Abstract
Obstructive Eustachian tube dysfunction (OETD) is a common condition resulting from inadequate opening of the Eustachian tube (ET). A new surgical treatment involves high-pressure inflation of a balloon within the ET, with the aim of dilating the soft tissue structure. However, the mechanical effects of this intervention have not been established, nor the impact of changing device size or other technical parameters. A novel experimental technique allowed quantification of plastic and elastic tissue deformation in model materials and then human cadaver ETs during balloon dilation, based on the measured balloon inflation pressure-volume relationship. Plastic tissue deformation was found to be greater using larger balloons and deeper device insertion, but increasing the inflation pressure had a more limited effect, with most deformation occurring well below the clinically used pressures. Histological assessment of ET tissue suggested that mucosal tearing and cartilage cracking were in part responsible for the mechanical changes. Balloon dilation of the ET has huge potential if found to be clinically effective, but currently there is a need to understand and develop the technique further. The novel methods employed in this study will be valuable in future laboratory and in vivo studies of ET balloon dilation. Pressures are reported in Bar as this unit is used for medical balloon dilation procedures in clinical practice. 1 Bar = 100,000 Pa.Graphical abstract captionDilation of the Eustachian tube for obstructive dysfunction is performed clinically with 3- and 6-mm-diameter balloons of approximately the same overall length. Our data suggest that dilation with a 6-mm balloon causes greater deformation of the soft tissue structure than dilation with a 3-mm balloon. This difference has yet to be demonstrated clinically. Plastic deformation was measured in terms of energy (J) dissipated during balloon inflation.
Highlights
Obstructive Eustachian tube dysfunction (OETD) is a common condition resulting from inadequate opening of the Eustachian tube (ET), a structure that is crucial in the ventilation pathway of the gas-filled middle ear
This study demonstrates the effective application of several engineering methods to a clinical problem, where mechanical data have provided an insight into the mechanism of a surgical intervention that can be used to direct clinical assessment and future development
The precise pressure-volume assessment and data analysis employed in this study have not been previously described, but appear to allow quantification of tissue deformation that may be of relevance in the assessment many applications of balloon dilation, such as for vascular or tracheal stenosis
Summary
Obstructive Eustachian tube dysfunction (OETD) is a common condition resulting from inadequate opening of the Eustachian tube (ET), a structure that is crucial in the ventilation pathway of the gas-filled middle ear. Symptoms of OETD affect approximately 0.9% of the UK adult population, but associated middle ear disorders are seen in significantly higher numbers [1]. Clinical results appear to indicate that the procedure is an effective means to reduce symptoms and normalise middle ear pressure [2], in a condition where other medical and surgical interventions have been found ineffective [3]. The principle of dilatation to open an obstructed tube or orifice has been successfully applied for many years in blood vessels and other structures [4]. The part of the ET treated by BET is formed largely from a glandular soft tissue lining (mucosa and submucosa) and a cartilage skeleton, shaped like an inverted-J, that arches over the tube along its length
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