EUSTACHIAN TUBE BALLOON DILATION

Eustachian tube dysfunction (ETD) can cause symptoms such as a blocked ear, feeling as if the ear is full of water, clicking noises on swallowing, tinnitus, earache (otalgia), dizziness, disorientation and balance problems. In more severe cases, it can lead to a ‘sucked in’ eardrum (‘tympanic membrane retraction’), glue ear (mucus on the inside of the eardrum) or recurrent infections on the inside of the eardrum (‘recurrent acute otitis media’). Until recently, the treatment of ETD consisted of medicines that were often ineffective, or the insertion of ventilation tubes (grommets). Fortunately, there is a now a means of treating the Eustachian tube itself, with a procedure called Eustachian tube balloon dilation (ETBD). This a simple, quick, low-risk procedure that can be performed under a short general or local anaesthetic.

How is Eustachian tube balloon dilation performed?

In most cases, the operation is performed under a short general anaesthetic. If the operation is being done under a local anaesthetic, a local anaesthetic spray is applied to the nose, followed by some injections of local anaesthetic to completely numb the inside of the nose.

The deflated balloon is then introduced to the back of the nose (nasopharynx) where the Eustachian tubes drain, under the guidance of a small telescope. The balloon is then gently inserted into the opening of the Eustachian tube and inflated for two minutes, before being deflated and removed. Depending on the side of the symptoms, either one or both tubes can be dilated.

What is recovery from Eustachian tube balloon dilation like?

In most cases, you will be able to go home one or two hours after the operation, once you have had something to eat and passed water (urinated). It is not a painful procedure. Occasionally patients experience mild discomfort. If you have had a general anaesthetic you should not drive for two days. You should plan to have a day off work after the procedure.

How successful is Eustachian tube balloon dilation?

As ETBD is a relatively new procedure, there is limited long-term outcome data, However, it has been found that to relieve ETD in the majority of cases.

What are the risks of Eustachian tube balloon dilation?

ETBD is a very safe procedure. Many thousand ETBDs have been performed around the world, with very few complications. There is a very small chance of having a nose bleed or ear infection after the procedure. Very rarely, air has been introduced into the tissues around the Eustachian tube, a condition known as ‘surgical emphysema’. In the small number of cases where this occurred, it settled spontaneously, and did not cause any problems.

If you are fit and healthy, the risks of a general anaesthetic are very small. When a general anaesthetic is not appropriate or not desired, the procedure can be performed under local anaesthetic. Allergic reactions can occur to local anaesthetics, but are unusual.

Are there any alternative treatments to Eustachian tube balloon dilation?

The alternatives to ETBD are simple observation, medicines or ventilation tube insertion (for example grommets). In many cases, Eustachian tube dysfunction will settle of its own accord, so a period of observation is usually appropriate in the first instance. Unfortunately, medicines are not usually effective, however it is sometimes worth trying a low-dose steroid spray in the nose along with some saline washes to help clear thick mucus away from the opening of the Eustachian tubes. If there are associated symptoms of inflammation of the nose or sinuses, these should also be treated.

Ventilation tubes, such as grommets, can be very helpful at alleviating Eustachian tube dysfunction. The disadvantage of grommets is that they usually only stay in place for roughly 9-12 months. When they do fall out, there is about a 2% chance of being left with a hole in eardrum (tympanic membrane perforation). The Eustachian tube dysfunction can also recur after the grommets have come out. Whilst longer term ventilation tubes (for example ‘T-tubes’ or Triune tubes) can be used, the longer they stay in, the greater the likelihood of being left with a hole in the eardrum. The risk of perforation is about 30% with T-tubes. Grommets can be put in at the same time as balloon dilation is performed.