Eustachian Tube

Question 1

Indications for Balloon Dilation of the Eustachian Tube: Adult

Answer 1

1) Recurrent otic barotrauma - symptomatic
- Pilots, Stewardesses
- SCUBA Divers
2) Chronic (> 3 months) h/o Eustachian Tube dysfunction as evidenced by:
- Persistent TM retraction with evidence of negative middle ear pressure
- Middle ear atelectasis with evidence of negative middle ear pressure
- Recurrent or persistent otitis media with effusion/serous otitis media

Question 2

Indications for Balloon Dilation of the Eustachian Tube: Pediatric (ages 8-17 years)

Answer 2

1) The patient must be age 8-17
2) Persistent obstructive Eustachian Tube dysfunction from inflammatory pathology, resulting in Chronic Otitis media with effusion
- COME: persistent Otitis Media with Effusion lasting 3 months
3) Refractory to at least one surgical intervention for persistent Obstructive Eustachian Tube Dysfunction
4) Absence of internal carotid artery dehiscence into the eustachian tube lumen or h/o ipsilateral patulous eustachian tube

Question 3

Contraindications for Balloon Eustachian Tuboplasty

Answer 3

1) TMJ disorders (including possible muscle of mastication or joint dysfunction as the source of ear pain and fullness)
2) Symptoms not disabling
3) Dehiscent carotid artery at risk from inadvertent balloon insertion into bony eustachian tube
4) Nasopharyngeal mass (need imaging to r/o a submucosal mass)
5) Fixed middle ear atelectasis without evidence of negative middle ear pressure

Question 4

Complications of Balloon Eustachian Tuboplasty

Answer 4

1) Exacerbation or creation of patulous eustachian tube - patient selection is critical
2) False passage (avoid by slow insertion, no force, direct view of catheter tip passing along anterolateral wall in initial portion of the ET lumen - lumen curves medially before turning laterally)
3) Carotid artery injury (temporal bone CT scan highly recommended preoperatively to evaluate for a dehiscent carotid artery) (Take note of the calibration on the catheter to avoid insertion of balloon beyond 25 mm into the lumen, risking entry into the bony eustachian tube)
4) Cervicofacial and/or mediastinal emphysema (avoid nose blowing or Valsalva maneuver for 1 week postoperatively - usually due to false passage or mucosal tear)
5) Nasal mucosal injury
6) Tympanic membrane perforation (avoided by assuring that the lumen of the catheter, if present, is patent and does not have a false passage. Slow insertion into the ET lumen and slow inflation of the balloon)
7) Bradycardia during inflation (inflate no faster than 1 atm/s)

Question 5

Medical Treatment For Patulous Eustachian Tube Dysfunction

Answer 5

Premarin Nasal Spray:
1) 25mg of Premarin in 30mL of Saline
2) 2 Sprays/Nostril TID