New Developments in the Management of Eustachian Tube Dysfunction

Here’s a look at what balloon dilation entails, as well as some other more recent management methods.

Balloon Dilation for Dilatory Dysfunction

Peter Catalano, MD, chief of otolaryngology at St. Elizabeth’s Medical Center, professor of otolaryngology at Tufts University School of Medicine, and medical director of research for Steward Health Care, all in Boston, Mass., was the first to perform this procedure in the U.S. with the technologies currently available. “I developed a way to anesthetize the Eustachian tube lumen for in-office dilation and replace myringotomy and tube insertion with a simple technique that could also be used as an adjunct to other nasal and sinus surgeries in the operating room,” he said.

In short, the procedure entails inserting a specially designed catheter with a small balloon at the tip through the nose and into the Eustachian tube, inflating it, and then withdrawing it, Dr. McCoul said.

A study of 100 Eustachian tube dilations with follow-ups over two years showed a 70% success rate and 15% recurrence rate (Otol Neurotol. 2012;33:1549-1552). “Repeat dilation is always effective and can easily be done in the office,” Dr. Catalano reported. Approximately 40% of patients were treated in an outpatient clinic and 60% in the operating room.

To date, no one has established how Eustachian tube dilation works. Consensus is that after dilation, the Eustachian tube opening pressure required for normal Eustachian tube function is reduced. Dennis Poe, MD, PhD, associate professor of otology and laryngology at Harvard Medical School and associate in otolaryngology at Boston Children’s Hospital in Boston, and colleagues have shown a significant inflammatory infiltrate in the submucosa of the dysfunctional Eustachian tube lumen, making it feasible that infectious, allergy, or another immune process within the cartilaginous portion may play a larger role than previously appreciated (Laryngoscope. 2014;125:436-441).

The key impediment to more widespread use of balloon dilation is two-fold: the absence of a technology specifically designed for this purpose and the cost of technology. “Several companies are developing Eustachian tube-specific balloon dilation systems, which will hopefully address both of these issues,” Dr. Catalano said. Another problem surfaced when the American Academy of Otolaryngology–Head and Neck Surgery deleted all CPT codes related to Eustachian tube surgery in 2014, stating that they were obsolete. “This leaves the ENT community with no way to obtain reimbursement for the procedure or technology,” he said.

“Nonetheless, balloon dilation is being performed on select patients with Eustachian tube dysfunction who have failed other treatment options,” Dr. McCoul said.