Balloon eustachian tuboplasty - technique, outcome, and indications

Veera Luukkainen

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Normal middle ear function is based on the air-filled middle ear (ME) cleft. The air in the ME is derived from the nasopharynx through the Eustachian tube (ET) and from the mastoid air cell system through transmucosal gas exchange. In chronic ear diseases, aeration is usually impaired because of ET dysfunction (ETD) or because the aeration routes from the mastoid are blocked or both. Balloon Eustachian tuboplasty (BET) aims at improving the function of the ET, thereby facilitating the prevention and treatment of chronic ear diseases. Only individual reports mention performing BET under local anesthesia (LA). However, BET under LA can offer several advantages, including reduced anesthesia-related risks and decreased time needed in the operation room. Although short-term outcomes of BET are promising, more studies focusing on the long-term outcomes of BET, subjective and objective, are warranted. Establishing accepted indications for BET is also necessary. In Study I, we investigated the feasibility of BET under LA by comparing it with endoscopic sinus surgery (ESS) that is routinely performed under LA. The study focused on safety of the procedure and the patients’ experience. The balloon dilation device was Acclarent Aera (Acclarent Inc., Menlo Park, CA, USA) but its import to the EU ceased and, therefore, in Study II, we decided to examine if BET was feasible under LA with other BET devices (TubaVent and TubaVent Short, Spiggle & Theis Medizintechnik GmbH, Overath, Germany). In Study II, we also compared lidocaine-prilocaine cream and cocaine-adrenaline solution in anesthetizing the ET. No adverse effects occurred among the patients treated with BET under LA. Intraoperatively, those treated with Acclarent Aera and TubaVent Short had similar visual analog scale (VAS) scores for pain to those of the ESS group. Compared with ESS patients, TubaVent patients reported significantly more pain and discomfort during BET. No differences emerged between the effects of lidocaine-prilocaine cream and cocaine-adrenaline solution. In Study III, we examined the long-term outcomes of BET in our institution, focusing on the patients’ perspective. The questionnaire study showed that pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged reduced the most, in 75% or more of the patients who had suffered from these symptoms preoperatively. Of all patients, 77% had milder overall ear symptoms after the mean follow-up of 3.1 years. In Study IV, a systematic literature review revealed that the studies on the long-term outcomes of BET were heterogeneous in definition of ETD, selection of patients, duration of follow-up, additional treatments, and chosen outcome measures. Together, data from the studies suggested that BET has a positive long-term effect on chronic ETD symptoms and objective findings. Study IV also presented national indications for BET in adults as proposed by the Finnish Otosurgical Society: chronic bothersome symptoms referring to ETD, ETD symptoms when atmospheric pressure changes rapidly, or recurring serous otitis media. We conclude that BET is safe and feasible under local anesthesia. In addition to regular nasal nerve block anesthesia, both lidocaine-prilocaine cream and cocaine-adrenaline solution are suitable for local anesthesia although room for improvement regarding the anesthesia method still exists. Pain and discomfort scores were similar between the three different BET devices. However, patients treated with TubaVent experienced significantly more pain and discomfort during the operation than patients undergoing ESS. With the knowledge of which symptoms of chronic ETD respond best to BET and with the national consensus on indications for BET, patient counseling and selection can be enhanced. However, more long-term studies – with uniform criteria – on the effect of BET are still needed.
Original languageEnglish
Supervisors/Advisors
  • Jero, Jussi, Supervisor
  • Sinkkonen, Saku Tapani, Supervisor
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-6159-8
Electronic ISBNs978-951-51-6160-4
Publication statusPublished - 2020
MoE publication typeG5 Doctoral dissertation (article)

Bibliographical note

M1 - 136 s. + liitteet

Fields of Science

  • Eustachian Tube
  • +diagnostic imaging
  • +physiopathology
  • Otitis
  • Otitis Media with Effusion
  • Maxillary Sinus
  • +surgery
  • Anesthesia, Local
  • Lidocaine, Prilocaine Drug Combination
  • Cocaine
  • Epinephrine
  • Tympanic Membrane
  • Mastoid
  • Ear
  • Nasopharynx
  • Pain
  • Patient Safety
  • Pressure
  • Middle Ear Ventilation
  • Equipment and Supplies
  • Treatment Outcome
  • 3125 Otorhinolaryngology, ophthalmology

Cite this