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Wu P, Cao X, Zhang R, Liu Y, Li H, Wang W, Li W. The long-term efficacy and safety of balloon dilation eustachian tuboplasty combined with tympanostomy tube insertion for patients with otitis media with effusion: study protocol for a prospective randomized controlled trial. Trials 2024; 25:572. [PMID: 39210408 PMCID: PMC11363521 DOI: 10.1186/s13063-024-08405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is a common disease in ear, nose, and throat clinics characterized by aural fullness and hearing loss and mainly caused by eustachian tube dysfunction (ETD). Tympanostomy tube insertion (TTI) is a conventional surgical treatment option that can alleviate symptoms but does not provide a definitive cure, and it is prone to recurrence. Balloon dilation eustachian tuboplasty (BDET) has become a novel procedure for the treatment of ETD, demonstrating significant potential in addressing the aforementioned limitations. However, it is not widely available in the clinic and few high-quality randomized clinical trials was conducted to investigate its long-term efficacy and security in OME. Therefore, the purpose of this study is to verify the efficacy of BDET combined with TTI for patients with OME and its prospects for providing a definitive cure. METHODS AND ANALYSIS This is a prospective, parallel-group, single-blind, randomized controlled prospective trial. Totally 124 patients with OME will be randomized into either group A or B. Group A will receive conventional therapy (TTI) while group B will use BDET therapy in addition to TTI. Outcome assessments will take place at baseline and at the 3rd, 6th, 12th, and 24th months after surgery. The primary outcome is eustachian tube function, which will be measured by the eustachian tube dysfunction questionnaire (ETDQ-7) and eustachian tube score (ETS). The secondary outcomes include middle ear function, hearing situation, and quality of life, which will be measured by acoustic impedance measurement, pure-tone audiometry, and Chinese-version Chronic Ear Survey (CCES). The main analysis of change in the outcomes will use mixed-model with repeated measures (MMRM) analyses of variance (ANOVAs). DISCUSSION This is the first prospective trial in Chinese populations that aims to validate the long-term efficacy and safety of BDET-combined TTI therapy in patients with OME. This parallel-group, single-blind, randomized controlled trial may provide an opportunity to decrease the recurrence rate of OME and explore a definitive cure for patients with OME. This trial's rigorous design enhances the reliability of the findings, ensuring a robust answer to the research question. In the future, the research team will further expand upon the clinical evidence and applications of the BDET combined therapy. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2400079632. Registered on 8 January 2024, https://www.chictr.org.cn/bin/project/edit?pid=214452 .
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Affiliation(s)
- Peixia Wu
- Vertigo and Balance Disorder Center, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Department of Nursing, Eye and ENT Hospital of Fudan University, Shanghai, China.
| | - Xuejiao Cao
- School of Nursing, Fudan University, Shanghai, China
| | - Ruiqi Zhang
- School of Nursing, Fudan University, Shanghai, China
| | - Yaoqian Liu
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Huawei Li
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Wuqing Wang
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Wenyan Li
- Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
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2
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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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3
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Hussain SZM, Hashmi S, Qayyum A. Informed consent in balloon Eustachian tuboplasty: a systematic review of possible complications and preventive measures. J Laryngol Otol 2024; 138:474-479. [PMID: 37973529 DOI: 10.1017/s0022215123001998] [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] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To systematically identify the complications associated with balloon Eustachian tuboplasty and their frequency of occurrence. This study will also highlight the measures that can be employed to avoid these complications and perform this procedure more safely. METHODS Systematically reviewed relevant papers published until January 2023. Each reference was checked and evaluated for any potential manuscripts. There was no registered protocol; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. RESULTS Sixty-nine publications were found, from which 14 publications met our inclusion criteria: 2 randomised clinical trials, 5 retrospective studies, 2 systematic reviews, 2 case series and 3 case reports. Studies with balloon Eustachian tuboplasty procedure only were included, regardless of ethnicity, gender and age. All studies were excluded in which more than one procedure was performed. CONCLUSION Balloon Eustachian tuboplasty is a relatively safe procedure with an overall complication risk of 1.66 per cent. Major complication rate was 0.43 per cent. Surgical emphysema was the most common, around 0.40 per cent.
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Affiliation(s)
| | | | - Asad Qayyum
- Peterborough City Hospital, Peterborough, UK
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4
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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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Fieux M, Tournegros R, Biot T, Tringali S. Eustachian tube balloon dilation. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:103-106. [PMID: 37620173 DOI: 10.1016/j.anorl.2023.08.003] [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] [Indexed: 08/26/2023]
Abstract
Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Université Paris-Est-Creteil, Inserm, IMRB, 94010 Créteil, France; CNRS EMR 7000, 94010 Créteil, France.
| | - R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France
| | - T Biot
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Institut de biologie et chimie des protéines, laboratoire de biologie tissulaire et d'ingénierie thérapeutique, UMR 5305, CNRS/université Claude-Bernard Lyon 1, 7, passage du Vercors, 69367, cedex 07 Lyon, France
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Ungar OJ, Demir Bajin M, Dahm V, Lin VYW, Chen JM, Le TN. Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review. Front Surg 2024; 11:1271248. [PMID: 38444902 PMCID: PMC10912332 DOI: 10.3389/fsurg.2024.1271248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
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.
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Affiliation(s)
- Omer J. Ungar
- Department of Otolaryngology, Head & Neck Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ikeda R, Ohta S, Yoshioka S, Endo S, Lee K, Kikuchi T, Yoshida H, Inagaki A, Kaneko A, Kobayashi H, Yoshida N, Oshima T, Mizuta K, Morita M, Yamaguchi N, Takahashi H, Kobayashi T. A manual of Eustachian tube function tests-illustration of representative test results obtained from healthy subjects and typical disorders with suggestion of the appropriate test method of choice. Auris Nasus Larynx 2024; 51:206-213. [PMID: 37419715 DOI: 10.1016/j.anl.2023.06.005] [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: 04/26/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
In the 19th century, Politzer devised a method to measure passage of the Eustachian tube (ET) by pressurizing the nasopharyngeal cavity, which marked the beginning of the ET function test. Since then, various examination methods have been developed. While ET function testing is important, recent advancements in diagnostic imaging and treatments have renewed interest on its importance. In Japan, the main objective methods used for examining ET function include tubotympanoaero-dynamic graphy (TTAG), sonotubometry, and the inflation-deflation test. The Japan Otological Society (JOS) Eustachian Tube Committee has proposed a manual of ET function tests, which presents typical patterns of the normal ear and typical diseases and suggests the ET function test of choice for each disease. However, the diagnosis of each disease should be made based on a comprehensive history and various examination findings, with ET function tests playing a supplemental role in the diagnosis.
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Affiliation(s)
- Ryoukichi Ikeda
- Otolaryngology-Head and Neck Surgery, Iwate Medical University School of Medicine, Japan.
| | - Shigeto Ohta
- Department of Otolaryngology - Head and Neck Surgery, Hyogo Medical University, Japan
| | - Satoshi Yoshioka
- Department of Otolaryngology, Fujita Health University School of Medicine, Japan
| | - Shiori Endo
- Ear Surgery/Eustachian tube Center, Shizuoka Saiseikai General Hospital, Japan
| | - Kana Lee
- Department of Otorhinolaryngology, Shinsuma General Hospital, Japan
| | | | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, National Hospital Organization Nagasaki Medical Center, Japan
| | | | | | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology- Head and Neck Surgery, Jichi Medical University Saitama Medical Center, Japan
| | - Takeshi Oshima
- Department of Otolaryngology - Head and Neck Surgery, Nihon University School of Medicine, Japan
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Park SC, Yeo CD. Traumatic Tympanic Membrane Perforation After Balloon Eustachian Tuboplasty in a Ventilation-Tube-Inserted Patient. EAR, NOSE & THROAT JOURNAL 2023:1455613231216849. [PMID: 38014570 DOI: 10.1177/01455613231216849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Su Cheol Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Cha Dong Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Lin JT, Hsu HJ, Ho CY, Tsai SW, Li YL, Wu JL. Balloon Dilation Eustachian Tuboplasty for Dilatory Dysfunction With and Without Effusion: A Comprehensive Outcome Analysis. Otolaryngol Head Neck Surg 2023; 169:1179-1186. [PMID: 37264984 DOI: 10.1002/ohn.383] [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: 08/03/2022] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study aimed (1) to demonstrate the efficacy of balloon dilation Eustachian tuboplasty (BDET) for dilatory Eustachian tube dysfunction (ETD) and (2) to determine whether adjunctive ventilation tube insertion (VTI) is superior to myringotomy in relieving symptoms for patients with ETD and concurrent middle ear effusion (MEE) treated with BDET. STUDY DESIGN A retrospective cohort study. SETTING Tertiary care academic center. METHODS Patients with dilatory ETD undergoing BDET with a ≥6-month follow-up period were enrolled and evaluated mainly using Eustachian tube function (ETF) tests and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). Participants with concurrent MEE were further classified into 2 subgroups, BDET with VTI and BDET with myringotomy. An intergroup comparison and comprehensive outcome evaluation were performed. RESULTS In total, 35 patients with 50 symptomatic ears were enrolled. According to ETF test results, the normalized ETF rate was 94% on the last visit. The mean ETDQ-7 scores decreased significantly from 3.7 ± 1.4 to 2.0 ± 0.9 after interventions, with the most improvement in symptoms occurring for "ear fullness" and "muffled hearing." For the final visit, strong correlations among ETF tests, tympanometry, and Valsalva results were noted. The aforementioned assessment results did not significantly differ between (1) the patients with MEE and patients without MEE and (2) "BDET with VTI" subgroup and "BDET with myringotomy" subgroup. CONCLUSION BDET was effective for dilatory ETD, even in cases with concurrent MEE. For patients with ETD and MEE, further research is required to evaluate the benefits of adjunctive myringotomy with or without VTI.
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Affiliation(s)
- Jung-Ting Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Otolaryngology, Kuo General Hospital, Tainan City, Taiwan
| | - Chen-Yu Ho
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Otolaryngology, Kuo General Hospital, Tainan City, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yi-Lu Li
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Sharma R, Meher R, Wadhwa V, Soni SV. Acceptance of Endoscopes in Otology - An Indian Perspective and Review of the Literature. Int Arch Otorhinolaryngol 2023; 27:e713-e722. [PMID: 37876680 PMCID: PMC10593540 DOI: 10.1055/s-0042-1759577] [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: 07/30/2022] [Accepted: 09/14/2022] [Indexed: 03/31/2023] Open
Abstract
Introduction The role of endoscopes in the ear, nose, and throat (ENT) field has been described since the 1980s; It started with endoscopic nasal surgeries, followed by otological and laryngological procedures, and, since then, it has experienced a rapid evolution. Endoscopes help otologists understand how to approach difficult areas of middle ear, as well as the physiology of middle ear cleft. Objectives Despite the introduction of endoscopes in the field of otology, microscopes are still widely used in clinics and in operation theaters either alone or with endoscopes. The present study, which was conducted amongst otologists in India, is on their experience with and knowledge of the use of the endoscope compared to microscopes. Methods A Google form-based questionnaire comprising 18 questions was developed and sent online to otologist all over the country. The final dataset included responses from 354 active otologists. Results Out of 354 participants, only 3% had more than 5 years of experience in endoscopic ear surgery (EES), and 16.1% had never worked with an endoscope. Endoscopes were used in clinics and in operation theaters by 74.9% of the participants. Conclusion There has been a rise in the acceptance and use of endoscopes among Indian otologists and otology surgeons in last few decades.
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Affiliation(s)
- Raman Sharma
- Department of ENT and Head and Neck Surgery, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- Department of ENT and Head and Neck Surgery, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
| | - Vikram Wadhwa
- Department of ENT and Head and Neck Surgery, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
| | - Sanjay Vikram Soni
- Department of ENT and Head and Neck Surgery, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
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Sandoval M, Navarro JJ, Martínez-Beneyto P, Herrera M, Alfaro J, López F, Marco J, Plaza G. Balloon Eustachian tuboplasty for obstructive Eustachian tube dysfunction: retrospective multicentre cohort study of 248 patients. Eur Arch Otorhinolaryngol 2023; 280:4045-4055. [PMID: 36976369 PMCID: PMC10382357 DOI: 10.1007/s00405-023-07906-0] [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: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To present the results after balloon eustachian tuboplasty (BET) in patients with obstructive Eustachian tube dysfunction (OETD) grouped up into: baro-challenge, chronic serous otitis media and adhaesive otitis media. METHODS A retrospective study was carried out on patients who underwent BET surgery. As outcome measures, otoscopy, tympanometry, Eustachian tube dysfunction questionnaire-7 (ETDQ-7) and ability to perform the Valsalva manoeuvre were recorded at baseline and at 3, 12 and 24 months after BET. A p value of 0.05 was used to indicate a statistically significant difference for all statistical tests. RESULTS Three hundred and nineteen ears (248 patients) were included with a 3-month follow-up, 272 ears had a 12-month follow-up, and 171 ears had 24-month follow-up. Globally, a statistical significance improvement in all groups in all outcome measures was found. According to BET indication, in the baro-challenge group, there was no improvement in otoscopy, but ETDQ-7, Valsalva manoeuvre and tympanogram improved significantly. In the chronic serous otitis media group, otoscopy, ETDQ-7 and Valsalva manoeuvre were significantly improved in all the three timelines, including the avoidance of a new transtympanic tube after the BET in over 80% of cases. In the adhaesive otitis media group, Valsalva manoeuvre improved significantly, ETDQ-7 decreased and tympanogram improved but not significantly. Few mild complications were reported. CONCLUSIONS BET is an effective method for the treatment of OETD in all etiologic groups. The greatest benefit was observed in patients with baro-challenge. A long-term follow-up is recommended since the benefit seems to increase over time.
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Affiliation(s)
- Marta Sandoval
- Department of Otolaryngology, Hospital Clínic Barcelona, Universitat de Barcelona (UB), C. Villarroel 170, 08036 , Barcelona, Spain.
- Departament de Medicina i Especialitats Médicoquirúrgiques, Facultat de Medicina, Universitat de Barcelona (UB), C. Casanova 143, 08036, Barcelona, Spain.
| | - Juan-J Navarro
- Department of Otolaryngology, Hospital Universitario de Donostia, Donostia-San Sebastian, Spain
| | | | - Mayte Herrera
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jorge Alfaro
- Department of Otolaryngology, Hospital Quirónsalud Zaragoza, Zaragoza, Spain
| | - Felipe López
- Department of Otolaryngology, Hospital Sant Joan Despí-Moisès Broggi, Barcelona, Spain
| | - Jaime Marco
- Department of Otolaryngology, Hospital Clínico Universitario, Valencia, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
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12
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Cetin-Ferra S, Teixeira MS, Swarts JD, Rath TJ, Alper CM. CT Imaging of Eustachian Tube Balloon Dilation: Method Development on Cadaver Heads. Bioengineering (Basel) 2023; 10:bioengineering10050592. [PMID: 37237662 DOI: 10.3390/bioengineering10050592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Objective: To develop a methodology for the measurement of balloon dilation (BD) effects on Eustachian Tube (ET) structure using Computerized Tomography (CT) images. Methods: The BD of the ET was performed on three cadaver heads (five ears) through the nasopharyngeal orifice. The axial CT images of the temporal bones were obtained before dilation, while an inflated balloon was in the lumen of ET, and after balloon removal in each ear. Utilizing Dicom images captured by the ImageJ software 3D volume viewer function, the anatomical landmark coordinates of the ET were matched with their pre- and post-dilation counterparts, and the longitudinal axis of the ET was captured with serial images. The histograms of the regions of interest (ROI) and three different lumen width and length measurements were obtained from captured images. The densities of air, tissue, and bone were determined with histograms as a baseline to determine the BD rate as a function of increased air in the lumen. Results: The small ROI box included the area of prominently dilated ET lumen after BD and best represented the visually obvious changes in the lumen, compared to the ROIs that extended the wider areas (longest and longer). Air density was the outcome measure for comparison with each corresponding baseline value. The average increase in air density in the small ROI was 64%, while the longest and long ROI boxes showed 44 and 56% increases, respectively. Conclusion: This study describes a method to image the ET and quantify the outcomes of BD of the ET using anatomical landmarks.
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Affiliation(s)
- Selma Cetin-Ferra
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
| | - Miriam S Teixeira
- Graduate Medical Education Research Division, Arnot Ogden Medical Center, Elmira, NY 14905, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine Pittsburgh, PA 15213, USA
| | - Tanya J Rath
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine, Phoenix, AZ 85054, USA
| | - Cuneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine Pittsburgh, PA 15213, USA
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 1 Children's Place, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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13
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Dahm V, Lui JT, Jung S, Lin VY, Chen JM, Le TN. The feasibility and safety of eustachian tube dilation with a standard endovascular balloon: a clinical pilot study. J Otolaryngol Head Neck Surg 2023; 52:20. [PMID: 36855202 PMCID: PMC9976517 DOI: 10.1186/s40463-022-00599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/03/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Obstructive eustachian tube dysfunction is a common pathology, generally accepted as the underlying cause for chronic ear diseases. Eustachian tube dilation has shown promising results in randomized controlled trials, but is a costly procedure. The aim of the current study was to assess the feasibility of transnasal balloon dilatation of the eustachian tube with an endovascular balloon in the context of ease of use, maneuverability, and safety. METHODS Clinical pilot study carried out at a university tertiary care facility. In total, twelve patients, were included over a period of 6 months. All patients underwent tympanoplasty or tympanomastoidectomy surgeries. Eustachian tube dilation was carried out transnasal using an endovascular balloon. A computed tomography was carried out after surgery to assess for any potential damages and compared to preoperative imaging studies. Postoperative endoscopy was performed intraoperatively and at follow up to assess for any potential damages. RESULTS All eustachian tube dilations were carried out successfully. No severe adverse events were noted during the procedure, in the postoperative period, or on imaging studies. Minor adverse events such as mild intraoperative bleeding was managed in a routine fashion. CONCLUSIONS Balloon dilation of the eustachian tube with the endovascular balloon was feasible and safe in all cases. It is likely a more cost-effective alternative to commercially available balloons with similar designs and specifications. Trial registration The study was registered at clinicaltrials.gov; NCT04809753, initial release February 24th, 2021.
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Affiliation(s)
- Valerie Dahm
- grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, Sunnybrook Research Institute, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Justin T. Lui
- grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, Sunnybrook Research Institute, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Soyeon Jung
- grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vincent Y. Lin
- grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, Sunnybrook Research Institute, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Joseph M. Chen
- grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, Sunnybrook Research Institute, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Trung N. Le
- grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, Sunnybrook Research Institute, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, Canada
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14
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Wang Z, Hu HT, Bakheet N, Yoon SH, Park JH, Kim KY, Jeon JY, Kang WS, Kim YR, Lopera JE, Park HJ, Song HY. The rat eustachian tube: Anatomical, histological, and radiological features. J Interv Med 2023; 6:14-19. [PMID: 37180372 PMCID: PMC10167518 DOI: 10.1016/j.jimed.2022.12.002] [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: 10/17/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose This study investigated the anatomical and histological characteristics of the rat Eustachian tube (E-tube) and the feasibility of Eustachian tubography in a rat model. Materials and methods Fifteen male Wistar rats were used in this study, and the bilateral E-tubes of each rat were examined. Ten E-tubes were used for anatomical studies, another ten for histological analysis, and the other ten for Eustachian tubography. Five rats were euthanized and decapitated, and ten E-tubes were dissected to describe the anatomy of the E-tube. Ten E-tube specimens obtained from five other rats were sectioned to investigate E-tube histology. Eustachian tubography was performed on the bilateral E-tubes of the other five rats using the trans-tympanic approach. Results The rat E-tubes consisted of bony and membranous parts. Cartilage and bone tissue covered only the bony part. The E-tubes' mean diameter and overall length were 2.97 mm and 4.96 mm, respectively. The tympanic orifices' mean diameter was 1.21 mm. The epithelium of E-tubes was mainly composed of pseudostratified ciliated and goblet cells. Eustachian tubography was successfully performed on both sides of the E-tube for each rat. The technical success rate was 100%, the average running time was 4.9 min, and no procedure-related complications occurred. On tubography images, the E-tube, tympanic cavity, and nasopharynx could be identified because of the visualization of bony landmarks. Conclusion In this study, we described the anatomical and histological features of rat E-tubes. With the aid of these findings, E-tube angiography was successfully performed using a transtympanic approach. These results will facilitate further investigation of E-tube dysfunction.
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Affiliation(s)
- Zhe Wang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, CN, 300052, China
| | - Hong-Tao Hu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Minimal-Invasive Intervention, Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou City, Henan Province, 450003, China
| | - Nader Bakheet
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Gastrointestinal Endoscopy and Liver Unit, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sung Hwan Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Ree Kim
- Department of Otorhinolaryngology Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jorge E. Lopera
- Department of Radiology, UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Hong Ju Park
- Department of Otorhinolaryngology Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
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15
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Kang JM, Kim SH, Ryu DS, Park Y, Won DS, Kim JW, Zeng CH, Kang WS, Park JH, Park HJ. Tapered self-expandable metallic stent optimized for Eustachian tube morphology in a porcine ET model. Sci Rep 2022; 12:20290. [PMID: 36434004 PMCID: PMC9700756 DOI: 10.1038/s41598-022-24615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
Several investigations on the feasibility of stent placement into the Eustachian tube (ET) are being conducted. However, stents optimized for the anatomical structure of the ET have not yet been developed. In this study, the efficacy and safety of a self-expandable metallic stent (SEMS) optimized for porcine ET morphology was investigated. Silicone was injected into a cadaveric porcine ET to analyze the ET morphology. The three-dimensional-reconstructed porcine ET phantom images obtained after a computed tomography scan were measured to determine the dimensions of the porcine ET. The SEMS was designed as a tapered structure on the basis of the morphological findings of the porcine ET. The tapered SEMS (T-SEMS) and conventional SEMS (C-SEMS) were placed into the porcine ET to compare the safety and efficacy of the two types of SEMSs. Stent-induced tissue hyperplasia in the T-SEMS group was significantly lower than that in the C-SEMS group (p < 0.001). The T-SEMS optimized for the porcine ET was effective in maintaining stent patency. T-SEMS seems to be better than C-SEMS in suppressing stent-induced tissue hyperplasia, owing to the reduced stent-mediated mechanical injuries and maintaining ET patency.
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Affiliation(s)
- Jeon Min Kang
- grid.413967.e0000 0001 0842 2126Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea ,grid.267370.70000 0004 0533 4667Department 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
- grid.413967.e0000 0001 0842 2126Biomedical 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
- grid.413967.e0000 0001 0842 2126Biomedical 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
- grid.413967.e0000 0001 0842 2126Biomedical 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
- grid.413967.e0000 0001 0842 2126Biomedical 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
- grid.413967.e0000 0001 0842 2126Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Chu Hui Zeng
- grid.413967.e0000 0001 0842 2126Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Woo Seok Kang
- grid.267370.70000 0004 0533 4667Department 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
- grid.413967.e0000 0001 0842 2126Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Hong Ju Park
- grid.267370.70000 0004 0533 4667Department 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
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16
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Yang HH, Alonso J, Ishiyama A, Gopen QS, Suh JD, Wang MB, Wells C, Wung V, Lee JT. Clinical Predictors of Symptom Improvement Following Eustachian Tube Balloon Dilation. Ann Otol Rhinol Laryngol 2022:34894221129912. [PMID: 36226334 PMCID: PMC10359951 DOI: 10.1177/00034894221129912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to identify clinical predictors of treatment response to Eustachian Tube Balloon Dilation (ETBD) as measured by changes in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores. METHODS One hundred thirteen patients who underwent ETBD at an institution from 2017 to 2021 completed ETDQ-7 pre- and post-operatively. We conducted multivariable regression analyses with ETDQ-7 normalization (<2.1 post-op), minimum clinically important difference (MCID) (>0.5 pre-op - post-op), and quantitative improvement in ETDQ-7 score as outcome variables. Pre-operative ETDQ-7 score, tympanogram type, chronic otitis media, chronic rhinosinusitis (CRS), inferior turbinate hypertrophy, deviated septum, allergic rhinitis, and rhinorrhea were included as covariates. Models controlled for age, sex, ethnicity, prior ear or sinus surgery, and follow-up duration. RESULTS The mean age was 49 years old. 51% were females, and all patients had pre-operative ETDQ-7 above 2.1. After a mean follow-up period of 13 months, 77% achieved MCID and 37% had normalized. Higher pre-operative ETDQ-7 score was associated with greater ETDQ-7 score improvement (B = 0.60, 95% CI = [0.37, 0.83]) and greater odds of achieving MCID (aOR = 1.65; 95% CI = [1.06, 2.59]). A history of CRS improved chances of achieving MCID (aOR = 4.53; 95% CI = [1.11, 18.55]) and a history of chronic otitis media predicted increased odds of ETDQ-7 normalization (aOR = 2.88; 95% CI = [1.09, 7.58]). CONCLUSIONS Our findings suggest that ETBD was highly effective among patients with pre-operative ETDQ-7 above 2.1. Furthermore, higher pre-operative ETDQ-7 score, CRS, and chronic otitis media predicted more favorable symptomatic benefit from ETBD. These factors may be important to consider when counseling potential candidates for this procedure.
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Affiliation(s)
- Hong-Ho Yang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jose Alonso
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Quinton S Gopen
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Christine Wells
- Office of Advanced Research and Computing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vivian Wung
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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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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18
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Kim Y, Kang JM, Ryu DS, Park JH, Kang WS, Park HJ. Serial histological changes in the cartilaginous eustachian tube in the rat following balloon dilation. PLoS One 2022; 17:e0268763. [PMID: 35613135 PMCID: PMC9132338 DOI: 10.1371/journal.pone.0268763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
Although balloon dilation has shown promising results in the treatment of dilatory Eustachian tube (ET) dysfunction, the histological effects of ET balloon dilation (ETBD) is unknown because histological examination of the whole human cartilaginous ET is impossible. Animal studies are needed to elucidate the effect of ETBD so we evaluated the histological changes after ETBD in a rat model. The left ET of 20 Wistar rats was dilated with a balloon catheter and the right ET was used as a control. Five rats were sacrificed immediately after ETBD, at 1, 4 and 12 weeks after the procedure for histological examination. The epithelial cells, presence of epithelial hyperplasia, and the proportion of the goblet cells in the epithelium; the vascular structures and dimensions of the submucosa; and presence of cartilage fracture and the area of the ET lumen were evaluated and compared between the groups. Desquamation of nearly all epithelial cells and the fracture of tubal cartilages were observed immediately after ETBD. At 1-week post-ETBD, the ciliated epithelial cells started to recover with epithelial hyperplasia. The goblet cells recovered by 4 weeks post-ETBD and epithelial hyperplasia decreased but was still present at 12 weeks post-ETBD. The depth of the submucosa increased and neovascularization in this region was observed at 1-week post-ETBD and persisted up to 12 weeks post-ETBD. The lumen of the cartilaginous ET increased immediately after ETBD but decreased at 1-week post-ETBD. The cartilaginous ET lumen recovered to the normal value at 4 weeks post-ETBD. This study is the first to describe the serial histological changes to the cartilaginous ET after ETBD and helps our understanding of the histological changes that occur after an ETBD intervention for intractable ET dysfunction.
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Affiliation(s)
- Yehree Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeon Min Kang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Dae Sung Ryu
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
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19
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Perilymph Fistula as a Complication of Eustachian Tube Dilation and Tympanoplasty. Case Rep Otolaryngol 2022; 2022:5978757. [PMID: 35578706 PMCID: PMC9107369 DOI: 10.1155/2022/5978757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Eustachian tube dilation (ETD) is an established, minimally invasive therapeutic approach for chronic eustachian tube dysfunction. The complications associated with performing a ETD are rare. A 22-year-old female patient presented with chronic otitis media on the right side and chronic obstructive tube dilation disorder on both sides. A type I tympanoplasty was performed on the right side because of a tympanic membrane perforation after a ETD on both sides without apparent complications. On the 5th postoperative day, she presented with headache, dizziness and hearing loss on the right side. There was a decrease of hearing threshold on the right side in the pure-tone audiogram and vHIT, cVEMP, and SVV were irregular. The β-2-transferrin test was positive. Since a right-sided perilymph fistula was suspected, an emergency tympanotomy was performed with a round window membrane cover with fascia on the right side. Intraoperatively, a regular, intact ossicular chain was found with a slightly moist middle ear mucosa. The round window membrane was covered by the promontorial lip. Under these measures, the patient’s dizziness regressed. The right ear pure-tone threshold vHIT, cVEMP, and SVV normalized.
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Choi SW, Hwangbo L, Cho KS, Kong SK. Chronic Eustachian Tube Dilatory Dysfunction as a Manifestation of Meningioma. EAR, NOSE & THROAT JOURNAL 2022:1455613221082624. [PMID: 35272511 DOI: 10.1177/01455613221082624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sung-Won Choi
- Department of Otorhinolaryngology-Head and Neck Surgery and Pusan National University School of Medicine, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Republic of Korea
| | - Lee Hwangbo
- Department of Radiology and Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Republic of Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology-Head and Neck Surgery and Pusan National University School of Medicine, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology-Head and Neck Surgery and Pusan National University School of Medicine, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Republic of Korea
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Sirolimus-eluting cobalt-chrome alloy stent suppresses stent-induced tissue hyperplasia in a porcine Eustachian tube model. Sci Rep 2022; 12:3436. [PMID: 35236923 PMCID: PMC8891339 DOI: 10.1038/s41598-022-07471-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022] Open
Abstract
Various preclinical studies with developed Eustachian tube (ET) stents are in progress but have not yet been clinically applied. ET stent is limited by stent-induced tissue hyperplasia in preclinical studies. The effectiveness of sirolimus-eluting cobalt–chrome alloy stent (SES) in suppressing stent-induced tissue hyperplasia after stent placement in the porcine ET model was investigated. Six pigs were divided into two groups (i.e., the control and the SES groups) with three pigs for each group. The control group received an uncoated cobalt–chrome alloy stent (n = 6), and the SES group received a sirolimus-eluting cobalt–chrome alloy stent (n = 6). All groups were sacrificed 4 weeks after stent placement. Stent placement was successful in all ETs without procedure-related complications. None of the stents was able to keep its round shape as original, and mucus accumulation was observed inside and around the stent in both groups. On histologic analysis, the tissue hyperplasia area and the thickness of submucosal fibrosis were significantly lower in the SES group than in the control group. SES seems to be effective in suppressing stent-induced tissue hyperplasia in porcine ET. However, further investigation was required to verify the optimal stent materials and antiproliferative drugs.
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Choi SW, Oh SJ, Kim Y, Kwak MY, Suh MW, Park MK, Lee CK, Park HJ, Kong SK. A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty. Sci Rep 2021; 11:23296. [PMID: 34857843 PMCID: PMC8639820 DOI: 10.1038/s41598-021-02848-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2021] [Indexed: 11/12/2022] Open
Abstract
To assess the safety and efficacy of navigation-guided balloon Eustachian tuboplasty (BET) compared to medical management (MM) alone in patients with chronic Eustachian tube dilatory dysfunction (ETD). This is a prospective, multicenter, 1:1 parallel-group, randomized controlled trial (RCT). It aims to assess the efficacy of navigation-guided BET compared to MM alone in patients with chronic ETD. The primary outcome measure was an improvement in the Eustachian tube dysfunction questionnaire (ETDQ)-7 score at the 6-week follow-up compared with baseline. Secondary outcome measures included changes in the signs and symptoms during the follow-up, changes in the score for each subcategory of ETDQ-7, type of tympanometry, pure tone audiometry, and the availability of a positive modified Valsalva maneuver. Navigation-guided BET was safely performed in all patients. A total of 38 ears of 31 patients (19 ears of 16 patients in the BET group and 19 ears of 15 patients in the control group) completed the planned treatment and 6 weeks of follow-up. More patients in the BET group (1.99 ± 0.85) had less symptomatic dysfunction than in the control group (3.40 ± 1.29) at 6 weeks post-procedure (P = 0.001). More patients experienced tympanogram improvement in the BET group at 6 weeks compared to the control group (36.5% vs. 15.8%) with a positive modified Valsalva maneuver (36.6% vs. 15.8%, P = 0.014). Additionally, air–bone gap change was significantly decreased in the BET group compared to the control group at the 6-week follow-up visit (P = 0.037). This prospective, multicenter, RCT study suggests that navigation-guided BET is a safe and superior treatment option compared to MM alone in patients with chronic ETD.
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Affiliation(s)
- Sung-Won Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro 179, Seo-Gu, Busan, 49241, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro 179, Seo-Gu, Busan, 49241, Republic of Korea
| | - Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Young Kwak
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Kyou Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro 179, Seo-Gu, Busan, 49241, Republic of Korea.
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The Feasibility of Eustachian Tube Dilation With a Standard Endovascular Balloon: A Comparative Cadaver Study. Otol Neurotol 2021; 43:256-262. [PMID: 34739430 DOI: 10.1097/mao.0000000000003404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Balloon dilation of the eustachian tube is a new therapeutic option for eustachian tube dysfunction. One of the limiting factors of wider adoption of this technique in many parts of the world is the high cost of the devices, in spite of regulatory approval of safety. OBJECTIVE Evaluate the performance and usability of standard less-expensive endovascular balloons for eustachian tube dilation in comparison to an approved device in a preclinical study. STUDY DESIGN Comparative cadaver feasibility study. SETTING University tertiary care facility. METHODS Ten eustachian tube dilations were performed with an approved eustachian tube dilation device. Ten other procedures were carried out with an endovascular balloon of similar dimensions. Cone beam computerized tomography was performed to evaluate the extent of dilation and possible damages. The lumen and mucosal lining were inspected endoscopically post-dilation. Volume measurements were compared before and after the procedure in both groups using contrast enhancement. RESULTS All 20 eustachian tube dilations were carried out successfully. No tissue damages could be identified on cone-beam computerized tomography or via endoscopic examination. There was a statistically significant difference of eustachian tube volumes between pre- and post-dilations, with no statistically significant difference between the devices. CONCLUSION Eustachian tube dilation with a less costly endovascular balloon achieved similar results to an approved eustachian tube dilation device. No damages or any other safety concerns were identified in a cadaver study.
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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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Jamil W, Izzat S. Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review. World J Otorhinolaryngol Head Neck Surg 2021; 7:54-62. [PMID: 33474545 PMCID: PMC7801258 DOI: 10.1016/j.wjorl.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/15/2020] [Accepted: 04/13/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Multiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments. This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction. DATA SOURCES A total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language. References of included studies were checked. METHODS A systematic review was undertaken. Outcomes assessed were: primary outcomes-subjective improvement in symptoms (ETDQ-7), audiometric improvement of hearing, improvement of negative middle ear pressure noticed in tympanometry, objective improvement of tympanic membrane retraction. Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e. Valsalva manoeuvre, improved quality of life, passive tubal opening, tubomanometry, swallowing test, reduction in mucosal inflammation of Eustachian tube orifice in the nose, complications from the procedure, the need for further procedures. Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data. RESULTS Three studies were included. All included studies were small-scale case series (13-38 participants). Studies were conducted outside the UK. Subjective and objective improvement of Eustachian tube function was reported in all studies. But all included studies were at high risk of bias and subject to multiple limitations. No major complications were reported in either study. CONCLUSIONS Based on current evidence, it is not possible to recommend the clinical use of either of these two interventions i.e. Laser or Microdebrider Eustachian tuboplasty. Lack of controlled studies was identified as a gap in the evidence. Future research should be directed toward designing randomised controlled trials. These trials should use strict standard methodology and reporting criteria. Future trials should make use of consensus statement document about Eustachian tube dysfunction definition, diagnostic methods, and outcome assessment criteria to design clinical trials.
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Affiliation(s)
- Waqas Jamil
- ENT Department Birmingham Heartland Hospital, UK
| | - Steve Izzat
- Wrightington Wigan and Leigh, NHS Foundation Trust, UK
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Lee S, Kim SD, Choi SW, Kong SK, Oh SJ. Nasopharyngeal Mucocele Following Balloon Eustachian Tuboplasty. JAMA Otolaryngol Head Neck Surg 2020; 146:768-769. [PMID: 32525531 DOI: 10.1001/jamaoto.2020.1031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Seokhwan Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Dong Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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Choi SW, Lee SH, Oh SJ, Kong SK. Navigation-Assisted Balloon Eustachian Tuboplasty for Eustachian Tube Dilatory Dysfunction. Clin Exp Otorhinolaryngol 2020; 13:389-395. [PMID: 32392639 PMCID: PMC7669314 DOI: 10.21053/ceo.2019.01305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/11/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives. Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD. Methods. Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients’ symptoms preoperatively and at the postoperative follow-up. Results. Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient’s final visit at 6 months post-procedure. Conclusion. Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.
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Affiliation(s)
- Sung-Won Choi
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seok-Hwan Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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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]
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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.
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Alper CM, Teixeira MS, Rath TJ, Hall-Burton D, Swarts JD. Change in Eustachian Tube Function With Balloon Dilation in Adults With Ventilation Tubes. Otol Neurotol 2020; 41:482-488. [PMID: 32176133 PMCID: PMC8126344 DOI: 10.1097/mao.0000000000002559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assess the changes in Eustachian tube (ET) function (ETF) with balloon dilation of Eustachian tube (BDET). STUDY DESIGN Prospective cohort for repeated testing measures. SETTING Clinical research center. PATIENTS Eleven adults with at least one patent ventilation tube (VT) inserted for chronic ET dysfunction (ETD) and history of otitis media with effusion. INTERVENTIONS Subjects with evidence of moderate to severe ETD on the side with a VT underwent unilateral BDET. MAIN OUTCOME MEASURES Changes in ETF parameters after BDET measured by Forced Response Test (FRT), Inflation Deflation Test (IDT), and Pressure Chamber test. RESULTS With the FRT at 11 ml/min, opening pressure (OP) decreased from 458 ± 160 to 308 ± 173 daPa and closing pressure (CP) from 115 ± 83 to 72 ± 81 daPa at the 3-month post-BDET visit. The IDT and Pressure Chamber test showed that the percentage of middle ear (ME) pressure gradient equilibrated with swallows improved from 28 ± 34 to 53 ± 5% for positive and from 20 ± 28 to 38 ± 43% for negative ME pressure. Images from the pre- and post-BDET functional CT scans did not show apparent changes in the anatomy. Comparisons of ETF test parameters pre- and post-BDET suggested that the ET was easier to open and stayed open longer after the procedure. However, during the limited duration of follow-up most subjects continued to have ETD, some requiring VT re-insertion after the study period. CONCLUSIONS Adults with severe ETD may benefit from BDET, however ETD may not be completely resolved and patients may continue to need VTs.
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Affiliation(s)
- Cuneyt M. Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine (UPSOM)
- Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh (CHP)
- Clinical and Translational Research, UPSOM
| | - Miriam S. Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine (UPSOM)
| | | | | | - J. Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine (UPSOM)
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Balloon Eustachian tuboplasty for Eustachian tube dysfunction: report of long-term outcomes in a UK population. The Journal of Laryngology & Otology 2020; 134:34-40. [PMID: 31910908 DOI: 10.1017/s0022215119002548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Balloon Eustachian tuboplasty is a surgical management option for Eustachian tube dysfunction; it has shown promising results in studies worldwide, but has had limited uptake in the UK. This study reports long-term outcomes for patients offered balloon Eustachian tuboplasty for chronic dilatory and baro-challenge-induced Eustachian tube dysfunction, and describes practical experience gained from its implementation. METHODS Balloon Eustachian tuboplasty was conducted in 25 patients (36 ears) with Eustachian tube dysfunction over three years. Information on presenting symptoms and signs, audiometric findings, tympanometry, and Eustachian Tube Dysfunction Questionnaire-7 scores were recorded pre- and post-operatively with a minimum follow up of one year. RESULTS Sixteen (64 per cent) of the 25 patients demonstrated symptom resolution after balloon Eustachian tuboplasty according to the Eustachian Tube Dysfunction Questionnaire-7. Fourteen (64 per cent) of the 22 patients with a type B or C tympanogram pre-operatively, had a type A trace post-operatively. Fifteen (75 per cent) of 20 patients with pre-operative conductive hearing loss showed improvement post-operatively, and 11 (50 per cent) of 22 patients with pre-operative middle-ear effusion or tympanic membrane retraction showed resolution. CONCLUSION Balloon Eustachian tuboplasty can improve subjective and objective measures of Eustachian tube dysfunction, and provide longer-term resolution.
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Alper CM, Teixeira MS, Swarts JD. Eustachian Tube Function in Adults with Ventilation Tubes Inserted for Otitis Media with Effusion. J Int Adv Otol 2019; 14:255-262. [PMID: 30256199 DOI: 10.5152/iao.2018.4521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the eustachian tube (ET) function (ETF) in adults with ventilation tube (VT) inserted for the treatment of chronic otitis media with effusion (COME). MATERIALS AND METHODS A total of 17 subjects with at least one VT were enrolled. A detailed history was obtained, and risk factors were assessed with questionnaires. Examination including nasopharyngeal video endoscopy and ETF tests, the forced response test (FRT), inflation-deflation test (IDT), and nasal/nasopharyngeal maneuvers (such as sniffing and Valsalva, Toynbee, and the diver's maneuvers) were performed. RESULTS Averages for FRT were 580±333 daPa, 382±251 daPa, and 138±192 daPa for opening pressure, steady-state pressure, and closing pressure, respectively. Most subjects demonstrated minimal or weak active function during the FRT and IDT. While nasopharyngeal maneuvers changed the nasal/nasopharyngeal pressures, they did not significantly change the middle-ear pressures. These results indicated that most subjects had severe obstructive ET dysfunction (ETD) with an ET lumen that required high pressure differences to open and poor active muscular function inadequate for luminal dilation. These results imply that while any treatment to widen the ET, such as balloon dilation of the ET, is not expected to change the voluntary active muscular function, it may reduce the tissue pressures and resistance, thus facilitating luminal opening both passively and actively. CONCLUSION Most patients with VT inserted for the treatment of COME appear to have an abnormal ETF with difficulty in passively opening the ET and weak active muscular function. Management of such patients addressing only passive properties may not be sufficient for the resolution of ETD.
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Affiliation(s)
- Cüneyt M Alper
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA; Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Miriam S Teixeira
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - J Douglas Swarts
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Patel A, Smith ME, Norman G, Llewellyn A, Tysome JR. Balloon dilatation of the Eustachian tube for obstructive Eustachian tube dysfunction in adults. Hippokratia 2019. [DOI: 10.1002/14651858.cd013429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anant Patel
- Norfolk & Norwich University Hospital; Department of ENT Surgery; Conley Lane Norwich UK NR4 7UY
| | - Matthew E Smith
- Cambridge University Hospitals NHS Foundation Trust; Department of ENT Surgery; Hills Road Cambridge Cambridgeshire UK CB2 0QQ
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Alexis Llewellyn
- University of York; Centre for Reviews and Dissemination; York UK YO10 5DD
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation Trust; Hills Road Cambridge UK
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Outcome Measures for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review. Otol Neurotol 2019; 39:138-149. [PMID: 29315176 DOI: 10.1097/mao.0000000000001666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Baro-challenge-induced Eustachian tube dysfunction (baro-induced ETD) is characterized by failure of the Eustachian tube (ET) to open adequately to permit middle-ear pressure regulation during ambient pressure changes. There are no well-characterized tests for identifying the condition, which makes both patient diagnosis and research into treatment efficacy challenging. This systematic review evaluates ET function tests as potential outcome measures for baro-induced ETD. DATA SOURCES MEDLINE and CENTRAL were searched (database inception to March 2017) and reference lists reviewed for all relevant English Language articles. STUDY SELECTION Tests in included studies were required to measure ET function in patients reporting baro-induced ear symptoms or barotrauma. DATA EXTRACTION Data were extracted in a standardized manner, and studies assessed according to Standards for Reporting of Diagnostic Accuracy Studies (STARD) criteria. The primary outcome of interest was the accuracy of ET function tests. DATA SYNTHESIS Heterogeneity of subject demographics, ET function test methodology, and reference standards only permitted narrative systematic review. CONCLUSION Sixteen studies involving seven different types of ET function tests were identified. The nine-step test was the most commonly used outcome measure, with overall test sensitivity and specificity ranges of 37 to 100% and 57 to 100%, respectively. Tympanometry test sensitivity was consistently poor (0-50%) while specificity was higher (52-97%). Published accuracy data for other ET function tests and test combinations were limited. Currently, no single test can be recommended for use in clinical practice. A combination of the nine-step test with other objective tests or patient-reported measures appears most promising as a core set of outcome measures for baro-induced ETD.
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Song HY, Park HJ, Kang WS, Kim KY, Park JH, Yoon SH, Jeon JY. Fluoroscopic Balloon Dilation Using a Flexible Guide Wire to Treat Obstructive Eustachian Tube Dysfunction. J Vasc Interv Radiol 2019; 30:1562-1566. [PMID: 31409566 DOI: 10.1016/j.jvir.2019.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To prospectively evaluate the midterm outcomes of fluoroscopic eustachian tube (E-tube) balloon dilation by using a flexible guide wire in patients with obstructive E-tube dysfunction. MATERIALS AND METHODS From October 2016 to September 2017, adult outpatients with persistent otitis media who were unable to perform the Valsalva maneuver were prospectively enrolled. The analysis included 32 E-tubes from 31 patients (18 women, 13 men; mean age, 47 years old, range 25-72 years). Participants underwent fluoroscopic E-tube balloon dilation with a 0.035-inch flexible guide wire and a 6- × 20-mm balloon catheter. Clinical examinations to check for the ability to perform the Valsalva maneuver and otomicroscopy were conducted at 1 week and then at 1, 3, 12, and 18 months after the procedure. RESULTS Balloon dilation was technically successful in all E-tubes. The mean time required for the procedure was 6.9 minutes (range, 5.8-10.3 minutes). The Valsalva maneuver was successful in opening 25 of 32 E-tubes (78.1%) at 3 months after balloon dilation. During the median follow-up of 15.9 months, failure of the Valsalva maneuver occurred in 4 of 25 improved E-tubes (16%), yielding a 2-year patency rate of 84%. CONCLUSIONS The fluoroscopic balloon dilation results were encouraging, and using a flexible guide wire for E-tube balloon dilation did not cause a false passage.
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Affiliation(s)
- Ho-Young Song
- Department of Radiology and Research, Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Hong Ju Park
- Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Woo Seok Kang
- Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology, Chonbuk National University Hospital, Republic of Korea
| | - Jung-Hoon Park
- Department of Radiology and Research, Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sung Hwan Yoon
- Department of Radiology and Research, Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jae Yong Jeon
- Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Tucci DL, McCoul ED, Rosenfeld RM, Tunkel DE, Batra PS, Chandrasekhar SS, Cordes SR, Eshraghi AA, Kaylie D, Lal D, Lee J, Setzen M, Sindwani R, Syms CA, Bishop C, Poe DS, Corrigan M, Lambie E. Clinical Consensus Statement: Balloon Dilation of the Eustachian Tube. Otolaryngol Head Neck Surg 2019; 161:6-17. [PMID: 31161864 DOI: 10.1177/0194599819848423] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop a clinical consensus statement on the use of balloon dilation of the eustachian tube (BDET). METHODS An expert panel of otolaryngologists was assembled with nominated representatives of general otolaryngology and relevant subspecialty societies. The target population was adults 18 years or older who are candidates for BDET because of obstructive eustachian tube dysfunction (OETD) in 1 or both ears for 3 months or longer that significantly affects quality of life or functional health status. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. RESULTS After 3 iterative Delphi method surveys, 28 statements met the predefined criteria for consensus, while 28 statements did not. The clinical statements were grouped into 3 categories for the purposes of presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. CONCLUSION This panel reached consensus on several statements that clarify diagnosis and perioperative management of OETD. Lack of consensus on other statements likely reflects knowledge gaps regarding the role of BDET in managing OETD. Expert panel consensus may provide helpful information for the otolaryngologist considering the use of BDET for the management of patients with OETD.
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Affiliation(s)
- Debara L Tucci
- 1 Duke University Medical Center, Durham, North Carolina, USA
| | | | | | | | - Pete S Batra
- 5 Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | - David Kaylie
- 1 Duke University Medical Center, Durham, North Carolina, USA
| | | | - Jivianne Lee
- 10 UCLA Department of Head & Neck Surgery, Los Angeles, California, USA
| | - Michael Setzen
- 11 Weill Cornell Medical College New York, New York, USA
| | | | | | - Charles Bishop
- 14 University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Dennis S Poe
- 15 Children's Hospital Boston, Boston, Massachusetts, USA
| | - Maureen Corrigan
- 16 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Erin Lambie
- 16 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Malik J, Ghadiali SN. Multi-scale modeling of an upper respiratory airway: Effect of mucosal adhesion on Eustachian tube function in young children. Clin Biomech (Bristol, Avon) 2019; 66:11-19. [PMID: 29395489 PMCID: PMC6067987 DOI: 10.1016/j.clinbiomech.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Eustachian tube is a collapsible upper respiratory airway that is periodically opened to maintain a healthy middle ear. Young children, <10 years old, exhibit reduced Eustachian tube opening efficiency and are at risk for developing middle ear infections. Although these infections increase mucosal adhesion, it is not known how adhesion forces alters the biomechanics of Eustachian tube opening in young children. This study uses computational techniques to investigate how increased mucosal adhesion alters Eustachian tube function in young children. METHODS Multi-scale finite element models were used to simulate the muscle-assisted opening of the Eustachian tube in healthy adults and young children. Airflow during opening was quantified as a function of adhesion strength, muscle forces and tissue mechanics. FINDINGS Although Eustachian tube function was sensitive to increased mucosal adhesion in both adults and children, young children developed Eustachian tube dysfunction at significantly lower values of mucosal adhesion. Specifically, the critical adhesion value was 2 orders of magnitude lower in young children as compared to healthy adults. Although increased adhesion did not alter the sensitivity of Eustachian tube function to tensor and levator veli palatini muscles forces, increased adhesion in young children did reduced the sensitivity of Eustachian tube function to changes in cartilage and mucosal tissue stiffness. INTERPRETATIONS These results indicate that increased mucosal adhesion can significantly alter the biomechanical mechanisms of Eustachian tube function in young children and that clinical assessment of adhesion levels may be important in therapy selection.
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Affiliation(s)
- Jennifer Malik
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio 43210, United States of America
| | - Samir N Ghadiali
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio 43210, United States of America,Dorothy M. Davis Heart and Lung Research Institute, College of Medicine and Wexner Medical Center, The Ohio State University, Columbus, Ohio 43210, United States of America,Department of Internal Medicine (Division of Pulmonary, Critical Care and Sleep Medicine), Wexner Medical Center, The Ohio State University, Columbus, Ohio 43210, United States of America
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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.
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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
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A Systematic Literature Review of the Safety and Efficacy of Eustachian Balloon Tuboplasty in Patients with Chronic Eustachian Tube Dysfunction. Indian J Otolaryngol Head Neck Surg 2019; 71:406-412. [PMID: 31559212 DOI: 10.1007/s12070-019-01637-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022] Open
Abstract
Eustachian tube dysfunction (ETD) is a common condition afflicting 1% of the adult population and is said to be higher in the pediatric population. Currently, it is primarily managed with medical therapy. However, newer management techniques like balloon tuboplasty have been introduced. To systematically review the available evidence on eustachian tube balloon dilation for treating chronic ETD covering indications, efficacy, safety, short term, and long term outcomes, a literature search was conducted on Google Scholar and Pubmed. 21 publications met the inclusion criteria. Based on the literature review the procedure was found to be effective in alleviating symptoms in adult and pediatric patients immediately postoperatively and long term, up to 5 years. The adverse event rate was 3% and these were mostly minor self-resolving complications. The perioperative protocol varies from center to center. Balloon tuboplasty was found to be safe and efficacious in the short and long term post operatively in select patients with chronic ETD.
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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.
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Affiliation(s)
- Steven Micucci
- 1 Kaiser Permanente Oakland Medical Center, Oakland, Caliornia, USA
| | | | - Jonathan Liang
- 1 Kaiser Permanente Oakland Medical Center, Oakland, Caliornia, USA
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Cartilaginous Eustachian tube length and carotid canal dehiscence in children: a radiological study. Eur Arch Otorhinolaryngol 2018; 275:2675-2682. [DOI: 10.1007/s00405-018-5128-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/11/2018] [Indexed: 11/26/2022]
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In Vivo Measurement of Middle Ear Pressure Changes during Balloon Eustachian Tuboplasty. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9519204. [PMID: 30258853 PMCID: PMC6146622 DOI: 10.1155/2018/9519204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/04/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022]
Abstract
Background Balloon Eustachian tuboplasty (BET) is known as a treatment for chronic obstructive Eustachian tube dysfunction (OETD). The precise mechanism of action is not fully understood. Observations in sheep cadavers and human cadavers have shown specific middle ear pressure changes related to BET. Methods In this prospective study using a microfibre optical pressure sensor, pressure changes during BET were for the first time monitored transtympanically in five normal human middle ears in vivo. Results Middle ear pressure changes during 21 BETs consisted of five stages (insertion, inflation, deflation, withdrawal, and recovery). The highest pressure change occurred in most of the cases during the withdrawal of the balloon catheter. Withdrawal pressure yielded a mean middle ear pressure of 4.76 mmHg (61.89 daPa) with a maximum of 13.88 mmHg (179.55 daPa). Pressure amplitudes capable of causing barotrauma to ear structures were not detected. Internal carotid artery dehiscences were detected as causative of sinusidual pressure changes. Conclusion The middle ear pressure changes detected in vivo during BET can be attributed to the balloon inflation. Further human studies with patients affected by OETD are necessary to gain more insight into the mechanism of action of BET to clarify a possible pressure related second mechanism of action of BET.
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Shah RR, Thomas WW, Naples JG, Ruckenstein MJ. Subcutaneous Emphysema and Pneumomediastinum after Eustachian Tube Balloon Dilation. Otolaryngol Head Neck Surg 2018; 159:203-205. [PMID: 29759024 DOI: 10.1177/0194599818768519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ravi R Shah
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William W Thomas
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James G Naples
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Ruckenstein
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wang TC, Lin CD, Shih TC, Chung HK, Wang CY, Tsou YA, Huang CH, Tsai MH. Comparison of Balloon Dilation and Laser Eustachian Tuboplasty in Patients with Eustachian Tube Dysfunction: A Meta-analysis. Otolaryngol Head Neck Surg 2018; 158:617-626. [PMID: 29557245 DOI: 10.1177/0194599817753609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective We aimed to perform a meta-analysis examining balloon dilatation and laser tuboplasty for the treatment of eustachian tube dysfunction (ETD). Data Sources PubMed, Cochrane, and Embase search up to April 18, 2016, with the following keywords: eustachian, middle-ear, eustachian tuboplasty, balloon tuboplasty, laser tuboplasty, laser dilatation, and balloon dilatation. Review Methods Randomized controlled trials and prospective, retrospective, and 1-arm studies of patients with ETD treated with balloon dilatation or laser tuboplasty were included. Outcome measures were improvement of eustachian tube score (ETS) and tympanometry and Valsalva maneuver results. Results Two retrospective and 11 prospective studies were included (1063 patients; 942 treated with balloon and 121 with laser tuboplasty). Balloon tuboplasty resulted in a significant improvement of ETS (pooled standardized mean difference [SMD], 0.94; 95% confidence interval [CI], 0.23-1.66; P = .009) and, compared with laser tuboplasty, a greater tympanometry improvement rate (pooled event rate = 73% vs 13%; P = .001). Valsalva maneuver improvement rate was not different between the group results (pooled event rate = 67% vs 50%; P = .472). The maximum number of studies that provided outcome data for any one measure was only 4, and sensitivity analysis indicated ETS results may have been overly influenced by 2 studies. No balloon tuboplasty studies reported ETS data, preventing comparison between the 2 procedures. Conclusion Both procedures can improve symptoms of ETD; however, because of the limited numbers of studies reporting data of the outcomes of interest, it remains unclear if one procedure provides greater benefits.
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Affiliation(s)
- Tang-Chuan Wang
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzu-Ching Shih
- 3 Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hsiung-Kwang Chung
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Yuang Wang
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Yung-An Tsou
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Hsuan Huang
- 4 Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Hsui Tsai
- 1 Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,2 College of Medicine, China Medical University, Taichung, Taiwan
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Ikeda R, Kikuchi T, Miyazaki H, Hidaka H, Kawase T, Katori Y, Kobayashi T. The efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube patient. Acta Otolaryngol 2018; 138:6-9. [PMID: 28880712 DOI: 10.1080/00016489.2017.1366053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube (PET) patients. METHODS A prospective survey of medical records identified 36 patients and 47 ears with PET, and 15 patients and 15 ears as control. The ETDQ-7, patulous Eustachian tube handicap inventory-10 (PHI-10) and Likert scale were evaluated. PET patients were divided into two groups based on severity of symptoms using the PHI score. RESULTS The Cronbach α value of the PET group was 0.765. The average total score of the ETDQ-7 in the control group was 7.6 ± 1.1 and 22.5 ± 10.0 in the PET group (p < .01). No correlation was found between ETDQ-7 and Likert scale (r = 0.248, p = .09). The average total score of the ETDQ-7 in the mild or moderate PET group was 19.9 ± 9.0 and 25.3 ± 11.1 in the severe PET group and this was not statistically different (p = .08). CONCLUSION The highest ETDQ-7 score was also observed in PET patients and in ET dysfunction patients. These findings necessitate careful discrimination between ET dysfunction and PET in balloon dilation Eustachian tuboplasty (BET) based on ETDQ-7.
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Affiliation(s)
- Ryoukichi Ikeda
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Sen-En Rifu Otologic Surgery Center, Sendai, Japan
| | - Toshiaki Kikuchi
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiromitsu Miyazaki
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Sen-En Rifu Otologic Surgery Center, Sendai, Japan
| | - Hiroshi Hidaka
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshimitsu Kobayashi
- Department of Otolaryngology – Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Sen-En Rifu Otologic Surgery Center, Sendai, Japan
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Ashry Y, Kawai K, Poe D. Utility of Adjunctive Procedures With Balloon Dilation of the Eustachian Tube. Laryngoscope Investig Otolaryngol 2017; 2:337-343. [PMID: 29299505 PMCID: PMC5743173 DOI: 10.1002/lio2.110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023] Open
Abstract
Objective To assess the role and effect of concomitant adjunctive procedures when combined with balloon dilation of the Eustachian tube (BDET), including a new technique for treating obstructive disease within the bony Eustachian tube (ET). Study Design Retrospective case series. Setting Tertiary medical center. Subjects Adults with persistent (≥2 years): 1) OME or non‐fixed TM retraction AND type B or C tympanogram OR 2) Consistent symptoms of barochallenge with flights or diving, all despite medical treatment for ≥6 weeks. Methods Balloon dilation of the cartilaginous ET (BDET) was performed under general anesthesia using concomitant myringotomy with or without tube placement if indicated. Adjunctive turbinectomy, adenoidectomy, and/or tympanoplasty were used in selected cases. For suspected disease in the bony ET, an illuminated guidewire was used for probing and clearing the lumen. Outcome measures were tympanogram, otomicroscopy, ET mucosal inflammation score, Valsalva maneuver, and PTA audiometry. Results 67 ETs (48 patients) underwent BDET: 1) 30/67 balloon w/wo myringotomy, w/wo tube, 2) 20/67 plus adjunctive procedure or 3) 17/67 plus guidewire. Follow‐up was ranging from 0.4 to 3.4 years (mean 1.3 year, SD = 0.7). Significant improvement occurred in 79%. There was no significant difference in the failure rate comparing balloon dilation with adjunctive procedures 5/20 (25%) or without adjunctive procedures; 4/30 p = 0.45 (13%). Failure rate for BDET plus guide wire was 5/17 (29%) and resistance within the bony ET occurred in 8/17 (47%). Conclusion Balloon dilation of the cartilaginous ET demonstrated significant improvement despite expansion of indications that necessitated the addition of adjunctive procedures. Level of Evidence 4
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Affiliation(s)
- Yehia Ashry
- Department of Otolaryngology and Communications Enhancement Boston Children's Hospital and Harvard Medical School Boston Massachusetts U.S.A.,Department of Otolaryngology Suez Canal University Ismailia Egypt
| | - Kosuke Kawai
- Department of Otolaryngology and Communications Enhancement Boston Children's Hospital and Harvard Medical School Boston Massachusetts U.S.A.,Clinical Research Center Boston Children's Hospital Boston Massachusetts U.S.A
| | - Dennis Poe
- Department of Otolaryngology and Communications Enhancement Boston Children's Hospital and Harvard Medical School Boston Massachusetts U.S.A
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48
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Cervicofacial and mediastinal emphysema after balloon eustachian tuboplasty (BET): a retrospective multicenter analysis. Eur Arch Otorhinolaryngol 2017; 275:81-87. [DOI: 10.1007/s00405-017-4805-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022]
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Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction. Eur Radiol 2017; 28:910-919. [PMID: 28956124 DOI: 10.1007/s00330-017-5040-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/23/2017] [Accepted: 08/17/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To prospectively evaluate the technical feasibility and safety of fluoroscopy-guided balloon dilation in patients with Eustachian tube (ET) dysfunction. METHODS Patients who could not do a Valsalva manoeuvre for more than 6 months and diagnosed with chronic otitis media or ET dysfunction were prospectively enrolled. A 0.035-in. guide wire and 6-mm long balloon catheter with a diameter of 2 mm were used to dilate the cartilaginous portion of the ET under fluoroscopic guidance. The balloon was inflated by manual injection twice for 1 min each time. Clinical outcomes were assessed by the patient's ability to perform a Valsalva manoeuvre, and symptoms were assessed using the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. RESULTS Balloon dilation was attempted in a total of ten adult patients from October 2016 to March 2017. Technical success was achieved in all procedures (10/10). Ninety percent (9/10) of the balloons were fully dilated without waist deformity. There were no major complications. All patients were able to perform a Valsalva manoeuvre at the time of their last visit and/or improvement of at least one ETDQ-7 score. CONCLUSION Fluoroscopy-guided balloon dilation seems to be technically feasible and safe in the treatment of ET dysfunction. KEY POINTS • Fluoroscopy-guided balloon dilation without general anaesthesia was well-tolerated in all patients. • Location of the balloon catheter can be monitored during the procedure. • Inflation state of the balloon catheter can be monitored during the procedure. • Using guide-wire during the procedure would prevent false passage creation. • All patients had clinical improvement within 3 months after balloon dilation.
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Teixeira MS, Swarts JD, Alper CM. Accuracy of the ETDQ-7 for Identifying Persons with Eustachian Tube Dysfunction. Otolaryngol Head Neck Surg 2017; 158:83-89. [PMID: 28949806 DOI: 10.1177/0194599817731729] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare the accuracy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) in identifying people with eustachian tube (ET) dysfunction based on symptoms and an objective ET function test. Study Design Cross-sectional study. ObjSettingective Tertiary referral center. Subjects and Methods Fifty-five subjects with and without symptoms suggestive of ET dysfunction completed the ETDQ-7 and had their ET function evaluated by the percentage of middle ear pressure equilibrated after 5 swallows (PEq5) either during a pressure chamber test (intact tympanic membranes) or by the inflation-deflation test (nonintact tympanic membranes). ETDQ-7 score ≥14.5 and PEq5 <60% were used to define ET dysfunction, and sensitivity, specificity, and receiver operating characteristic curves were used to assess the level of association between ETDQ-7 scores and PEq5. Results Twenty-five asymptomatic subjects (group 1 = 15 females, 15 white; mean ± SD age, 32 ± 12.8 years) and 30 subjects with ET dysfunction symptoms (group 2 = 17 females, 25 white; age, 27 ± 16.3 years) were included in the analysis. ETDQ-7 sensitivity and specificity regarding correct group assignment were 70% and 100%, respectively, and with respect to predicting PEq5<60%, 54% and 78%. An area under the curve (AUC) of 0.68 (95% CI, 0.53-0.83) at the participant level and 0.64 (95% CI, 0.50-0.77) at the ear level indicated a moderate level of association that was lower, though not statistically significant, for nonintact tympanic membranes (AUC = 0.63 at the participant level and AUC = 0.49 at the ear level). Conclusion The ETDQ-7 score had a higher correlation with the ET dysfunction symptoms than with an objective measure of ET function.
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Affiliation(s)
- Miriam S Teixeira
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J Douglas Swarts
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cuneyt M Alper
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,2 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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