Eustachian Tube Balloon Research Articles

Serial histological changes in the cartilaginous eustachian tube in the rat following balloon dilation.

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.

The mechanism of balloon Eustachian tuboplasty: a biomechanical study

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.

Persistant dysfunction of the eustachian tube: solving the problem

Each person experienced an unpleasant sensation of congestion of the ear during a flight or in rhinorrhea, which is caused by dysfunction of the Eustachian tube (ET). People with persistent ET dysfunction live with this sensation for months and years. Persistent ET dysfunction in children reaches 40%, in adults it is up to 5%. Most of the pathological conditions of the middle ear, leading to socially significant hearing loss, and the main reasons for failures in hearing-improving operations are associated with persistent ET dysfunction. The effectiveness of various methods of treating this pathology, despite their large quantity, still remains doubtful due to the lack of clear criteria and golden standard for diagnosis, indications for specific methods and long-term results of treatment. According to the aim of the study a diagnostic and treatment algorithm was developed for persistent ET dysfunction in adults and children. We researched this problem for more than 10 years, and the effectiveness of the proposed diagnostic and therapeutic measures has been statistically proven, both by a large sample of patients and by a long period of observation. Researchers of L. I. Sverzhevsky Research Institute of Otorhinolaryngology have developed a diagnostic algorithm for persistent ET dysfunction, optimized the treatment of persistent dysfunction and recurrent concomitant secretory otitis media, and also determined the indications and methods for conducting ET balloon dilatation in adults and children with persistent ET dysfunction. We improved the functionality results of hearing-improving operations (tympanoplasty) in patients with persistent ET dysfunction. All of the above allowed us to reduce the treatment time for this group of patients by up to 50%, to achieve high clinical efficacy in up to 100%, and to obtain a lasting functionality in hearing-improving operations in 93% of cases.

Cartilage tympanoplasty combined with eustachian tube balloon dilatation in the treatment of adhesive otitis media.

To investigate the simultaneous application of cartilage tympanoplasty combined with eustachian tube (ET) balloon dilatation in the treatment of adhesive otitis media (AdOM). Multicenter, prospective, double-blind, randomized, controlled clinical trial. Patients with AdOM were randomly divided into four groups: control group (conservative treatment), ET balloon dilatation (ETBD) group, cartilage tympanoplasty (CT) group, and cartilage tympanoplasty combined with ET balloon dilatation (ETBD+CT) group. Patients were followed up at 3 months, 6 months, 1 year, and 2 years after treatment, receiving otoendoscopy and pure-tone audiometry, and were evaluated using the Tinnitus Handicap Inventory (THI), visual analogue scale (VAS) for the symptom of ear stuffiness, Chronic Otitis Media Outcome Test (COMOT-15), and eustachian tube scores (ETS). There was no improvement in tympanic membrane (TM) morphology and mean pure-tone air-bone gap (ABG) after treatment in the control and ETBD groups. The postoperative TM morphology was improved in the CT group and ETBD+CT group, although retraction pockets reoccurred in two cases of CT group. Reduced ABG and improvements in ETS, THI, VAS, and COMOT-15 were all achieved in these two groups, but the difference was not statistically significant. Cartilage tympanoplasty combined with ET balloon dilatation could be used as an appropriate surgical technique for AdOM, which could relieve the symptoms of tinnitus and ear stuffiness, and improve postoperative TM morphology, hearing level, ET functions, and quality of life, with low incidence of complications. 2 Laryngoscope, 129:1462-1467, 2019.

Fluoroscopic balloon diameter measurement at different pressures during Eustachian balloon dilation.

To measure the diameter of inflated balloons at different pressures during Eustachian tube (ET) balloon dilation under fluoroscopic guidance. Prospective cohort study. Tertiary academic referral centre. Eighteen patients who underwent ET balloon dilation with use of a balloon catheter, 20mm long and 6mm in diameter, under combined endoscopic and fluoroscopic guidance. Degrees of inflation at three different portions (proximal, middle and distal) of the balloon at controlled pressures (3, 5, 8 and 10 atmospheres [atm]) and at the maximum pressure manually applied. The mean proximal, middle and distal diameters of the inflated balloons were 5.3±0.4mm, 5.3±0.4mm and 4.9±0.5mm at 10atm. The distal diameters were significantly smaller than middle and proximal diameters at all the pressures (P<0.01). When compared to the distal diameter (100%, 4.9±0.5mm) at 10atm, the distal diameters were 73% (3.6±0.6mm) at 3atm, 88% (4.3±0.5mm) at 5atm and 96% (4.7±0.4mm) at 8atm. The distal diameter (4.1±0.3mm) at the maximum pressure manually applied was in between those at 3 and 5atm. The distal diameter of the balloon increased significantly as a function of the pressure and most (88%) inflation occurred at a low pressure of 5atm, which was sufficient to inflate the distal diameter of the balloon more than 3mm. The manual pressurisation could inflate a balloon by as much as could be expected, at between 3 and 5atm.

Balloon Catheter Dilatation of Eustachian Tube

Eustachian tube dysfunction is a common problem and transnasal endoscopic balloon dilation of the Eustachian tube (ET) is a new surgical technique. The goal of this study is to review the evolution of this novel technique and study the preliminary outcomes. Balloon catheter dilation of the 100 Eustachian tubes in 70 adults was performed at a tertiary medical center from January 2009 to January 2011. A 5-mm sinus balloon catheter was endoscopically placed transnasally into the proximal ET to dilate the cartilaginous ET. Cases were reviewed with respect to indications, outcomes, and complications. Of the 100 ETs, ear fullness and pressure were improved in 71% of patients studied for 26.3 weeks (± 3.6). Of 8 patients followed for a minimum of 34 months, 87% reported persistent improvement. One complication is reported. Endoscopic transnasal ET balloon dilation is a novel approach to treating ET dysfunction. Benefits can be durable up to 3 years. This technique holds much promise and merits further investigation.