Balloon dilation Eustachian Tuboplasty (BET)

Balloon dilation Eustachian Tuboplasty (BET)

Eustachian tube dysfuntion (ETD) is estimated to occur as a chronic condition in approximately 4% of adult worldwide (Clin Otolaryngol. 1992;17:317-321).

Intrinsic and extrinsic factors in and around Eustachian tube such as inflammation, excessive lymphoid tissues, scarring etc. may lead to ETD. It may lead to hearing loss and chronicity. Hearing loss and its dysfunctions irrespective of their causes determine the quality of life.

Initial treatment targets the potential factors that may lead to ETD and includes pharmaceutical treatment with antihistamine and anti-inflammatory medications and acid suppressant. In cases of failure, the standard of surgical treatment is myringotomy and tympanostomy tube placement. This technique allows equalization of middle ear pressure and drainage of fluid through the middle ear effectively bypassing the Eustachian tube.

Widespread development of the endoscope and introduction of the microcatheters have led to the advancement of minimal invasive interventions in the field of otorhinolaryngology. The development of balloon dilation Eustachian tuboplasty (BET) is an alternative to the ventilation tube insertion which was described by Ockerman and co-workers as a new method for treating ETD in 2010.

Surgery may be appropriate for patients with chronic Eustachian tube dysfuction that is moderately severe and disrupts daily function or in the presence of chronic middle ear fluid that produces hearing loss.

The advancements include

  • New theory about the pathophysiology of ETD stating that the nasopharyngeal end of the tube and not the proximal bony segment is the site of obstruction.
  • New endoscopic equipment for better visualization
  • New tools for enlarging the Eustachian tube opening like laser, microdebriders, dilators: balloons)

Balloon dilation entails:

  • Balloon dilation for dilatory dysfuction:
    • The procedure entails inserting a specially designed catheter with a small balloon at the tip through the nose into the Eustachian tube, inflating it gradually and then withdrawing. (20mm long with 3mm diameter balloon inflated for 2 mins at 10 bar)
    • It can be done either as an outpatient procedure or in the theater.
    • It has a 70% success rate with 15% recurrence rate.
    • It is thought that after dilation, the Eustachian tube opening pressure required for normal Eustachian tube function is reduced
  • Reconstruction of the obliterated Eustachian tube.
    • Procedure involves making a hole in the tympanic membrane, passing a sinus guidewire down the Eustachian tube from ear, opening up the Eustachian tube and inserting a stent.
  • Patulous Eustachian tube repair
    • Catheters preocculded with bone wax is inserted into the full length of the concavity of the Eustachian tube and wedged into the bony cartilaginous isthmus where the tube narrows, holding it in place
    • Hydroxyapatite or collagen fillers can be injected in the submucosa of the Eustachian tube.
  • Obliteration for cerebrospinal fluid leak repair
    • CSF leak occurs in 5-10% of skull base surgeries.
    • It is used for lateral skull base or posterior fossa lesions that results in spinal fluid leak that drips down the Eustachian tube.
    • The lumen is filled with alloderm and oversewn shutAlthough there are commercial companies providing it, The Belfiel Eustachian tube dilation system (Spiggle and Theis, Overath, Germany), the key impediment is the cost of technology and the absence of a technology specifically designed for this purpose.