Balloon dilation originated in cardiac catheterization procedures and has become reasonably common in otolaryngology, most notably as balloon sinuplasty. Eustachian tube balloon dilation, however, is a more recent variant of the procedure that was approved for adults by the Food and Drug Administration (FDA) in 2016 and is currently performed only off label in children in the United States.
Explore This IssueApril 2023
But to his surprise, it did.
“The lesson learned is that you have to keep an open mind, because it actually was working much better than we thought it should,” he said. “We observed in our patients that it really was quite remarkable in reducing inflammation.”
Although they didn’t understand the mechanism by which the balloon was working at first, they later performed biopsies and discovered that the balloon was crushing the inflamed mucous membrane and adenoid-like tissue in the submucosa; it was essentially like performing an adenoidectomy on the tissue clogging the Eustachian tube.
“I basically tell people we stumbled on this technology that turns out to be very effective for doing an adenoidectomy in a narrow tube that we previously couldn’t access,” he said.
Before Dr. Poe and his colleagues published their findings in 2011, German otolaryngologist Thorsten Ockermann, MD, and his colleagues published a study on cadavers that concluded that BDET seemed to be a feasible and safe procedure to dilate the Eustachian tube (Otol Neurotol. 2010;31:1100–1103). Dr. Poe was one of many people who helped design the first FDA approved device in the United States. He said that a series of recent meta analyses and reviews have shown very favorable results.
In 2019, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) released a set of clinical statements on BDET use (Otolaryngol Head Neck Surg. 2019;161:6–17); Dr. Poe and rhinologist Edward McCoul, MD, MPH, a professor and vice chair in the department of otolaryngology at Ochsner Medical Center in New Orleans, were among the co-authors. “The most relevant takeaways were related to the diagnosis and identification of Eustachian tube dysfunction,” Dr. McCoul said, “which remains to be fully standardized.”
Some of the areas of consensus in the statements were that audiometry, specifically tympanometry, is required in the assessment. Nasal endoscopy is also strongly encouraged, as well as functional assessment, such as the ability to perform the Valsalva maneuver. All of these, Dr. McCoul said, should be abnormal in obstructive Eustachian tube dysfunction.