BDETs were performed without complications. Post-operative tympanometry was A in 8/12 ears. Post-operatively, Eustachian Tube Dysfunction Questionnaire-7 results reduced to within normal limits (average score ≤3) in 11/12 ears (p = 0.0014). The systematic literature review included 6 papers (193 patients, 262 ETs) with comparable results, most also with little adverse effects.

Conclusion

BDET using an EVB is a safe and effective option for OETD. It is well tolerated under local anesthesia in properly selected individuals. The reduced procedural cost may be an important factor in certain healthcare jurisdictions.

Comparison of outcomes for balloon dilation of the Eustachian tube under local vs general anesthesia

Objective

To compare the effectiveness of balloon dilation of the Eustachian tube (BDET) under local versus general anesthesia in the treatment of obstructive Eustachian tube dysfunction (OETD).

Study Design

Retrospective review.

Methods

Consecutive patients ages ≥18 with persistent OETD having failed adequate medical therapy underwent BDET between 2013 and 2018 under local or general anesthesia. Inclusion criteria were persistent type B or C tympanograms with symptoms or type A with symptoms upon barochallenge. Objective outcome measures were tympanometry, otoscopy and the need for additional subsequent intervention (revision dilation and tympanostomy tube). Primary outcome (failure) was defined as no change or worse in tympanogram.

Results

The 191 patients (332 ETs), ages 18–88 years (mean 58.0) underwent BDET. The 112 patients (59%) were female. The 107 procedures (32%) were performed under local anesthesia. Mean duration of follow‐up was 3.1 years (SD 1.9). Tympanograms improved to type A in 88% for BDET under local and 74% for general anesthesia at 12 months. Probability of being failure‐free at 5 years was 70% (95% confidence interval [CI]: 52%–82%) in the local anesthesia group versus 65% (95% CI: 55%–73%) in the general anesthesia group. Risk of failure did not significantly differ between the groups (HR = 0.60; 95% CI: 0.27–1.31; p = .20).

Conclusion

BDET under local anesthesia is effective in treating OETD and results in sustained improvements over 2 years. The procedure was successfully performed in all but one case utilizing a precise anesthesia protocol, and results are comparable with the procedure performed under general anesthesia.

Level of evidence

4

In vivo study measuring middle ear pressure during various stages of Eustachian tube balloon dilation

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.

Intraluminal Monitoring of Micro Vessels. A Surgical Feasibility Study

Objective: Monitoring of vessel perfusion is of high clinical importance in vascular anastomosis of free flaps. Current sensor systems are based on different principles and show limitations in validity and accuracy. Fiber optic pressure sensors exhibit high accuracy and are small in size. The aim of the present study was to evaluate the surgical feasibility of intraluminal pressure (ILP) measurements with a fiber optic pressure sensor in an animal model. Methods: In a microsurgical setting we sedated 10 Wistar rats with weight adapted phenobarbital, xylazine, and fentanyl. We performed a surgical approach to A. carotis communis and V. jugularis and introduced a 600 μm fiber optic pressure sensor into the vessels followed by measuring the ILP. The sensor was stabilized by the surrounding tissue, and the vessels were closed. Results: In all cases, surgical placement was uneventful. Measurement of intra-venous and intra-arterial pressure was possible and stable over the whole measurement period of an hour. Conclusion: Fiber optic pressure measurement in microvessels is possible and surgically feasible. An application to monitor the perfusion of free flaps seems possible.

Sensorineural Hearing Loss After Balloon Eustachian Tube Dilatation

Objective: Eustachian tube function is of central importance for the ventilation of the middle ear. A dysfunction can be associated with chronic otitis media, and cholesteatoma. Balloon Eustachian tube dilatation (BET) is a treatment option used to solve eustachian tube dysfunction. Although BET is widely performed, little is known about the occurrence rate of the complications associated with BET. The aim of the present study was to observe the rate of sensorineural hearing loss (SNHL) after BET.

Methods: We retrospectively evaluated in a chart review 1,547 patients and 2,614 procedures of BET performed in a single center between 2015 and 2019 using the Spiggle and Theis, Overath, Germany eustachian tube dilatation system.

Results: We observed seven cases of SNHL after BET. In two cases, the SNHL persisted, and in five cases, the SNHL was transient. In two cases of SNHL, a simultaneous tympanoplasty was performed. The overall rate of SNHL per procedure is 0.3%. The rate of permanent SNHL is 0.08%.

Conclusion: BET has a low rate of SNHL. Rapid middle ear pressure changes are assumed to cause BET-related hearing loss.

In-office balloon dilation of the Eustachian tube under local anesthesia: A retrospective review

Objective

To study the effectiveness and feasibility of in office balloon dilation of the Eustachian tube (BDET) utilizing a novel anesthetic protocol. Study design: retrospective review.

Methods

Retrospective chart review looking at the tolerability and effectiveness of stand-alone BDET in an office setting utilizing a novel topical anesthesia protocol in 33 patients with Eustachian tube dysfunction as defined by an ETDQ-7 score greater than 2.2 and type B or C tympanograms for greater than 3 months despite maximal medical management, including at least 4 weeks of nasal steroids.

Results

BDET in the office was well tolerated with 94% (31/33) of patients completing the procedure as planned. No adverse effects or complications were reported; however, the planned dilation time was cut short in one case due to significant discomfort and aborted prior to dilation in another due significant coughing. Tympanograms normalized at six weeks in 87.1% (27/31) of patients who underwent dilation.

Conclusion

This study demonstrates that performing BDET in an office setting utilizing a local anesthesia protocol is feasible and effective when the unique barometric considerations of BDET are addressed.