scholarly journals Navigation-Assisted Balloon Eustachian Tuboplasty for Eustachian Tube Dilatory Dysfunction

2020 ◽  
Vol 13 (4) ◽  
pp. 389-395
Author(s):  
Sung-Won Choi ◽  
Seok-Hwan Lee ◽  
Se-Joon Oh ◽  
Soo-Keun Kong
Keyword(s):  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Balloon Catheter ◽  
Treatment Method ◽  
Final Visit ◽  
Topical Steroids ◽  
Insertion Depth ◽  
Image Guided ◽  
Balloon Catheters ◽  
Balloon Eustachian Tuboplasty

Objectives. Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD.Methods. Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients’ symptoms preoperatively and at the postoperative follow-up.Results. Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (<i>P</i><0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient’s final visit at 6 months post-procedure.Conclusion. Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.

Transtympanic balloon dilatation of eustachian tube: a human cadaver pilot study

2012 ◽  
Vol 126 (11) ◽  
pp. 1102-1107 ◽  
Author(s):  
J Kepchar ◽  
J Acevedo ◽  
J Schroeder ◽  
P Littlefield
Keyword(s):  
Computed Tomography ◽  
Eustachian Tube ◽  
Balloon Dilatation ◽  
Balloon Catheter ◽  
Previous Treatment ◽  
Safety Issues ◽  
Carotid Canal ◽  
Balloon Catheters ◽  
Vidian Canal ◽  
Tomography Scan

AbstractObjective:To determine the feasibility and safety of transtympanic balloon dilatation of the eustachian tube.Methods:Transtympanic eustachian tube dilatation was performed on six cadaver heads using balloon catheters. Catheters were placed in each eustachian tube and the head scanned by computed tomography. Randomised, blinded dilatation of one balloon in each head was performed, followed again by a second computed tomography scan. The scans were reviewed by a neurotologist and neuroradiologist who were blinded to previous treatment, and measurable dilatation and incidental damage noted.Results:There was adequate placement of the balloon catheter beyond the bony isthmus in 6 of 10 eustachian tubes. There was one insufficient catheter placement and three adverse placements (one into the petrous carotid canal and two into the vidian canal). Only one dilated tube showed a measurable increase in diameter.Conclusion:This experiment revealed serious safety issues with transtympanic eustachian tube dilatation. Therefore, this approach should not be considered feasible at this time.

scholarly journals A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sung-Won Choi ◽  
Se-Joon Oh ◽  
Yehree Kim ◽  
Min Young Kwak ◽  
Myung-Whan Suh ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Controlled Trial ◽  
Pure Tone Audiometry ◽  
Secondary Outcome ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Multicenter Rct ◽  
Balloon Eustachian Tuboplasty

AbstractTo assess the safety and efficacy of navigation-guided balloon Eustachian tuboplasty (BET) compared to medical management (MM) alone in patients with chronic Eustachian tube dilatory dysfunction (ETD). This is a prospective, multicenter, 1:1 parallel-group, randomized controlled trial (RCT). It aims to assess the efficacy of navigation-guided BET compared to MM alone in patients with chronic ETD. The primary outcome measure was an improvement in the Eustachian tube dysfunction questionnaire (ETDQ)-7 score at the 6-week follow-up compared with baseline. Secondary outcome measures included changes in the signs and symptoms during the follow-up, changes in the score for each subcategory of ETDQ-7, type of tympanometry, pure tone audiometry, and the availability of a positive modified Valsalva maneuver. Navigation-guided BET was safely performed in all patients. A total of 38 ears of 31 patients (19 ears of 16 patients in the BET group and 19 ears of 15 patients in the control group) completed the planned treatment and 6 weeks of follow-up. More patients in the BET group (1.99 ± 0.85) had less symptomatic dysfunction than in the control group (3.40 ± 1.29) at 6 weeks post-procedure (P = 0.001). More patients experienced tympanogram improvement in the BET group at 6 weeks compared to the control group (36.5% vs. 15.8%) with a positive modified Valsalva maneuver (36.6% vs. 15.8%, P = 0.014). Additionally, air–bone gap change was significantly decreased in the BET group compared to the control group at the 6-week follow-up visit (P = 0.037). This prospective, multicenter, RCT study suggests that navigation-guided BET is a safe and superior treatment option compared to MM alone in patients with chronic ETD.

scholarly journals Balloon eustachian tuboplasty for patients with chronic eustachian tube dysfunction: a novel method for Iranian samples

2020 ◽  
Author(s):  
Mahnaz Mohamadi ◽  
Masoud Motasaddi Zarandy ◽  
Mojtaba Mohammadi Ardehali ◽  
Mina Motasaddi Zarandy
Keyword(s):  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Case Series ◽  
Eustachian Tube Dysfunction ◽  
Type B ◽  
Case Series Study ◽  
Tube Dysfunction ◽  
Novel Method ◽  
Prospective Case Series ◽  
Balloon Eustachian Tuboplasty

Background and Aim: Balloon eustachian tub­oplasty (BET) is a recently developed and app­roved method for management of chronic eus­tachian tube dysfunction (ETD). In the present study we aimed to evaluate the safety and effi­cacy of this method in Iranian samples. Methods: In this prospective case-series study, we included 15 adult patients with chronic ETD who were resistant to previous medical manage­ments and/or ventilation tube use. All patients underwent baseline audiometry (pure tone audio­metry and tympanometry), Valsalva maneuver, EDT questionnaire-7 (ETDQ-7), and physical examination. Three to six months after the BET procedure, all patients underwent four evaluation methods again. Results: We found a significant improvement in the mean ETDQ-7 scores comparing pre- and post-test scores (p < 0.0001). There was also a statistically significant decrease in the average air-bone gap from 40.55 at baseline to 27.22 after treatment (p < 0.001). In the Valsalva test, 17 out of 18 study ears (92.3%) had a positive result after the surgery. Under tympanographic evalu­ation, 9 ears (50%) reported a conversion from type B to type A after treatment, 2 ears (11%) had a conversion from type B to C, and 7 ears (39%) showed no any change and stayed in type B after BET. Conclusion: As a novel method in Iran, BET can be an alternative safe treatment option for chro­nic ETD. Keywords: Balloon eustachian tuboplasty; eustachian tube dysfunction; Iranian

scholarly journals Differentiated approach of using extraction balloon catheters in endoscopic biliary surgery

2021 ◽  
Vol 26 (3) ◽  
pp. 123-134
Author(s):  
A. E. Kotovskiy ◽  
B. M. Magomedova ◽  
K. G. Glebov ◽  
A. A. Martyntsov ◽  
A. K. Mahmudova ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Balloon Catheter ◽  
Main Function ◽  
Biliary Surgery ◽  
Benign Diseases ◽  
Balloon Catheters ◽  
Tumor Lesion ◽  
Endoscopic Extraction ◽  
Design Characteristics

Aim. Expand and determinate indications for using of extraction balloon catheters in endoscopic biliary surgery, as an additional and auxiliary endoscopic technique, which optimizes the technical conditions for performing medical and diagnostic tasks.Material and methods. We used disposable two- and three-lumen extraction balloon catheters with a diameter of 7.5 Fr. The catheters assumed delivery of an extractor balloon along a conductor with a diameter of 0.35 in into the bile duct, and also made it possible to inject a radiopaque substance. 136 retrograde endoscopic interventions were performed on the bile ducts using extraction balloon catheters.Research results. Indications for the use of an extractor balloon have been determined and proposed as a conventional standard. Interventions on the bile ducts were carried out using only a balloon catheter and in combination with a Dormia basket (n = 61). An extraction balloon catheter was used during retrograde endoscopic intervention on the bile ducts as an additional diagnostic endoscopic manipulation to facilitate the performance of the diagnostic task (n = 38). The device was also used to optimize the technical conditions of medical and diagnostic tasks (n = 37). 116 patients had benign diseases, 20 patients had tumor lesion.Сonclusion. The main function of an extraction balloon catheter is to move or displace the contents from the proximal to the distal parts of the bile duct, followed by its extraction into the duodenum. The design characteristics of the instrument make it possible to significantly expand the indications for its use, including not for its intended purpose, but as an additional method, optimizes the technical conditions for performing medical and diagnostic tasks. The endoscopic extraction balloon catheter is a multipurpose instrument that can be used to solve both diagnostic and therapeutic tasks of retrograde interventions on the bile ducts.

Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes

2020 ◽  
Vol 163 (5) ◽  
pp. 870-882
Author(s):  
Michael H. Froehlich ◽  
Phong T. Le ◽  
Shaun A. Nguyen ◽  
Theodore R. McRackan ◽  
Habib G. Rizk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Eustachian Tube Dysfunction ◽  
Significant Difference ◽  
Tube Dysfunction ◽  
Outcome Metrics

Objective To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction. Data Sources PubMed, Scopus, and Google Scholar. Review Methods A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver. Results The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, –3.02 to −1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms ( P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline ( P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term ( P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks ( P < .001) and 55.4% in the long term ( P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline ( P < .001). Conclusion Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.

Balloon Eustachian tuboplasty treatment of longstanding Eustachian tube dysfunction

2017 ◽  
Vol 131 (7) ◽  
pp. 614-619 ◽  
Author(s):  
T Singh ◽  
V Taneja ◽  
K Kulendra ◽  
M Farr ◽  
J Robinson ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Eustachian Tube ◽  
Balloon Dilation ◽  
Primary Outcome Measure ◽  
Eustachian Tube Dysfunction ◽  
Secondary Outcome ◽  
Tube Dysfunction ◽  
Previously Treated ◽  
Objective Outcomes ◽  
Balloon Eustachian Tuboplasty

AbstractBackground:Eustachian tube dysfunction is a poorly defined condition associated with various symptoms and it can predispose to middle-ear disease. Balloon dilation Eustachian tuboplasty has been proposed as a treatment for Eustachian tube dysfunction.Objective:To evaluate the subjective and objective outcomes of balloon dilation Eustachian tuboplasty in patients with recurrent, previously treated chronic Eustachian tube dysfunction.Methods:The study was conducted on 11 patients (13 ears) who had undergone previous unsuccessful medical and surgical treatment. Tympanometry was the primary outcome measure. Secondary outcome measures included pure tone audiogram assessment and seven-item Eustachian Tube Dysfunction Questionnaire score.Results:Balloon dilation Eustachian tuboplasty resulted in significant improvements in 11 patients’ subjective but not objective outcome measures.Conclusion:The objective abnormality and subjective symptoms in Eustachian tube dysfunction may represent two distinct pathological processes, which may nevertheless influence and exacerbate each other.

Comparison of Balloon Dilation and Laser Eustachian Tuboplasty in Patients with Eustachian Tube Dysfunction: A Meta-analysis

2018 ◽  
Vol 158 (4) ◽  
pp. 617-626 ◽  
Author(s):  
Tang-Chuan Wang ◽  
Chia-Der Lin ◽  
Tzu-Ching Shih ◽  
Hsiung-Kwang Chung ◽  
Ching-Yuang Wang ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Balloon Dilatation ◽  
Event Rate ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Outcome Data ◽  
Eustachian Tube Dysfunction ◽  
Improvement Rate ◽  
Tube Dysfunction

Objective We aimed to perform a meta-analysis examining balloon dilatation and laser tuboplasty for the treatment of eustachian tube dysfunction (ETD). Data Sources PubMed, Cochrane, and Embase search up to April 18, 2016, with the following keywords: eustachian, middle-ear, eustachian tuboplasty, balloon tuboplasty, laser tuboplasty, laser dilatation, and balloon dilatation. Review Methods Randomized controlled trials and prospective, retrospective, and 1-arm studies of patients with ETD treated with balloon dilatation or laser tuboplasty were included. Outcome measures were improvement of eustachian tube score (ETS) and tympanometry and Valsalva maneuver results. Results Two retrospective and 11 prospective studies were included (1063 patients; 942 treated with balloon and 121 with laser tuboplasty). Balloon tuboplasty resulted in a significant improvement of ETS (pooled standardized mean difference [SMD], 0.94; 95% confidence interval [CI], 0.23-1.66; P = .009) and, compared with laser tuboplasty, a greater tympanometry improvement rate (pooled event rate = 73% vs 13%; P = .001). Valsalva maneuver improvement rate was not different between the group results (pooled event rate = 67% vs 50%; P = .472). The maximum number of studies that provided outcome data for any one measure was only 4, and sensitivity analysis indicated ETS results may have been overly influenced by 2 studies. No balloon tuboplasty studies reported ETS data, preventing comparison between the 2 procedures. Conclusion Both procedures can improve symptoms of ETD; however, because of the limited numbers of studies reporting data of the outcomes of interest, it remains unclear if one procedure provides greater benefits.

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