Literature Review: A Roundup of Important Recent Studies

• Transnasal Balloon Catheter Dilation of Eustachian Tube Relieves Ear Pressure
• Fat Graft Myringoplasty Highly Successful in Certain Tympanic Membrane Perforations
• Molecular Testing May Improve Differentiated Thyroid Cancer Diagnoses
• Polysomnography Widely Used in Pediatrics, but Not Up to Practice Guidelines
• Length of Intubation, Number of Sedation Doses Affect Subglottic Stenosis Risk in Children
• Little Difference Between Tetracaine and Lidocaine for Nasal Endoscopy

Transnasal Balloon Catheter Dilation of Eustachian Tube Relieves Ear Pressure

Is there a way to relieve refractory middle ear pressure symptoms from Eustachian tube dysfunction other than through myringotomy and tubes?

Background: About 1 percent of adults in the general population have Eustachian tube dysfunction, and the percentage of these patients in otolaryngology practices is much higher. For patients with nasal symptoms, the standard treatment typically includes nasal steroid spray, antihistamines and decongestants. If there are no concomitant nasal symptoms, a myringotomy with or without a tube is often performed. The recent advent of nasal sinus balloon catheters raises the question of the feasibility of transnasal balloon catheter dilation of the Eustachian tube.

Study design: Prospective, non-controlled.

Setting: Academic practice.

Synopsis: Seventy adult patients underwent 100 Eustachian tube dilations (40 unilateral, 30 bilateral) for symptoms of chronic ear pain, pressure, fullness and otitic barotrauma. Patients were evaluated for temporomandibular joint disease, childhood ear disease and cochlear hydrops, and were excluded if positive. Sixty-three percent of patients had general anesthesia for concomitant procedures, and 37 percent had local anesthesia in the office setting. Overall, 71 percent of 100 ears showed notable improvement or reduction in symptoms, with average follow-up of 30.6 weeks.

Bottom line: Transnasal balloon catheter dilation of the Eustachian tube is in the early stages of development. Several issues, including those surrounding objective outcome measures, the best combination of dilation pressure, the size of the balloon diameter, duration of dilation and more specific indications, need better definition. However, this technique seems feasible and holds promise in properly selected patients.

Citation: Catalano PJ, Jonnalagadda S, Yu VM. Balloon catheter dilatation of Eustachian tube: a preliminary study. Otol Neurotol. 2012;33:1549-1552.

—Reviewed by Larry Lundy, MD

Fat Graft Myringoplasty Highly Successful in Certain Tympanic Membrane Perforations

What are the characteristics of a chronic tympanic membrane perforation that favor an in-office fat graft myringoplasty?

Background: Options for closure of chronic tympanic membrane perforations include cauterization with trichloroacetic acid, paper patches, gelfoam plugs, fat grafts and formal tympanoplasty. The selection of technique and successful outcome depends on multiple factors.