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Schmitt K, Timm M, Krüger P, Oppel N, Napp A, Pohl F, Schuon R, Kampmann A, Kötter L, Bankstahl M, Lenarz T, Stein T, Paasche G. Long-Term Preclinical Evaluation of a Permanent Stent Developed for the Human Eustachian Tube. Bioengineering (Basel) 2024; 11:755. [PMID: 39199713 PMCID: PMC11352055 DOI: 10.3390/bioengineering11080755] [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: 05/30/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
The Eustachian tube (ET) is a bottleneck when it comes to middle ear (ME) health. If its function is impaired, this can lead to serious consequences for the patient, such as hearing problems or deafness. Therefore, this study investigated a tapered nitinol stent (3-5 mm × 14 mm) for the human ET as a potential new permanent treatment for chronic Eustachian tube dysfunction (ETD) and thus ME ventilation disorders. The self-expanding stent was inserted unilaterally into the ET of 24 sheep with observation periods of 3, 6, and 12 months. Local tissue effects and the safety of the stent insertion were analyzed based on regular endoscopic checks, weekly tympanometry measurements, final imaging, and histological examinations. The animals showed no stent-related health restrictions. However, the individual anatomy and stenting procedure had an influence on the results. The tissue reaction in the endoscopic examinations was mild even though no concomitant antibiotics were administered. After all three monitoring periods, stented ETs had a significantly larger ET lumen than the non-stented contralateral ETs. However, tissue growth was detected in the stent. Overall, the first long-term study on an ET stent showed that the tapered ET stent could be a promising treatment option for ETD.
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Affiliation(s)
- Katharina Schmitt
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Malena Timm
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Philipp Krüger
- bess pro GmbH, Gustav-Krone-Str. 7, 14167 Berlin, Germany; (P.K.); (T.S.)
| | - Niels Oppel
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Alexandra Napp
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Friederike Pohl
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Robert Schuon
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Andreas Kampmann
- Department of Cranio-Maxillo-Facial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
| | - Lisa Kötter
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
| | - Marion Bankstahl
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
- Institute of Pharmacology and Toxicology, Department of Biological Sciences and Pathobiology, University of Veterinary Medicine Vienna, 1210 Wien, Austria
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
- Cluster of Excellence Hearing4all, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Tobias Stein
- bess pro GmbH, Gustav-Krone-Str. 7, 14167 Berlin, Germany; (P.K.); (T.S.)
| | - Gerrit Paasche
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (K.S.); (M.T.); (R.S.); (L.K.); (T.L.)
- Cluster of Excellence Hearing4all, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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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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Azevedo C, Moreira F, Lima AF, Mar FM, Vilarinho S, Dias L. Prospective Evaluation of the Efficacy of Isolated Balloon Eustachian Tuboplasty: Short- and Medium-term Follow-up Results Based on Tubomanometry, ETDQ-7, Tympanometry, and Valsalva Maneuver. Int Arch Otorhinolaryngol 2024; 28:e76-e82. [PMID: 38322434 PMCID: PMC10843926 DOI: 10.1055/s-0043-1767804] [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: 06/27/2022] [Accepted: 11/03/2022] [Indexed: 02/08/2024] Open
Abstract
Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective To evaluate the efficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performed a prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction ( p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement ( p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short- and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.
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Affiliation(s)
- Cátia Azevedo
- Otorhinolaryngology Service, Hospital de Braga, Braga, Portugal
| | - Filipa Moreira
- Otorhinolaryngology Service, Hospital de Braga, Braga, Portugal
| | | | | | | | - Luís Dias
- Otorhinolaryngology Service, Hospital de Braga, Braga, Portugal
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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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Maddineni S, Ahmad I. Updates in Eustachian Tube Dysfunction. Otolaryngol Clin North Am 2022; 55:1151-1164. [DOI: 10.1016/j.otc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Raymond MJ, Shih MC, Elvis PR, Nguyen SA, Brennan E, Meyer TA, Lambert PR. A Systematic Review of Eustachian Tube Procedures for Baro-challenge Eustachian Tube Dysfunction. Laryngoscope 2022; 132:2473-2483. [PMID: 35442523 DOI: 10.1002/lary.30132] [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: 01/08/2022] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the effectiveness of Eustachian tube procedures for the treatment of baro-challenge Eustachian tube dysfunction. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases, including PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and CINAHL (EBSCO), were searched for articles examining the effectiveness of Eustachian tube procedures for baro-challenge Eustachian tube dysfunction. Outcome measures included symptom resolution, ability to return to work, equalization problems (EP) scores, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and pressure chamber testing parameters. Pooled meta-analysis was performed for dichotomous measures and ETDQ-7 scores. RESULTS Eleven articles with 81 patients were included. Seventy-two patients from 10 articles underwent balloon Eustachian tube dilation; nine patients in 1 study underwent laser Eustachian tuboplasty (LET). All 81 patients were preoperatively symptomatic with barometric pressure change, and 26/30 (86.7%) were unable to work due to symptoms. On meta-analysis, after balloon dilation Eustachian tuboplasty (BDET), 82.5% (n = 30 [95% confidence interval: 42%-100%]) had improvement in ability to valsalva, 79.1% (n = 16 [57.9%-94.1%]) in ability to return to work, and 84.3% (n = 69 [69.8%-94.7%]) in any symptom. Of 25 patients with individual ETDQ-7 scores, 79.1% [51.4, 96.9] had improvements after BDET. For four case series with 36 patients, ETDQ-7 scores decreased by 1.2 [0.7, 1.7] (p < 0.00001). Of 20 patients with preoperative ETDQ-7 scores >2.0, there was a mean decrease of 2.1 [1.3, 2.8] (p < 0.00001). CONCLUSION From the available evidence, Eustachian tube procedures appear to be effective at improving symptoms of baro-challenge Eustachian tube dysfunction. However, higher quality evidence is needed to support making definite recommendations for the use of balloon Eustachian tube dilation or LET for these patients. Laryngoscope, 132:2473-2483, 2022.
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Affiliation(s)
- Mallory J Raymond
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Michael C Shih
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phillip Ryan Elvis
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina Libraries, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Paul R Lambert
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Tang Y, Lou Z, Jin K, Sun J, Deng Y. Comparison of Electrocoagulation Tuboplasty and Continued Medical Therapy for Treating Persistent Eustachian Tube Dysfunction With Hypertrophic Mucosa Disease. Am J Rhinol Allergy 2021; 36:297-306. [PMID: 34796735 DOI: 10.1177/19458924211057353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this trial was to compare outcomes of electrocoagulation tuboplasty and continued medical therapy for treating persistent Eustachian tube dysfunction (ETD) with hypertrophic mucosa disease in the Eustachian tube (ET) orifice. STUDY DESIGN Prospective, case-control trial. MATERIAL AND METHODS Patients with persistent ETD were recruited and allocated to electrocoagulation tuboplasty and continued medical therapy groups. The ETD questionnaire-7 (ETDQ-7) score and objective parameters were compared between the groups at 6 and 12 months. RESULTS The proportion of patients with a decrease in ETDQ-7 scores was greater in the electrocoagulation group than in the medical therapy group at the 6-month follow-up (53.49% and 34.38%, respectively; p = .158), but the difference was not statistically significant. However, at the 12-month follow-up, there was a significantly higher proportion of patients with a decrease in ETDQ-7 scores in the electrocoagulation group (88.37% and 40.63%, respectively; p = .001). Additionally, a significant difference was observed between the groups in terms of the proportion of patients who improved 12 months after the treatment (tympanometry: 72.09% and 9.38%, respectively; p = .001; air-bone gap: 79.07% and 25.00%, respectively; p = .001; tympanic membrane status: 62.79% and 0.00%, respectively). In addition, the proportion of patients with improvements in the ET inflammation score was significantly different between the groups at 6-month (67.44% and 34.38%, respectively; p = .009) and 12-month (93.02% and 34.38%; p = .001) follow-ups. No device- or procedure-related serious adverse events were reported in any patients. CONCLUSIONS Electrocoagulation Eustachian tuboplasty appears to be a safe and feasible procedure for adult persistent ETD with hypertrophic mucosa disease in the ET orifice, and is superior to continued medical management alone. The improvements in ETDQ-7 and objective parameters persisted for 12 months.
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Affiliation(s)
- Yongmei Tang
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Zhengcai Lou
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Kangfeng Jin
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Junzhi Sun
- Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Yue Deng
- Changzheng Hospital, Naval Medical University Shanghai, Shanghai City, China
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Lou Z, Lou Z, Sun J, Chen Z, Yin S. Microwave ablation eustachian tuboplasty: a preliminary investigation with long-term follow-up. J Otolaryngol Head Neck Surg 2021; 50:39. [PMID: 34167591 PMCID: PMC8223355 DOI: 10.1186/s40463-021-00520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to evaluate the efficacy of microwave ablation (MWA) eustachian tuboplasty for the treatment of patients with retracted tympanic membrane (TM) due to eustachian tube dysfunction (ETD). Methods This was a prospective study of 20 patients with ETD (middle ear atelectasis) who underwent MWA eustachian tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, audiometry results, tympanometry results, ETD Questionnaire (ETDQ-7) score, and TM status. Results Eighteen patients (18 ears) were included in this study. There were statistically and clinically significant improvements in the mean ETDQ-7 score at 6 months postoperatively (change in mean score of 16.7 ± 3.6, P < 0.001) and at 30 months postoperatively (change in mean score of 18.9 ± 2.9, P < 0.001). Type A tympanogram was obtained in 27.8% of patients (5/18) at 6 months postoperatively, and in 77.7% at 30 months postoperatively. A Valsalva maneuver was possible in 72.2% of patients at 6 months postoperatively and in 88.9% of patients at 30 months postoperatively. In addition, the ears of 13 patients (72.2%) showed both normal tympanograms and TM at 30 months postoperatively. Interestingly, 38.5% of patients (5/13) exhibited complete sclerosis of the pars tensa. None of the patients experienced severe MWA-related complications during follow-up. Conclusions MWA eustachian tuboplasty is a feasible alternative to conventional tuboplasty, and can improve subjective and objective outcomes in patients with ETD for up to 30 months following treatment. In addition, this study showed that the extent of sclerotic plaque increased over time, whereas the extents of atrophy and tensa retraction decreased following tuboplasty in most patients. Graphical abstract ![]()
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China. .,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
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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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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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Eustachian tube balloon dilatation: a cross-sectional, survey-based study of 137 UK consultants. The Journal of Laryngology & Otology 2019; 134:41-45. [DOI: 10.1017/s0022215119002561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction.MethodA 10-question online survey was distributed to ENT consultants currently practising in the UK (July–September 2018).ResultsA total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years’ experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty.ConclusionThe majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines.
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Zeng H, Chen X, Xu Y, Zheng Y, Xiong H. Buteyko breathing technique for obstructive Eustachian tube dysfunction: Preliminary results from a randomized controlled trial. Am J Otolaryngol 2019; 40:645-649. [PMID: 31130270 DOI: 10.1016/j.amjoto.2019.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/25/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the effectiveness of Buteyko breathing technique in patients with obstructive Eustachian tube dysfunction (ETD). MATERIALS AND METHODS Fifty-one patients (77 ears) aged between 21 and 62 years were randomized to Buteyko breathing in conjunction with medical management (nasal steroid) group or medical management alone group. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) symptom scores, tympanogram, positive Valsalva maneuver were evaluated at baseline, 6-week and 12-week follow-up. RESULTS Normalization of ETDQ-7 symptom scores at 6-week follow-up was observed in 30.0% (12/40) of the Buteyko breathing group versus 16.2% (6/37) of the controls (P > 0.05). At 12-week follow-up, the ratio rose to 50.0% (20/40) in the Buteyko breathing group and 24.3% (9/37) in the controls (P < 0.05). Tympanogram normalization at 12-week follow-up was observed in 53.6% (15/28) of the Buteyko breathing group versus 26.9% (7/26) of the controls (P < 0.05). The Buteyko breathing group showed slight improvement in positive Valsalva maneuver at 6- and 12-week follow-up (P > 0.05). CONCLUSIONS Our study shows that Buteyko breathing technique might be an effective adjunctive intervention in treatment of obstructive ETD, especially for those patients who are refractory to medical treatment and cannot afford Eustachian tube balloon dilation surgery.
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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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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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Giunta AA, Liberati L, Pellegrino C, Ricci G, Rizzo S. Eustachian tube balloon dilation in treatment of equalization problems of freediving spearfishermen. Diving Hyperb Med 2019; 49:9-15. [PMID: 30856662 DOI: 10.28920/dhm49.1.9-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Eustachian tube balloon dilation is a minimally invasive surgical procedure used to treat Eustachian tube dysfunction which is not responsive to conventional therapies. METHODS In this cohort intervention series we report the results of balloon dilation in treating refractory equalization problems in 20 freediving spearfishermen; in 19 cases the problem was unilateral and in one case bilateral. All the patients had already received medical and insufflation therapy and four patients had also had nasal surgery. None of these treatments or procedures had achieved improvement. We used a 20 mm x 3 mm disposable balloon catheter inserted through a 70-degree guide catheter and inflated up to 12 ATM three times at three different depths of insertion within the Eustachian tube. Every inflation lasted 120 seconds. RESULTS Fifteen out of 20 patients improved. Ten patients reported a complete resolution of equalization problems, five showed improvement with persistence of a slight equalization delay on the treated side. Five patients did not report any improvement. Two complications occurred: subcutaneous emphysema of the parotid region in one case; and a mild high frequency (4-8 KHz) sensorineural hearing loss in another patient. CONCLUSION Balloon dilation of the Eustachian tube is an effective therapy in the treatment of equalization problems with a good success rate.
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Affiliation(s)
- Antonio Am Giunta
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy.,Corresponding author: Antonio Alberto Maria Giunta, ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy,
| | - Luca Liberati
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| | - Cristina Pellegrino
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
| | - Giampietro Ricci
- ENT Department of Santa Maria della Misericordia of Perugia, Piazza Menghini 1, Perugia, Italy
| | - Santino Rizzo
- ENT Department of Santa Maria Hospital of Terni, Viale Tristano di Joannuccio, Terni, Italy
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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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