From the Guidelines
Eustachian tube dilation is indicated for patients with chronic Eustachian tube dysfunction (ETD) who have failed medical management, specifically those with persistent symptoms such as ear fullness, pressure, pain, muffled hearing, or recurrent middle ear effusions for at least 3 months despite appropriate medical therapy. The decision to proceed with Eustachian tube dilation should be based on a thorough evaluation of the patient's symptoms and medical history, including documentation of negative middle ear pressure on tympanometry or retracted tympanic membrane on otoscopy 1.
Key Considerations
- Patients should have attempted medical management first, including nasal steroids, oral antihistamines for allergic patients, and a trial of proton pleaders if reflux is suspected
- Traditional interventions like the Valsalva maneuver or politzerization should also have been attempted before considering Eustachian tube dilation
- Contraindications include patulous Eustachian tube, craniofacial abnormalities affecting the Eustachian tube, and acute otitis media
Procedure and Pathophysiology
- The procedure works by mechanically dilating the cartilaginous portion of the Eustachian tube using a balloon catheter, which stretches the tissues and may break adhesions to improve tube function and middle ear ventilation
- This addresses the underlying pathophysiology of ETD, which involves inadequate opening of the Eustachian tube during swallowing or yawning, leading to negative middle ear pressure and associated symptoms
- As noted in a review of the literature on balloon dilatation of the eustachian tube, only uncontrolled case series in adults with OME were identified, with heterogeneous data collection methods and no long-term follow-up 1
Patient Selection
- Candidates for Eustachian tube dilation should have documented evidence of negative middle ear pressure on tympanometry or retracted tympanic membrane on otoscopy
- Patients should also demonstrate failure of traditional interventions like the Valsalva maneuver or politzerization
- The procedure may be considered for adults with persistent symptoms such as ear fullness, pressure, pain, muffled hearing, or recurrent middle ear effusions for at least 3 months despite appropriate medical therapy
From the Research
Indications for Eustachian Tube Dilation
The indications for Eustachian tube dilation are based on the diagnosis of persistent Eustachian tube dysfunction (ETD) that is refractory to medical therapy. The following points highlight the key indications:
- Medically refractory persistent Eustachian tube dysfunction (ETD) 2, 3, 4, 5, 6
- Symptoms of ETD, such as hearing loss, fullness in the ear, and difficulty equalizing ear pressure 2, 3, 4, 5, 6
- Abnormal middle ear assessments, including tympanogram type and tympanic membrane position 2, 3, 4, 5, 6
- Failure to respond to medical management, such as nasal steroids and decongestants 2, 3, 4, 5, 6
Patient Selection
Patient selection for Eustachian tube dilation is crucial to ensure the best outcomes. The following points highlight the key considerations:
- Adult and pediatric patients with chronic ETD can be considered for balloon dilation 3, 4, 5
- Patients with abnormal baseline assessments, such as tympanogram type and tympanic membrane position, may benefit from balloon dilation 2, 3, 4, 5, 6
- Patients who have failed medical management or have recurrent ETD may be good candidates for balloon dilation 2, 3, 4, 5, 6
Key Considerations
The following points highlight the key considerations for Eustachian tube dilation:
- Balloon dilation is a safe and effective treatment for persistent ETD, with a low complication rate 2, 3, 4, 5, 6
- The procedure can be performed in an office setting under local anesthesia, with a high technical success rate 2
- Long-term follow-up data show durable improvements in symptoms and middle ear assessments, with high patient satisfaction 6