Balloon dilation for chronic eustachian tube dysfunction

The eustachian tube is a narrow tube that connects the middle ear with the back of the nose. If it is blocked or does not open properly, there can be symptoms such as muffled hearing, pain, a feeling of fullness in the ear, tinnitus or dizziness. The eustachian tube typically becomes blocked after an upper respiratory tract infection or allergic rhinitis. It is usually a temporary problem that resolves spontaneously, but sometimes symptoms persist and treatment is necessary. Long-term eustachian tube dysfunction is associated with damage to the eardrum and middle-ear transformer mechanism.

Medical treatments include oral and nasal corticosteroids, decongestants and antihistamines. Autoinflation is a technique that reopens the eustachian tube by raising pressure in the nose. This can be achieved in several ways, including forced exhalation against a closed mouth and nose.

If eustachian tube dysfunction persists, a tympanostomy tube (also known as a ventilation tube or grommet) may be inserted through a small incision in the tympanic membrane. These typically fall out after several months, and repeated tube insertions may be needed. Some tubes are designed to stay in place for longer, but these can become crusted, infected or obstructed. Tympanostomy tubes may result in a small permanent hole in the tympanic membrane; this is more common with long-lasting tubes.

Balloon dilation of the eustachian tube is done using local or general anaesthesia. A balloon catheter is introduced into the eustachian tube via the nose, under transnasal endoscopic vision. Once the balloon is correctly positioned in the eustachian tube, it is filled with saline up to a pressure of about 10 to 12 bars. Pressure is maintained for about 2 minutes. The balloon is then emptied and removed.

The aim of the procedure is to widen the eustachian tube and improve its function.