Eustachian Tube Balloon Dilation

What is it?

 A tiny tube is passed through the nose or mouth into the eustachian tube, which connects the ear to the back of the throat.

 

Who benefits from this treatment?

Those who have trouble equalising their ears when flying or diving. Adults and older children who have long term problems with otitis media (glue ear and or recurrent ear infections), but who do not have significant structural damage to their ear drums. Subject to various criteria, the procedure is covered by most health insurance companies.

​

What's involved?

The procedure is performed under a general anaesthetic, although there is no pain from the procedure. There is always some degree of throat irritation, typically for a few days as a result of the anaesthetic breathing tube ( endo tracheal tube) which is placed by the anaesthetist for the procedure. The catheter is passed into the eustachian tube, guided by a mirror in the back of the mouth. A 2 cm balloon at the end of the catheter is inflated for 2 minutes, and then withdrawn.  After waking up, most people are able to return home within two hours.They will need someone to drive them home following the sedative effects of the anaesthetic and should not drive for 24 hours. It may take two to four weeks before the ear begins to clear. During this time, eustachian tube exercises ("equalising" or "popping the ear") are performed regularly.

​

How well does it work?

Scientific papers published so far, show that up to 40-50% of adults with long term eustachian tube problems, who are only able to be treated by different forms of grommets or other surgery, may benefit, following three randomised trials. We also have less reliable cohort studies which compare treatment with eustachian tube balloon dilation with historic expected outcomes.  Most adults who I see with long term problems with their eustachian tubes, have only standard or long acting grommets as an option for treatment, or alternatively, extra tympanic (sometimes known as sub annular) grommets. While these all work well, treatment needs to be repeated, often on an annual basis for standard grommets, and there is always the small risk of leaving a perforation in the ear drum when the grommet extrudes. While the development of a perforation may then mean no more grommets would be required (because , in effect, there would now be a permanent grommet), there is always some hearing loss associated with an ear drum perforation. In addition, with a grommet or a perforation, the ear is not "waterproof"-- with attendant risks of ear infection or discharge associated with swimming or water exposure.

 

Are there side effects?

• Temporary  (days) development of air in the soft tissues of the neck. This seems to be extremely rare with only 2 or 3 cases reported out of 17,000 dilations performed using one style of balloon. This would be treated with oral antibiotics.

• 1/5000 risk of permanent reduction in inner ear hearing

• Minor, temporary bleeding from the nose may occur, and occasionaly an ear infection may occur afterwards within the first two weeks.

​

Is there any downside?

The main downside is that there is (within certain parameters) no certain way of predicting in advance who might be an ideal candidate for the procedure and who may not. I regard this as a minimally invasive procedure, and if this is unsucessful, typically I would recommend  long term extra tympanic ventilation tube insertion as the next least invasive option.

​

​