Definition & Overview
Eustachian tube dilation is a recently developed technique used for the management of Eustachian tube dysfunction. The condition, which affects less than 1% of the population, can lead to cholesteatoma formation and conductive hearing loss, resulting in a compromised quality of life. In the past, there were few options in the treatment of the said condition, making the introduction of Eustachian tube dilation quite a breakthrough.
Who Should Undergo and Expected Results
The procedure is recommended for those who suffer from Eustachian tube dysfunction, also known as ETD.
The Eustachian tube refers to the narrow passage that runs from the pharynx to the middle ear cavity. It begins at the rear of the nose (near the soft palate) and goes upwards, all the way up to the middle ear. It is around 3 mm in diameter and 35 mm long in adults, with the first two-thirds made up of cartilage and the rest with bone. It is lined with tissue that is similar to that found in the nasal cavity.
The Eustachian tube is responsible for the proper ventilation of the middle ear region in order to maintain normal air pressure in the ears. Without it, the middle ear space would simply be a closed air pocket and very vulnerable to air pressure changes. It is also responsible for draining out any accumulated secretions or debris from the middle ear. The tube’s function, which requires it to open when necessary, is regulated by a number of small muscles located at the back of the throat.
However, some medical issues may cause the tube to remain open, in which case it can become blocked or obstructed. When this happens, the patient is at a higher risk of developing chronic middle ear infections and the tube will lose its ability to effectively regulate the air pressure within the ear, leading to several symptoms such as:
- Ear fullness
- Popping sensation inside the ear
- Moderate to severe ear pain
- Intense pain when experiencing sudden air pressure changes
- Muffled sounds
- Tinnitus or ringing in the ears
- Poor balance
Eustachian tube blockages are commonly caused by:
- Colds or other upper respiratory infections
- Sinus infections* Allergic reactions that can cause the tube’s tissue lining to become swollen
- Enlarged adenoids
- Mass or tumour at the base of the skull or nasopharynx
Blockages are particularly common among young children, whose tubes are narrower and in a more horizontal orientation than adults'. However, some children, such as those born with Down syndrome, may have excessively narrow tubes and are thus at high risk of Eustachian tube dysfunction.
As a blocked Eustachian tube does not function properly, it is likely that the air pressure in the ear will fall below normal levels, causing a vacuum to form inside leading to the fluid to be drawn inwards. This condition is identified as otitis media, a major risk factor for the common middle ear infection called suppurative otitis media.
According to studies, Eustachian tube dilation is effective in up to 70% of adults who suffer from long-term ETD.
How is the Procedure Performed?
In this procedure, an ENT specialist passes a tiny tube through the patient’s nose or mouth and guides it slowly into the Eustachian tube. Once there, the doctor inflates a 2 cm balloon located at the end of the catheter for about 2 minutes to dilate the tube and resolve any blockage issues.
Although not painful, the procedure is performed under general anaesthesia to make sure the patient is completely still throughout. For this reason, patients are placed in a recovery room after the procedure and are discharged a few hours after they wake up. They are not allowed to drive following the procedure and are thus advised to arrange for a ride home.
Patients may still have plugged ears immediately after the procedure, with their ears gradually clearing over a period of two weeks. During this recovery period, the patient is advised to perform Eustachian tube exercises, such as popping the ear.
Possible Risks and Complications
The procedure’s minor side effects include minor nosebleeds, an ear infection within the first two weeks following the procedure, and the temporary development of air particularly in the soft tissues located in the neck. The latter, however, occurs in only 2 to 3 cases out of 17,000 dilations.
There is a very small chance that the tip of the catheter used during the procedure will puncture the carotid artery. This may cause serious bleeding, arterial wall dissection, aneurysm, stroke, or even death. This is prevented by a small bone that separates the Eustachian tube from the carotid artery, but the risk of serious complications is higher in patients who do not have this bone in place.
Williams B., Taylor B., Clifton N., Bance M. “Balloon dilation of the Eustachian tube: a tympanometric outcomes analysis.” Journal of Otolaryngology – Head & Neck Surgery. 2016. https://journalotohns.biomedcentral.com/articles/10.1186/s40463-016-0126-6
Llewellyn A., Norman G., Harden M. et al. ‘”Interventions for adult Eustachian tube dysfunction: a systematic review.” Health Technology Assessment. NIHR Journals Library. 2014 Jul. http://www.ncbi.nlm.nih.gov/books/NBK262265/
Diaz R.C. “Patulous Eustachian tube and Eustachian tube dysfunction.” N Engl J Med 2009; 360:e27. http://www.nejm.org/doi/full/10.1056/NEJMicm073137#t=article