The American Academy of Otolaryngology–Head and Neck Surgery recently published a set of clinical statements on the indications for and appropriate use of balloon dilation of the Eustachian tube (BDET) for adult patients (aged 18 years and older) with obstructive Eustachian tube dysfunction (OETD). Published June 4, 2019 in Otolaryngology-Head and Neck Surgery, “Clinical Consensus Statements: Balloon Dilation of the Eustachian Tube” was compiled by a panel of experts in response to the increasing rates of use of this technology for treatment of OETD by otolaryngologists and the need for some guidance given evidence gaps regarding its use.
“Balloon dilation of the Eustachian tube holds promise for the management of OETD, but because it is new territory for most clinicians an official statement was deemed necessary to reduce variations in care and prevent misapplication of this technology,” said Edward D. McCoul, MD, MPH, associate professor and director of rhinology and sinus surgery in the department of otorhinolaryngology at the Ochsner Clinic in New Orleans and a coauthor of the statement. “This statement calls attention to the current state of the literature as interpreted by experts in the field.”
The consensus statement offers 28 specific points of guidance categorized into the areas of patient criteria, perioperative considerations, and outcomes. Dr. McCoul highlighted a number of key areas he thought may be new to otolaryngologists and therefore particularly useful.
Patient criteria: Accurate diagnosis of OETD prior to considering BDET is critical given the variable and nonspecific symptoms that patients may present with. Along with a careful history, the panel emphasized the need to identify any underlying extrinsic causes of OETC such as allergic rhinitis, rhinosinusitis, and laryngopharyngeal reflux for which targeted treatment could also improve OETC. If any of these comorbid conditions are found, the panel recommends treating them prior to offering BDET.
The panel also emphasized the need for nasal endoscopy prior to consideration of BDET. “Nasal endoscopy and tympanometry are important to include when evaluating a patient for the presence of OETD,” said Dr. McCoul, underscoring the need to rule out other causes of ear fullness, including patulous Eustachian tube dysfunction.
Perioperative considerations: The panel underscored that tympanostomy tube placement is not a mandatory prerequisite for performing BDET. In addition, the panel stated that BDET should be considered an alternative to tympanostomy tube placement for treating OETD.
Outcomes: To determine outcomes, the panel noted the most reliable outcome measure is a standardized questionnaire (the Eustachian Tube Dysfunction Questionnaire-7) to record patient-reported symptoms using.
The statement also discusses and highlights clinical areas for which no consensus could be reached. Dr. McCoul highlighted a few: the extent of optimal medical therapy prior to offering BDT remains unclear, and additional objective outcome measures are still needed.
Overall, the consensus statement offers clinicians a guide to what experts currently agree on regarding the role and implementation of BDET for OETD. The authors hope that application of the statements will reduce variation in how BDET is currently used for OETD and increase the quality of care.