Sensorineural Hearing Loss After Balloon Eustachian Tube Dilatation

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

Objective

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

Methods

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

Results

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

Conclusion

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

Bacterial diversity of middle ear cholesteatoma by 16S rRNA gene sequencing in China

In this study, the bacterial diversity of acquired middle ear cholesteatoma (MEC) was evaluated to reveal its pathogenesis and provides a guide for the use of antibiotics. Twenty-nine cases of acquired MEC and eight cases of healthy middle ears undergoing cochlear implantation (CI) were evaluated. Full-length 16S rRNA gene sequencing was performed to profile the bacterial communities in lesions and healthy tissues of the middle ear. ACE (P = 0.043) and Chao1 (P = 0.039) indices showed significant differences in alpha diversity (P < 0.05). Analysis of PERMANOVA/Anosim using the Bray-Curtis distance matrix results suggested that the between-group differences were greater than the within-group differences (R = 0.238, P < 0.05, R² = 0.066, P < 0.05). Bacterial community analysis revealed that Alphaproteobacteria at the class level and Caulobacterales and Sphingomonadales at the order level were significantly different (P < 0.05). In the LefSe (Linear discriminant analysis effect size) analysis, Porphyromonas bennonis was elevated, and Bryum argenteum and unclassified Cyanobacteriales were reduced at the species level in MEC (P < 0.05). Fifteen metabolic pathways were found to be significantly different between the two groups by analysing the abundance of metabolic pathways in level 2 of the Kyoto Encyclopaedia of Genes and Genomes (KEGG). Seven and eight metabolic pathways were significantly elevated in the MEC and control groups, respectively (P < 0.05). The role of bacteria in the pathogenesis of acquired MEC was further refined through analysis of metabolic pathways. These findings indicate that the acquired MEC and healthy middle ear contain more diverse microbial communities than previously thought.

Caution in Transnasal Balloon Dilation of the Eustachian Tube: Middle Ear Penetration of Catheter Tip in a Cadaveric Model

OBJECTIVE

To investigate the degree to which transnasal eustachian tube (ET) dilation balloon catheters are able to be passed through the ET in a cadaver model.

PATIENTS AND INTERVENTIONS

A cadaveric study of 8 cadaver heads (16 ears), which underwent transnasal ET insertion with a 3 × 20-mm balloon catheter with transtympanic endoscopic visualization and grading.

RESULTS

Catheter tip incursion into the protympanum or mesotympanum occurred in all ears. Radiological validation was obtained with correlation to published ET length data.

CONCLUSION

Middle ear incursion of balloon catheter tips can be demonstrated in a cadaver model and highlights the ongoing need for both caution in novel surgical techniques and evolution in device design.

Evaluation of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on Eustachian tube function with audiological tests: A randomized clinical trial

OBJECTIVES

Maxillary expansion improves the hearing function. This trial aimed to examine the effects of Eustachian tube function (ETF) with audiological tests in orthodontic patients who underwent rapid maxillary expansion (RME) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) treatment.

METHODS

Forty individuals (mean age = 13.35 years) included in the trial had a healthy eardrum, no history of orthodontic treatment, maxillary constriction, mandibular constriction and were not affected by acute or chronic otitis. Patients were randomly assigned to one of two groups (n = 20 each): the RME protocol or the Alt-RAMEC protocol. ETF was evaluated using Williams' test at three time points: before expansion (T0), after expansion (T1), and in the 3rd month of retention (T2).

RESULTS

In the RME group, Eustachian tube dysfunction (ETD) was observed in 18 of 40 ears before expansion (T0). The RME group showed significant improvement in tube function in the 3rd month of retention (T2) (p = 0.003). In the Alt-RAMEC group, ETD was observed in 22 of the 40 ears at baseline (T0). Significant improvements in tubal function were observed in the Alt-RAMEC group after expansion (T1) (p = 0.008) and in the 3rd month of retention (T2) (p < 0.001). In the RME group, 17 of 18 ears recovered, while in the Alt-RAMEC group, 21 of 22 ears recovered.

CONCLUSION

Eustachian tube function improved in the RME and Alt-RAMEC groups compared to the pre-expansion period.

REGISTRATION

This trial was not registered.

Balloon Eustachian Tuboplasty and Grommet Insertion: A Combined Surgical Treatment for Chronic Suppurative Otitis Media with Eustachian Tube Dysfunction

Objectives. This study aims to evaluate the effectiveness of Balloon Eustachian tuboplasty (BET) and grommet insertion in patients having chronic suppurative otitis media combined with eustachian tube dysfunction (CSOM-ETD). Methods. We evaluated the data of CSOM-ETD patients (n = 96) from January 2019 to January 2021, who were divided into the following groups: 48 cases underwent BET (BET group) and 48 cases underwent BET plus Grommet insertion (BET + Grommet group). The air-bone gap (ABG), Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) score, Eustachian tube inflammation scale, Chronic Otitis Media Outcome Test 15 (COMOT-15), Valsalva maneuver, and patient satisfaction were evaluated after surgery. Results. The postoperative ABG in the BET + Grommet group was better than that in the BET. In addition, the ABG was improved obviously in the BET + Grommet group at 6 and 12 months after the corresponding surgery. Moreover, the Eustachian tube inflammation scale, ETDQ-7, and COMOT-15 scores were reduced after the treatment with the combination of BET and Grommet insertion at 6 and 12 months. The postoperative ETDQ-7 score, Eustachian tube inflammation scale, and COMOT-15 score were lower in the BET + Grommet group than that in the BET group. The percentage of patients who could perform a positive Valsalva maneuver was significantly higher in the BET + Grommet group than that in the BET group at 6 months and 12 months after surgery with increased patient satisfaction. Conclusion. Our results demonstrate that BET plus Grommet insertion showed better treatment efficacy for patients with CSOM-ETD than BET alone via improving the Eustachian tube function hearing outcome and quality of life with less Eustachian tube inflammation.

The Eustachian Tube Dysfunction in Children: Anatomical Considerations and Current Trends in Invasive Therapeutic Approaches

The eustachian tube (ET) has a crucial role in the physiology of the middle ear. Thus, any condition that renders the tube dysfunctional is directly implicated with middle ear pathophysiology, like in the case of acute otitis media and otitis media with effusion. Children are more vulnerable to pathologies of the middle ear, primarily due to the immature development of their eustachian tubes. Otitis media with effusion, apart from being a burden for hearing, with direct consequences for speech development, may also be implicated in cholesteatoma formation. Medical therapy is not practically effective for the treatment of effusion. Moreover, the established surgical approaches, like grommets and adenoidectomy, deal only indirectly with the problem since they are not addressing the dysfunctional ET itself. An emerging interventional approach that intends to restore the function of the tube is the transnasal balloon dilation of the cartilaginous part of the ET. Growing international experience indicates that this promising technique is safe and effective. In the current review, we aim to provide background information on the anatomy, physiology, and pathophysiology of the ET and to present the progress of the balloon dilation technique with emphasis on pediatric patients.

Perilymph Fistula as a Complication of Eustachian Tube Dilation and Tympanoplasty

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.