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Right coronal temporal bone view including the external and middle ear, the cartilaginous and bony portion of the Eustachian tube, and the adjacent muscles.
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Eustachian tube dysfunction is regarded as a "black box" term, reflecting a spectrum of dysfunction. The key to its diagnosis and management is in identifying the aetiology and exact pathophysiology of the dysfunction.
We present our retrospective 5 year results for the technique of transnasal endoscopic balloon dilatation of the cartilaginous part...
Context in source publication
Context 1
... Eustachian tube dysfunction has multiple causes and is a difficult condition to treat. Analysis of the literature suggests that, despite the multifactorial nature of its aetiol- ogy, a common finding in Eustachian tube dysfunction is mucosal and/or cartilaginous functional obstruction of the lower portion of the tube (Fig. 1). This obstruction is potentially amenable to obturation and dilatation. Eusta- chian tube dysfunction, particularly obstructive dysfunction, results in inadequate ventilation of the middle ear and mastoid bone. This may lead to a myriad of symptoms and diseases, such as recurrent acute serous otitis media or chronic otitis media, ...
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Background
Otitis media with effusion (OME) is a common disease in ear, nose, and throat clinics characterized by aural fullness and hearing loss and mainly caused by eustachian tube dysfunction (ETD). Tympanostomy tube insertion (TTI) is a conventional surgical treatment option that can alleviate symptoms but does not provide a definitive cure, an...
Citations
... (2015) которые наблюдали за 622 пациентами (1076 СТ) от двух месяцев до четырех лет после БДСТ. Через 2 и 3 года после БДСТ стабильное улучшение результатов ETDQ-7 имело место у 60% пациентов [60]. ...
Dysfunction of the Eustachian tube (ET) has an incidence 0.9-4,6% in adults and 6.1% in children. Balloon Eustachian tuboplasty (BET) is not the only one treatment for Eustachian tube dysfunction (ETD), but is relatively new. The experience accumulated in the world over 12 years of using BET and the results require a comprehensive assessment, which was objective of this literature review. In this review, ETD refers to its obstructive variant, as the most common, and the only one in which ETD indicated. The article contains actual preoperative diagnostic studies for BET based on international and local clinical guidelines, which contains otomicroscopy, tympanometry, tuning fork tests, tone audiometry, nasopharyngoscopy, functional tests, ETDQ-7 (Eustachian Tube Dysfunction Questionnaire); indications and contraindications for BET are also presented. The options for access to ET, the technical features for performing BET and its modification in terms of the balloon inflation algorithm, exposure time, pressure inside the balloon and the frequency of the procedure are described. At the same time, in studies conducted under the conditions of BET simulation, it was proved that most of the plastic deformation occurs at low inflation pressure, below 5 bar, tissue deformation continues even when the pressure rises to 10 bar, but it is elastic, not plastic in nature. Plastic deformation was observed only during the first inflation, thus, multiple repeated inflations proposed by a number of authors do not increase the clinical efficacy of BET and increase the risk of complications. The article contains possible and documented complications of BET and the frequency of their occurrence, while no study reported serious negative consequences. The effectiveness of BET in the treatment of persistent ETD, in the early and in the long-term periods, more than 50% of any study population. However, it is difficult to assess the results of BET, since the design of studies varies: the differences begin with the definition of BET, the sample of patients and examination methods, and end with different criteria for evaluating the effectiveness of the technique. Further development of appropriate clinical guidelines will allow the maximum standardization of clinical trial planning and simplify the comparison of results and meta-analysis of data. The effect of BET requires further clinical studies in patients with secretory otitis media with respiratory allergies, patients with chronic suppurative otitis media and ETD, patients after ineffective primary BET.
Нарушение функции слуховой трубы (СТ) имеет частоту встречаемости от 0,9 до 4,6% у взрослых и 6,1% у детей. Баллонная дилатация слуховых труб (БДСТ) не единственный метод лечения дисфункции слуховых труб (ДСТ), но сравнительно новый. Накопленный в мире за 12 лет опыт использования БДСТ и полученные результаты требуют всесторонней оценки, что явилось целью данного обзора литературы. В настоящем обзоре под ДСТ подразумевается ее обструктивный вариант как наиболее распространенный и единственный, при котором в настоящий момент показана БДСТ. В статье размещены актуальные данные о предоперационной подготовке пациентов к БДСТ, перечне необходимых диагностических исследований. Так, в международных клинических рекомендациях отмечена необходимость проведения отомикроскопии, тимпанометрии, камертонных тестов, тональной аудиометрии, назофарингоскопии, функциональных тестов, опросник ETDQ-7 (Eustachian Tube Dysfunction Questionnaire). На основании клинических рекомендаций, принятых в разных странах, представлены показания и противопоказания к БДСТ. Основным показанием является обструктивная ДСТ, не поддающаяся медикаментозному лечению. Описаны варианты доступа к СТ, технические особенности методики исполнения БДСТ и ее модификации в части алгоритма раздувания баллона, времени экспозиции, давления внутри баллона и кратности проведения процедуры. При этом в исследованиях, проведенных в условиях моделирования БДСТ, доказано, что бόльшая часть пластической деформации происходит при низком давлении накачивания, ниже 5 бар, деформация тканей продолжается и при повышении давления до 10 бар, но она носит упругий, а не пластический характер. Пластическая деформация наблюдалась только при первом надувании, таким образом, множественные повторные раздувания, предложенные рядом авторов, не увеличивают клиническую эффективность БДСТ и повышают риск осложнений. Представлены возможные и зарегистрированные осложнения БДСТ и частота их встречаемости, при этом ни в одном из исследований не сообщалось о серьезных негативных последствиях. Приведены данные об эффективности БДСТ при лечении стойкой ДТС как в раннем, так и в отдаленном периодах более чем у 50% любой исследуемой популяции. Однако оценка результатов БДСТ затруднительна, поскольку дизайн исследований сильно различается: различия начинаются с определения ДСТ, выборки пациентов и методов обследования, заканчиваются разными критериями оценки эффективности методики. Дальнейшая разработка соответствующих клинических рекомендаций позволит максимально стандартизировать планирование клинических исследований и упростит сравнение результатов и мета-анализ данных. Результат БДСТ остается неясным и требует дальнейших клинических исследований у пациентов с экссудативным средним отитом при респираторной аллергии, пациентов с хроническим гнойным средним отитом и ДСТ, пациентов после неэффективной первичной БДСТ.
... According to our review, there is a dearth of studies that possess robust evidence, including randomization, blinding, and comparability against a gold standard. Furthermore, the selection of the gold standard has yet to be defined [5,21,28]. Furthermore, the method of BDET varied among the studies that were reviewed. Various sizes and inflation pressures of balloons have also been utilized. ...
Purpose
This study aimed to assess the efficacy and safety of ballon dilation of the eustachian tube (BDET) in adult population suffering from Eustachian tube dysfunction (ETD).
Methods
Following PRISMA criteria, a systematic review was conducted by searching PubMed, Cochrane, and Embase databases from January 2015 to March 2024. The primary outcomes included Eustachian Tube Score (ETS), tympanometry, and Valsalva maneuver. The quality of studies was assessed using the Quality in Prognostic Studies (QUIPS) instrument.
Results
Overall, 11 studies were incorporated into the systematic review: two RCTs, three prospective investigations, and six retrospective studies. The balloon dilation in all investigations was performed using either Spiggle & Theis or Acclarent catheters for balloon dilation. There was heterogeneity across studies examining the effect of BDET on persistent ETD in terms of patient selection, period of follow-up, administration of conservative or surgical therapies, and use of assessment methods. Overall, the treatment yielded alleviation of symptoms, which either exhibited stability over time or demonstrated further improvement after an average duration of follow-up. Moreover, the incidence of complications was categorized as low and resolving spontaneously. The majority of the studies exhibited a high risk of bias related to confounding variables, and consequently, the overall risk of bias across most studies was considered high.
Conclusion
The findings suggest BDET holds promise for ETD treatment, reducing symptom severity with minimal complications. Nonetheless, there is a need for improved studies that adhere to established indications, methodologies, and outcomes to establish a more robust body of evidence.
... In addition to tympanoplasty, balloon dilatation is also used for middle ear ventilation. [19,20] This technique involves expanding a balloon catheter within the f lexible cartilage segment of the ET. Preoperatively, HRTCT can measure the lengths of the bone and cartilage sections, as well as the isthmus width, of the ET. ...
Objectives: The study aimed to understand the causes of chronic otitis media (COM) with unilateral or bilateral cholesteatoma by examining the eustachian tube (ET) and mastoid ventilation from preoperative high-resolution temporal computed tomography (HRTCT) scans. Patients and Methods: In this retrospective case-control study, COM patients with cholesteatoma who underwent preoperative HRTCT scanning between January 2021 and December 2023 were analyzed. The study included 102 ears of 51 participants (31 males, 20 females; mean age: 35.7±14.0 years; range, 18 to 65 years). The participants were divided into three groups, each with 17 individuals: unilateral COM with cholesteatoma, bilateral COM with cholesteatoma, and a healthy control group. Variables, including Reid plane-ET angle, tubotympanic angle (TTA), ET length, ET tympanic orifice and isthmus widths, and mastoid ventilation type and volume, were examined in CT images. Results: The mean left TTA (p=0.045) was higher in the unilateral cholesteatoma group compared to the control group (148.88±5.30 and 144.24±6.51, respectively; p=0.045). The bilateral cholesteatoma group exhibited higher values for right and left ET isthmus widths (p=0.015 and p=0.014, respectively). The control group had significantly higher mastoid volumes compared to groups with cholesteatoma (p<0.001). Type 3 mastoid distribution was notably higher in groups with cholesteatoma (p<0.001). In the control group, the mean right and left ET angles were 25.13±3.35° and 24.67±3.38°, respectively. Conclusion: Tubotympanic angle and ET isthmus width may be a potential marker for cholesteatoma. Large-scale studies targeting the anatomy and function of the isthmus in combination with mastoid and ET radiomorphological data and clinical scores using standardized protocols may improve treatment strategies.
... 9 We observed an overall statistically significant improvement in TMM results in the 2 postoperative periods at all pressures (30, 40 and 50 mbar), compared with the baseline results, with a normalization of TMM values (R < 1 at all pressures) in 53.3 and 43.3% of cases in the short-and medium-term, respectively. Schroder et al. performed various studies on this subject, 9,14 including the TMM as a measure to evaluate the results after BET, although integrated in the ETS. They found that there was a significant improvement in ETS in 71% of cases after 2 months of BET (506 dilatation procedures were included) and in 73% after 1 year (188 dilatation procedures were included). ...
Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD).
Objective To evaluate the efficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD.
Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performed a prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up.
Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction ( p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement ( p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short- and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments.
Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.
... Perbaikan lebih lanjut setelah bulan pertama hampir stabil atau hanya sedikit peningkatan yang diamati dengan optimal 2 tahun pasca operasi. 26 Total skor rerata ETDQ-7 secara bermakna berkurang dari awalnya 4,6 (pra-operasi) menjadi 2,1 (p<0,0001) setelah 6 minggu follow-up pasca prosedur BET. Penurunan skor ETDQ-7 ini dipertahankan hingga 12 bulan follow-up (p<0,0001), tidak terdapat penurunan skor yang bermakna dari 6 minggu ke 12 bulan. ...
... Ketakutan akan otalgia atau ketakutan akan perforasi membran timpani dapat membatasi upaya ini. Penggunaan tubomanometer, seperti yang dilakukan oleh Schröder et al 26 akan menghilangkan faktor pengganggu ini. Namun demikian, baik timpanometri maupun tubomanometri hanya membuat gambaran sesaat dari aspek-aspek tertentu fungsi tuba. ...
Eustachian tube dysfunction (ETD) is a common condition complained by patients and most of them are still managed today by medical therapy. Newer management techniques such as Balloon Eustachian Tuboplasty (BET) has been introduced. This study aimed to evaluate the available studies regarding the indications, safety, and efficacy of BET in reducing the symptoms of patients with ETD. This was a systematic review study. A comprehensive literature search was carried out according to PRISMA guidelines, and seven articles were obtained. The follow-up results showed a significant improvement in the ETDQ-7 score and the results of middle ear assessments. Progress observed over 1-12 months confirmed the efficacy and demonstrated the durability of the BET procedure, without complications that occurred during follow-up. In conclusion, based on the literature review the procedure BET was found to be safe and efficient in the short and long terms up to five years post operatively in patient with chronic ETD. Keywords: Balloon Eustachian Tuboplasty; Eustachian tube dysfunction Abstrak: Disfungsi tuba Eustachius (ETD) merupakan kondisi yang umum dikeluhkan oleh pasien dan sebagian besar masih dikelola saat ini dengan terapi medis. Dewasa ini teknik manajemen yang lebih baru seperti Balloon Eustachian Tuboplasty (BET) telah diperkenalkan. Penelitian ini bertujuan untuk mengevaluasi studi-studi yang tersedia mengenai indikasi, keamanan, keberhasilan BET dalam mengurangi gejala pasien ETD. Jenis penelitian ialah suatu systematic review. Pencarian literatur dilakukan secara komprehensif sesuai dengan pedoman PRISMA. Hasil penelitian mendapatkan tujuh artikel untuk dilakukan tinjauan sistematis. Hasil follow-up dari semua peserta yang menjalani BET menunjukkan peningkatan bermakna berdasar-kan skor ETDQ-7 dan hasil penilaian telinga tengah. Perkembangan selama 1-12 bulan menunjuk-kan kemanjuran dan daya tahan prosedur BET tanpa disertai komplikasi berat yang muncul selama masa follow-up. Simpulan penelitian ini ialah prosedur BET dilaporkan aman dan efektif dalam jangka pendek dan jangka panjang hingga mencapai lima tahun pasca operasi pada pasien dengan ETD kronis. Kata kunci: Balloon Eustachian Tuboplasty; disfungsi tuba Eustachius
... 12 Since then, several studies on the results of BET have been published, but the indications of the operation are still controversial. 3,6,[13][14][15][16] The complications reported are mostly minor and reversible 14,17,18 and their incidence in a meta-analysis was 2%. 6 The aim of this study was to evaluate the outcome of the first series of BET performed in our tertiary referral hospital. ...
... 12 Since then, several studies on the results of BET have been published, but the indications of the operation are still controversial. 3,6,[13][14][15][16] The complications reported are mostly minor and reversible 14,17,18 and their incidence in a meta-analysis was 2%. 6 The aim of this study was to evaluate the outcome of the first series of BET performed in our tertiary referral hospital. ...
... Complication rates vary between 0.3% and 21%. 3 Nonetheless, BET seems to be safe and the complications reported are mild and reversible; minor nasal bleeding, mucosal laserations, local emphysema in the parotid region, hemotympanum, or temporary increase of tinnitus. 14,17,18 The usefulness of preoperative computer tomography (CT) to avoid critical carotid artery damage is limited. 22 ...
Background:
Eustachian tube dysfunction affects from 1% to 5% of adults. This study evaluates the effectiveness of balloon dilation of eustachian tube for treating nonselected patients with eustachian tube dysfunction in a long term.
Methods:
We evaluated all balloon dilation of eustachian tube operations at Turku University Hospital from 2013 to 2016. The data from 107 patients and 167 ears were collected retrospectively and a questionnaire was sent to these patients regarding their symptoms.
Results:
An evident reduction of the symptoms was noticed. Aural fullness, otalgia, recurrent acute otitis media, or otitis media with effusion as well as symptoms from changes to ambient pressure and the ability to do the Valsalva maneuver were significantly improved. The mean followup time with the questionnaire was 33 months. Of patients, 80% (36/45) reported long-term reduction of symptoms.
Conclusions:
In our study, balloon dilation of eustachian tube seems to have reduced symptoms of eustachian tube dysfunction and the results appear to be long lasting.
... [9][10][11] In refractory cases, Eustachian tube balloon dilation (ETBD) has emerged as a promising surgical treatment. 6,[12][13][14][15][16][17][18] Although prior randomized controlled trials have demonstrated the safety and efficacy of ETBD, little is known about factors predicting treatment success. 6,[12][13][14]18 The identification of such predictive variables may provide important implications in the selection of appropriate candidates for ETBD. ...
... Nevertheless, since we observed significant improvement in ETDQ-7 score from pre-to post-ETBD, our data supports the consensus in the literature that there is a significant symptomatic benefit of ETBD. 14,16,18 Few to no studies have investigated predictors of ETBD outcomes. The most similar study we could identify in the literature was a small-scale comparative analysis of ETDQ-7 score before and after functional endoscopic sinus surgery among 60 patients with CRS. 29 This study found high preoperative ETDQ-7 scores (≥4) to be independently associated with ETDQ-7 normalization (<2.1) in patients undergoing endoscopic sinus surgery. ...
Objective
This study aims to identify clinical predictors of treatment response to Eustachian Tube Balloon Dilation (ETBD) as measured by changes in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores.
Methods
One hundred thirteen patients who underwent ETBD at an institution from 2017 to 2021 completed ETDQ-7 pre- and post-operatively. We conducted multivariable regression analyses with ETDQ-7 normalization (<2.1 post-op), minimum clinically important difference (MCID) (>0.5 pre-op – post-op), and quantitative improvement in ETDQ-7 score as outcome variables. Pre-operative ETDQ-7 score, tympanogram type, chronic otitis media, chronic rhinosinusitis (CRS), inferior turbinate hypertrophy, deviated septum, allergic rhinitis, and rhinorrhea were included as covariates. Models controlled for age, sex, ethnicity, prior ear or sinus surgery, and follow-up duration.
Results
The mean age was 49 years old. 51% were females, and all patients had pre-operative ETDQ-7 above 2.1. After a mean follow-up period of 13 months, 77% achieved MCID and 37% had normalized. Higher pre-operative ETDQ-7 score was associated with greater ETDQ-7 score improvement (B = 0.60, 95% CI = [0.37, 0.83]) and greater odds of achieving MCID (aOR = 1.65; 95% CI = [1.06, 2.59]). A history of CRS improved chances of achieving MCID (aOR = 4.53; 95% CI = [1.11, 18.55]) and a history of chronic otitis media predicted increased odds of ETDQ-7 normalization (aOR = 2.88; 95% CI = [1.09, 7.58]).
Conclusions
Our findings suggest that ETBD was highly effective among patients with pre-operative ETDQ-7 above 2.1. Furthermore, higher pre-operative ETDQ-7 score, CRS, and chronic otitis media predicted more favorable symptomatic benefit from ETBD. These factors may be important to consider when counseling potential candidates for this procedure.
... Consistently with previously published data, we found improvements in ETS [15,16,18,31], tympanometry [8,11,14,17,[32][33][34] and Eustachian tube function quality of life ( ETDQ-7) [8,11,17,21,28,32,34,35]. In our study, the median ETS improved from 2 (Q25; Q75: 1; 4) before BDET to 6 (Q25; Q75: 2; 8) one year after BDET. ...
... In published studies using the ETS as the primary endpoint, there is an increase in ETS after BDET. In the retrospective study by Schröder et al. [31], the mean ETS increased from 3.13 (± 2.47 SD) before BDET to 5.75 (± 2.76 SD) at one year, in the retrospective study by Xiong et al. [16], the mean ETS was 3.3 (±1.4 SD) before BDET and 7.9 (±1.2 SD) at one year post-BDET. In their prospective study, Dalchow et al. [15] used a composite score similar to the ETS but with only four parameters. ...
... Therefore, it should be part of diagnostic and follow-up criteria for COETD. However, only three recent studies [15,16,31] used this composite score. TMM is still not widely used, partly because of its cost, which may hamper using ETS in clinical studies. ...
Purpose
Balloon dilatation of the Eustachian tube (BDET) is an option for treating chronic obstructive Eustachian tube dysfunction (COETD). In this prospective multicentric study, the main objective was to evaluate the results of BDET in unilateral COETD refractory to medical treatment.
Methods
Adults with unilateral COETD whose Eustachian Tube Score (ETS) was less than 5 despite medical pressure therapy were included. The primary endpoint was the change in ETS measured at 2, 6, and 12 months after BDET. Secondary objectives were the evolution of clinical symptoms assessed by the Eustachian Tube Questionnaire (ETDQ-7), audiometry, tympanometry, and otoscopy changes after BDET.
Results
Twenty-eight patients were included between May 2014 and December 2017 and were treated with BDET without adverse effects in three different referral centers. Population’s median age was 52 (Q25; Q75: 24, 82) years. The median follow-up time was 381 (Q25; Q75: 364; 418) days. The median ETS was 2 (Q25; Q75: 1; 4) before BDET. There was a significant improvement in ETS at 2 and 6 months and 1 year after BDET (score at 1 year: 6 (Q25; Q75: 2; 8) (p < 0.0001)). There was a significant, sustained improvement in the ETDQ-7 with a score of 4.21 (Q25; Q75–3.50; 4.79) before BDET and 3.43 (Q25; Q75–2.43; 4.14) (p = 0.0012) at 1 year. There was a suggestive improvement in tympanometry results at 1 year (p = 0.025).
Conclusion
BDET provides an improvement in symptoms and objective measures assessed at 1 year in patients with COETD who have failed medical treatment.
Trial Registration: NCT02123277 (April 25, 2014).
... Some balloons bear a colored indication for the depth of insertion. The balloon is inflated with saline to a pressure that ranges from 8 to 12 bar for one or two minutes [25]. Some articles support an additional round of dilation after 2 minutes [26]. ...
... Many evaluations utilize ET scores in combination with other examinations. Such combined tests include, for example, a score that combines ETDQ-7, tympanometry, and click sounds created by ET opening during swallowing or yawning [25]. In other cases, a combination of examinations that includes Valsalva maneuver, tubomanometry in 30-40-50 mbar, plus click sound of the tube has been used [25]. ...
... Such combined tests include, for example, a score that combines ETDQ-7, tympanometry, and click sounds created by ET opening during swallowing or yawning [25]. In other cases, a combination of examinations that includes Valsalva maneuver, tubomanometry in 30-40-50 mbar, plus click sound of the tube has been used [25]. Another ET score combines ETDQ-7, Valsalva maneuver, and tympanometry [23]. ...
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.
... Until recent years, the understanding of ETD among otolaryngologists was limited, and few treatment options were available [6][7][8][9][10][11]. Surgical management is now available after the introduction of the ET balloon dilation (ETBD) procedure [12]. Since Ockermann et al. reported their first experience with ETBD in 2010 [13], many studies have since reported this procedure to be feasible and safe for the treatment of ETD [14][15][16][17][18][19][20][21]. The reported success rates of ETBD range from 36-80% [16,[21][22][23][24]. ...
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.
