What is Eustachian Tube Dilation?

The eustachian tube connects the middle ear to the back of the nose and throat, in the nasopharynx. About one-third of its length is bony (this portion enters into the middle ear), and about 2/3 cartilaginous (this portion enters the back of the nose and throat). The cartilaginous portion periodically opens and closes to allow air to flow into the middle ear from the nasopharynx. This can also occur vice-versa, where air flows from the middle ear back into the nasopharynx to equilibrate the pressure between the middle ear and the outside environment.

Eustachian tube dysfunction causes many types of ear problems, including frequent infections in the middle ear (otitis media), persistent fluid in the middle ear (otitis media with effusion and others. Eardrum skin may become trapped into a retracted pocket and develop into an expanding skin cyst in the middle ear and beyond (cholesteatoma). Eustachian tube dysfunction that doesn’t respond to medical management is currently treated by placement of a ventilating tube through the eardrum.

Ventilation tubes allow air pressure to passively equalize between the middle ear space and the outside environment to try to limit further middle ear problems. Ventilation tubes are usually effective if/when they remain open, but most tubes will eventually fall out of the eardrum or become clogged. Ventilation tubes may need to be replaced multiple times over one’s lifetime. Potential complications of ventilation tubes include further weakening of the eardrum and persistent hole in the eardrum which may need additional surgery to close. Ventilation tubes however do not address the root of the problem, the Eustachian tube dysfunction.

Balloon dilation of the eustachian tube attempts to restore normal function of the eustachian tube, with the goal of no longer needing ventilation tubes. The procedure is FDA approved for use in adults 18 years of age and older. It is typically performed under general anesthesia, and is often performed in conjunction with other procedures. It has been determined that the cause of Eustachian tube dysfunction is in the cartilaginous portion of the eustachian tube. This is the site of dilation with the instrument.

How does the Procedure Work?

To perform this procedure, Ear, Nose, Throat & Allergy Specialist uses endoscopic tools in patients under general anesthesia to thread a balloon catheter through the nose and into the dynamic cartilaginous portion of the Eustachian tube. The catheter is designed so that the balloon can’t enter the bony part of the tube, preventing risks associated with entering that passage.

With the balloon in place, the surgeons inflate it to 12 atmospheres of pressure for two minutes, then remove the catheter. The entire procedure takes just 20 minutes from beginning to end.

Follow-up of patients in the weeks and months after this procedure suggest that their Eustachian tubes remain open more appropriately, allowing better aeration for the middle ear and preventing the recurrent ear infections that are typically prevalent for patients with obstructive Eustachian tube dysfunction. Although the mechanism behind this effect isn’t completely clear, biopsy data from patients after surgery suggests that the balloon dilation crushes the lining of the tube, leading it to heal with a thin layer of fibrous scar tissue that helps prop it open and increases the size of the lumen.

What Should Be Done Before Surgery?

Here are a few things you can do before surgery to help things go more smoothly:

• Eliminate all medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon.
• Cease smoking at least 3 weeks before your surgery date.
• Notify your doctor if you get a chest cold or fever during the 5 days before the surgery. A cold may increase the risk from anesthesia.
• Sometimes blood counts and clotting are checked before surgery to make sure you are not at risk of increased bleeding.
• No food 8 hours prior to surgery.  No liquids for 4 hours prior to surgery.
• Arrange for a ride home after the procedure

What Can Be Expected After Surgery?

After surgery, the following should be expected:

• Discomfort is typically minimal after the procedure.
• A small amount of nose bleeding may occur
• A sore throat might be expected for a few days.
• Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
• Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain.

Success Rates

There are many studies that have demonstrated symptomatic as well as objective clinical improvement in patients undergoing balloon dilation of the Eustachian tube for Eustachian tube dysfunction. Studies have shown the success rate range between 64% to 97% with a complication rate of approximately 2%.

A peer-reviewed study in the August 2018 edition of the Otology & Neurotology journal has also found that “Eustachian tube balloon dilation is a safe and effective treatment for persistent Eustachian tube dysfunction”. Additionally, the study found that “procedures are well tolerated in the office setting under local anesthesia.”