CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(04): 489-495
DOI: 10.1055/s-0043-1769503
Review Article

CT and MRI in the Preoperative Planning of Balloon Dilation of the Eustachian Tube: Literature Review

1   Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
,
1   Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
,
1   Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
› Author Affiliations
 

Abstract

Balloon dilatation of the Eustachian tube (BET) is a surgical treatment method for Eustachian tube dysfunction (ETD), which relieves the symptoms in the majority of cases. However, there are potential intraoperative risks associated with BET; the decision-making process with regard to indications for BET is not standardized up to date. The objective of this study was to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the preoperative planning of BET. The literature review is based on a database search performed in August 2022.

BET is classified into transtympanic and nasopharyngeal. CT of the temporal bone provides good visualization of the site of obstruction, which allows to choose the adequate approach. Transtympanic approach is associated with risks of internal carotid artery damage due to possible carotid canal anomalies. This risk can be prevented with preoperative CT scan of the temporal bone. In case of nasopharyngeal BET, there is no sufficient data considering risks of possible artery damage, although CT can provide accurate measurements of ET. MRI is useful for differential diagnosis of conditions imitating ETD, such as endolymphatic hydrops and nasopharyngeal carcinoma. Thus, it is feasible to perform CT and MRI before BET to personalize the management of ETD patients.


#

Introduction

Balloon dilatation of the Eustachian tube (BET) is surgical treatment method for Eustachian tube dysfunction (ETD). The first evidence of BET efficiency in ETD management was reported in 2009.[1] The procedure of BET involves inflating a balloon catheter inside the cartilaginous part of the ET. The mechanism of subsequent clinical improvement is supposedly associated with mechanical effect on the mucosa. The balloon catheter removes cells that were irreversibly damaged by inflammation, which results in enhanced regeneration of normal tissue. A thin fibrous layer is formed, and the symptoms of dysfunction (muffled hearing, pain, ear fullness, tinnitus and dizziness)[2] [3] are relieved.

Today, BET is the most widely used surgical procedure for ETD; its clinical efficiency has been evaluated in various studies over the last decade.[4] Several researches have proven safety of balloon catheter exposure to the cartilage portion of ET.[5] [6] [7] [8] [9] [10] [11] [12] [13] [14] However, potential intraoperative risks associated with BET have been reported. The risks are primarily mediated by the specific morphology of ET and configuration of the anatomical structures in the surrounding area. The bony portion of ET lies in close proximity to the internal carotid artery (ICA), specifically its petrous segment, which is located in the carotid canal.[15] Excessive insertion of the catheter toward the proximal end of ET increases the risk of artery damage, which is significantly higher in case of structural abnormalities. Inadequate catheter insertion can cause fractures of the thin bone canal with fragment displacement toward the ICA, leading to dangerous bleeding.[16] Medical intervention in proximity to the carotid is known to cause possible plaque dislodgement and intimal tears.[16] These risks might necessitate preoperative imaging of ET and the nearby structures for the purpose of planning the intervention. Radiological diagnostic methods—computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone—provide for efficient preoperative imaging.

Another issue concerning BET is the lack of standardized indication for the procedure. Until now, no defined criteria are specified for the assessment of possible prognostic benefit of BET in patients with ETD. According to the latest meta-analysis, the effect of the procedure is characterized with both subjective and objective improvement in the majority of cases, evaluated with 7-item Eustachian Tube Dysfunction Questionnaire scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver.[8] However, the efficiency of the intervention is subtotal, as the symptoms of ETD do not resolve in 100% of patients. Thus, the role of CT and/or MRI in this regard is crucial, as these methods allow to predict the results of BET and ensure effectiveness and safety of the intervention.

The aim of this review is to determine the role of CT and/or MRI in the management of patients with ETD undergoing BET.


#

Materials and Methods

The search was based on the following keywords: ET, ETD, EBT dilation, CT, and MRI.

The main purpose of this study was to evaluate the necessity of CT and/or MRI in preoperative planning of BET. The literature review was performed on August 30, 2022, as recommended by the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. The following types of studies were included in the review: case reports, systematic reviews, retrospective studies, and prospective studies evaluating the role of CT and MRI in the preoperative management of BET. The authors independently reviewed all abstracts and excluded those that were not relevant to the topic of this study. Studies were included if they met the following inclusion criteria: (1) published articles written in English or German between 2000 and 2021; (2) published articles with full text, written only for the human species; (3) evaluation only for BET; (4) studies related only to ETD. Exclusion criteria included (1) results of other techniques rather than BET and (2) case reports with fewer than two patients.

The literature review was performed by a comprehensive search of PubMed database. The summary of the results using Medical Subject Heading keywords is shown in [Tables 1] [2] [3] to [4].

Table 1

PubMed search results using keywords

Keyword

Database

Total results after inclusion/exclusion criteria

Eustachian tube

PubMed

5,173 results

Eustachian tube dysfunction

PubMed

2,218 results

Balloon dilation

PubMed

15,641 results

CT

PubMed

541,560 results

MRI

PubMed

713,709 results

Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.


Table 2

PubMed cross-match keywords search results

Cross-match keywords

Database

Total results after inclusion/exclusion criteria

Removed results

Nonrelevant

Selected articles

Eustachian tube and balloon dilation

PubMed

177

160

12

5

Eustachian tube dysfunction and CT

PubMed

78

69

3

6

Eustachian tube dysfunction and MRI

PubMed

66

56

7

3

Total

321

285

22

14

Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.


Table 3

Summary of the literature review of CT in the context of BET

Publication date

2012

2016

2019

2019

2015

2013

2020

2014

2020

2020

2018

Authors

Kepchar et al17

Jufas et al16

Kapadia et al19

Kapadia et al19

Tarabichi and Najmi 20

Tisch et al21

Swain et al22

Abdel-Aziz et al23

Lee et al24

El-Anwar et al25

Falkenberg-Jensen et al26

Cadaver/clinical study

Cadaver

Cadaver

Cadaver

Clinical

Clinical

Clinical

Clinical

Clinical

Clinical

Clinical

Clinical

Total number of ears/ patients

6 Cadaveric heads, 10 ears

10 Cadaveric heads, 10 ears

8 Cadaveric heads, 15 ears

100 Patients

51 Patients, 53 ears

1,000 Patients, 2,000 ears

21 Patients, 25 ears, 14 male, 7 female, aged over 18

284 patients, 510 ears

29 patients, aged over 18

100 patients, 200 ears, 50 males, 50 females aged from 18 to 76

69 patients, 97 ears, 29 male, 40 female, mean aged 45

Performing of BET

Yes

Yes

Yes

Yes

No[a]

No[a]

Yes

Yes

No[a]

No[a]

Yes

BET approach

Transtympanic

Transtympanic

Transtympanic

Transtympanic

Nasopharyngeal

Nasopharyngeal

Nasopharyngeal

Imaging

Postoperative CT

Endoscopic guidance

Endoscopic guidance, CT

Endoscopic guidance, CT

Endoscopic guidance, CT

CT

CT

CT

CT

CT

CT

Parameters assessed

Complications

Complications

Complications

complications

Site of ET obstruction

Carotid canal anomalies

Carotid canal anomalies

Carotid canal anomalies

Site of ET obstruction

The bone and cartilage length, total length of ET, and the width and height of the tympanic orifice of ET

Length of cartilaginous part of ET

Complication after BET

Carotid canal trauma (3)

None

None

None

None

Soft tissue emphysema (2)

hypoglossal paresis (1)

Necessity of preoperative CT

Yes

Yes

No

No

Yes

No

No

No

Yes

Yes

Yes

Abbreviations: BET, balloon dilatation of the Eustachian tube; CT, computed tomography.


a Studies, in which BET was not performed, although they indirectly relate to the subject of the current review.


Table 4

Summary of the literature review of MRI in the context of BET

Publication date

2020

2012

2021

Authors

Aydın et al28

Lükens et al29

Bächinger et al32

Cadaver/clinical study

Clinical

Clinical

Clinical

Total number of ears

56 ears, aged from 18 to 65

16 patients, 32 ears, 9 male, 7 female, aged from 26 to 82

2 patients, 3 ears, 2 females, aged 42 and age 51

Performing of BET

No

No

Yes

BET approach

Nasopharyngeal

Imaging

MRI

MRI

Gadolinium-MRI

Parameters accessed

measurement of ET parameters

Reason of ET obstruction

Reason of ET obstruction

Complication after BET

None

Necessity of preoperative MRI

Yes

Yes

Yes

Abbreviations: BET, balloon dilatation of the Eustachian tube; MRI, magnetic resonance imaging.



#

Results

In total, 11 works on the use of CT in the context of BET were analyzed. Of these, three were experimental, performed on cadavers; eight were clinical studies and included patients with ETD (6 studies), healthy volunteers (1 study), and patients whose pathologies were not characterized (1 study). Three studies on the use of MRI in the context of BET were also analyzed.

The data are summarized in [Tables 3] and [4] that include the characteristics of patients (if mentioned; [Tables 3]–[4]). However, due to the small number of elected studies, it is not appropriate to perform statistical analysis; thus, these tables only provide a general impression of the issue, as well as the basis for our conclusions.


#

Discussion

Performing a CT or MRI scan prior to BET is aimed at preventing intraoperative trauma by visualization of ET and surrounding tissues. The most important structure near the bony portion of ET is the ICA, the bony canal of which may have dehiscences. Thus, intraoperative injury to this area will cause profuse bleeding. The risks of such a complication vary for transtympanic and nasopharyngeal BET approaches. Therefore, each method requires a separate discussion.

Role of Temporal Bone CT in Planning Transtympanic BET

Transtympanic approach includes BET as part of surgical intervention on the middle ear. One of the first cadaver studies raised the issue of the safety of this procedure. Transtympanic BET was performed on six cadaver heads (10 ears) under the microscope. No middle ear or skull base pathology was detected before the study. Subsequently, CT of the temporal bones showed that carotid canal trauma occurred in two specimens: one of them was damaged on the right side and the other bilaterally. The damaged specimens had preexisting temporal bone fractures that had not been detected before the intervention. It is noteworthy that during the procedure the catheter misplacement into the carotid canal did not emerge in any way and was recorded only on the postoperative CT scan. These facts reveal significant safety issues of BET performed through tympanic approach and under microscopic control only. Accordingly, there is a likelihood of surgical error associated with lacking data on the surrounding anatomical structures.[17]

Subsequent cadaveric studies have introduced endoscopic guidance as an additional method of control. The course of the catheter was monitored from both protympanic and nasopharyngeal sides of ET, which allowed to completely avoid complications of transtympanic BET. Thus, Jufas et al performed such a procedure in 10 cadaveric heads (10 ears) using dual endoscopic control. No damage to the surrounding anatomical structures was detected. Nevertheless, the authors emphasized the need to ensure complete safety of the ICA. In one of the cases, small dehiscence of the carotid canal was present; in the authors' opinion, this would become a contraindication to surgery in a real patient.[16]

Another cadaveric study also involved transtympanic BET with dual endoscopic control. The authors used CT to detail the course of the ICA regarding ET. Conventional axial CT scan gives the impression that the ICA lies in close proximity to ET in its entire length. CT of the temporal bone with multiplanar reconstruction, on the contrary, allows for a more detailed assessment of the interlocation of these structures, which lie in close proximity only within the small section of the bony part of ET. Therefore, careful endoscopic examination of this area, renders the procedure safe, and preoperative CT unnecessary. BET was performed in 8 cadaveric heads (15 ears) with no damage done to the surrounding structures. The authors stated good endoscopic guidance as the key factor to avoiding complications (in this study 30° rigid endoscope was used).[18]

Thereafter, Kapadia et al also performed transtympanic BET under endoscopic guidance in 100 patients. No bleeding was observed in any case.[19] In addition to endoscopic safety control, the authors emphasize the importance of identifying the site of ET obstruction. As an argument, they cite the results of their own study (2015). Using Valsalva CT and endoscopy, the patency of different sections of ET was studied (CT of the temporal bone was performed simultaneously with the Valsalva maneuver). The authors used data of 51 patients (53 auditory tubes) that underwent middle ear surgery. It was revealed that the most frequent site of ET obstruction in this group was the proximal part of ET close to the protympanum.[20] Authors state that knowledge of the exact location of the ET block defines the choice of either nasopharyngeal or transtympanic approach. It is recommended to combine the intervention with preoperative Valsalva-CT, endoscopic monitoring, and pre- and intraoperative measurement of auditory tube opening pressure.[19]

However, not all authors agree on the need for preoperative imaging. Tisch et al analyzed 1000 CT images (2000 carotid canals) for carotid canal digestion, aneurysms, or other vascular malformations and found none. The authors consider it unreasonable to expose patients to unnecessary radiation and overuse healthcare resources in search for rare anomalies.[21]


#

Role of Temporal Bone CT in Planning Nasopharyngeal BET

Nasopharyngeal BET approach is also used in clinical practice. Currently, there are no studies concerning the likelihood of ICA damage from such approach, rendering the risk only hypothetical. There is also no data on whether CT or MRI should be mandatory used prior to the procedure. The argument here may only be based on the subjective opinion of the authors of clinical trials. Swain et al describe the results of a retrospective study of 21 patients with auditory tube dysfunction that underwent nasopharyngeal BET. A CT scan of the temporal bone before and after the procedure was performed for all patients; no abnormalities or lesions were found. The authors believe that the risks of injury to the ICA in case of nasopharyngeal approach are minimal. There is, therefore, no need to include mandatory CT scanning in the routine preoperative examination.[22]

This opinion is shared by Abdel-Aziz et al. The authors conducted a retrospective study of preoperative CT images of 284 patients with ETD (510 auditory tubes). Carotid canal dehiscence was present in 18 patients (6.3%). In three patients (4 auditory tubes), intervention was not completed due to difficulties with balloon catheter insertion. Only one patient of these had bilateral carotid canal dehiscence. Other two CT scans showed no anatomical anomalies. Three cases of postoperative complications were reported after nasopharyngeal balloon dilatation: two cases of soft tissue emphysema and one case of hypoglossal paresis. However, CT scans of these patients did not reveal any abnormalities. Therefore, it was concluded that preoperative CT scanning is not sufficient to predict possible complications of balloon dilatation. The authors state that the key to ensuring success of the intervention for the healthcare specialist is to be increasingly careful as well as to use a device with an integrated dilatation stop mechanism to avoid too deep catheter insertion. The authors, however, believe that a preoperative CT scan can be useful in the practice of inexperienced surgeons to understand the relationship between the auditory tube and the ICA.[23]

Lee et al on the contrary insist on the visualization of the obstruction site before BET. The authors performed Valsalva-CT with measurement of ET parameters in 29 patients with ETD. Their findings indicate that the location of the narrowed area varies and can include the cartilaginous portion, the bony portion, or the isthmus region. BET is currently aimed at eliminating the obstruction in the cartilaginous part of ET and is performed mostly from nasopharyngeal approach. The authors suggest the necessity to determine the site of obstruction for optimal surgery planning. Preoperative Valsalva-CT aids in the adequate choice between nasopharyngeal or transtympanic approach.[24]

El-Anwar et al, who studied CT efficiency in evaluation of various auditory tube measurements, insist on performing a CT scan before nasopharyngeal BET. CT images of 100 healthy volunteers (200 auditory tubes) were studied and several parameters were measured, including the bone and cartilage length, total length of ET, and the width and height of the tympanic orifice of ET. The authors believe that knowing these parameters is necessary for surgeons to choose the optimal catheter size (e.g., the length of the cartilaginous part was found to be shorter in women than in men) as well as for proper balloon placement (the angle between the auditory tube and the Reid plane is smaller in women than in men).[25]

Falkenberg-Jensen et al also studied the length of cartilaginous part of ET before performing BET. Authors used temporal bone CT scans of 69 patients, who had ETD and underwent BET. The results correlate with the aforementioned study, and suggest a greater cartilage length in men. The authors believe that this information is useful in calculation of the depth of catheter insertion.[26]


#

Role of Temporal Bone MRI in Planning of BET

Several studies have raised the issue of MRI prior to BET. In particular, Aydın et al emphasize the importance of preoperative MRI of cartilaginous portion of ET. The study focused on different cartilage parameters and their features in patients with middle ear pathology (56 ears) in comparison to the control group without middle ear pathology (100 ears). The parameter that correlated with the presence of middle ear pathology was the diameter of the cartilaginous part lumen, measured at the level of isthmus, which is the narrowest part of ET that determines its normal functioning. Reportedly, decreased isthmus diameter is one of the factors known to contribute to otitis media development.[27] For these reasons, the authors considered MRI to be an important part of planning ear surgery, particularly BET. MRI is also a valuable tool for studying and introducing new treatment methods.[28] The advantage of MRI in this case is clearer visualization of the cartilaginous portion of ET, which gives more information about the target area of BET.

Another study illustrates the role of MRI in the differential diagnosis of conditions similar to ETD. This work describes the MRI findings of 16 patients (32 auditory tubes) with clinically confirmed ETD. Five ET blocks were caused by tumor tissue (nasopharyngeal or oropharyngeal carcinoma). In two of the five cases, the tumor had spread to the opposite side (beyond the midline), which caused an obstruction to the opening of both ET.[29]

Another study shows the importance of MRI in the context of differentiation between ETD and endolymphatic hydrops. For example, Meniere's disease associated with increased inner ear pressure (known as endolymphatic hydrops) may present with no clear clinical picture, but isolated symptoms, such as ear fullness, which can mimic ETD.[30] [31] This creates the possibility of wrong diagnosis, which is followed by unnecessary invasive treatment. Such case is demonstrated in the given retrospective study, which reports two cases (women, 42 and 51 years old). The leading complaint was ear fullness: one patient had a unilateral process, with a type “A” tympanogram, and the second patient had a bilateral process with a type “B” tympanogram. Both patients were initially treated for ETD with BET, which proved ineffective. Subsequently, gadolinium-MRI of the inner ear (contrast-enhanced gadolinium MRI) revealed endolymphatic hydrops. The scans of asymptomatic ears showed no pathology. In this case, the misdiagnosis led to excessive invasive treatment. The obtained results raise discussion whether MRI is necessary in preparation for BET.[32]


#
#

Limitations

The authors believe that the expected benefits of CT and MRI before BET have been confirmed in this study, although there is a variety of limitations in this literature review. The limitations of the study are related to the small number of cases, which is therefore difficult to evaluate statistically. Some of the discussed studies are based on subjective assessment. Therefore, it is crucial to conduct a randomized, statistically significant study with a larger sample to assess the feasibility of preoperative imaging.


#

Conclusion

The choice between nasopharyngeal or transtympanic approach for BET depends directly on the site of ET obstruction. CT scan of the temporal bone, especially Valsalva CT, can provide key information. Nasopharyngeal approach is currently indicated for cartilaginous level of obstruction. Transtympanic approach is more adequate if the obstruction site lies in proximity to the bony portion of ET. In our opinion, transtympanic approach is a newer technique that requires further research and is recommended to be performed with simultaneous middle ear surgery. The choice of surgical approach also affects the safety of the technique. In case of transtympanic BET the risk of the ICA damage is conditioned by its proximity to the bony part of ET. Despite the rarity of carotid canal dehiscences and other abnormalities, such findings should be a contraindication for BET and change the tactics of the surgeon. Thus, it is reasonable to perform CT imaging before BET to detect anomalies even if endoscopic control of the procedure is possible.

Both MRI and CT examination are valuable diagnostic tools, especially with regard to cancer alertness. However, MRI is preferable for differentiation between ETD and endolymphatic hydrops. Correct diagnosis is crucial to avoid unnecessary invasive treatment such as BET in patients with pathology unrelated to ETD.

The data provided suggests the feasibility of using CT and MRI as part of the planning of BET. Including these visualization methods in the preoperative examination will aid individualized management of patients with ETD. Despite the lack of information regarding the impact of preoperative CT and MRI on the response to treatment, these methods are certainly useful for selection of BET approach, as well as for differential diagnosis, which increases the effectiveness of treatment.

In general, the success of BET depends on the sufficiency of information about the course of the catheter and the anatomical structure of the ET. Therefore, it is necessary to study not only feasibility of preoperative imaging but also efficiency of intraoperative control of the catheter course (fluoroscopy-guided balloon dilation). Further studies are needed to decide whether fluoroscopic guidance is able to minimize frequency of BET complications.


#
#

Conflict of Interest

None declared.

  • References

  • 1 Holger Sudhoff Dienstort med, Bielefeld Hals-Nasen-Ohren Klinik K, Ockermann T. Die Ballondilatation der Eustachischen Röhre zur Behandlung der obstruktiven Tubendysfunktion; 2010
  • 2 Kivekäs I, Chao WC, Faquin W. et al. Histopathology of balloon-dilation Eustachian tuboplasty. Laryngoscope 2015; 125 (02) 436-441
  • 3 Smith ME, Weir AE, Prior DCC, Cope W, Tysome JR, Sutcliffe M. The mechanism of balloon Eustachian tuboplasty: a biomechanical study. Med Biol Eng Comput 2020; 58 (04) 689-699
  • 4 Llewellyn A, Norman G, Harden M. et al. Interventions for adult Eustachian tube dysfunction: a systematic review. Health Technol Assess 2014; 18 (46) 1-180 , v–vi
  • 5 Formánek M, Formánková D, Školoudík L, Zeleník K, Chrobok V, Komínek P. Effect of balloon Eustachian tuboplasty in adults that only have symptoms of chronic eustachian tube dysfunction, with a 1-year follow-up: prospective clinical trial. Ear Nose Throat J 2020; x: 145561320980199
  • 6 Alper CM, Teixeira MS, Rath TJ, Hall-Burton D, Swarts JD. Change in Eustachian tube function with balloon dilation in adults with ventilation tubes. Otol Neurotol 2020; 41 (04) 482-488
  • 7 Jansen S, Peters N, Hinkelbein J, Klußmann JP, Beutner D, Meyer MF. Subjective and objective effectiveness of eustachian tube balloon dilatation for patients with Eustachian tube dysfunction-evaluation in a pressure chamber. Otol Neurotol 2020; 41 (06) 795-801
  • 8 Froehlich MH, Le PT, Nguyen SA, McRackan TR, Rizk HG, Meyer TA. Eustachian tube balloon dilation: a systematic review and meta-analysis of treatment outcomes. Otolaryngol Head Neck Surg 2020; 163 (05) 870-882
  • 9 Utz ER, LaBanc AJ, Nelson MJ, Gaudreau PA, Wise SR. Balloon dilation of the eustachian tube for baro-challenge-induced otologic symptoms in military divers and aviators: a retrospective analysis. Ear Nose Throat J 2020. Doi: 145561320938156
  • 10 Anand V, Poe D, Dean M. et al. Balloon dilation of the Eustachian tube: 12-month follow-up of the randomized controlled trial treatment group. Otolaryngol Head Neck Surg 2019; 160 (04) 687-694
  • 11 Meyer TA, O'Malley EM, Schlosser RJ. et al. A randomized controlled trial of balloon dilation as a treatment for persistent Eustachian tube dysfunction with 1-year follow-up. Otol Neurotol 2018; 39 (07) 894-902
  • 12 Cutler JL, Meyer TA, Nguyen SA, O'Malley EM, Thackeray L, Slater PW. Long-term outcomes of balloon dilation for persistent Eustachian tube dysfunction. Otol Neurotol 2019; 40 (10) 1322-1325
  • 13 Luukkainen V, Vnencak M, Aarnisalo AA, Jero J, Sinkkonen ST. Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging. Acta Otolaryngol 2018; 138 (02) 122-127
  • 14 Choi SW, Oh SJ, Kim Y. et al. A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty. Sci Rep 2021; 11 (01) 23296
  • 15 Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification. Neurosurgery 1996; 38 (03) 425-432 , discussion 432–433
  • 16 Jufas N, Treble A, Newey A, Patel N. Endoscopically guided transtympanic balloon catheter dilatation of the Eustachian tube: a cadaveric pilot study. Otol Neurotol 2016; 37 (04) 350-355
  • 17 Kepchar J, Acevedo J, Schroeder J, Littlefield P. Transtympanic balloon dilatation of eustachian tube: a human cadaver pilot study. J Laryngol Otol 2012; 126 (11) 1102-1107
  • 18 Kapadia M, Tarabichi M, Najmi M, Hamza M. Safety of carotid canal during transtympanic dilatation of the Eustachian tube: a cadaver pilot study. Indian J Otolaryngol Head Neck Surg 2018; 70 (02) 211-217
  • 19 Kapadia M, Arsiwala Z, Tarabichi M. Endoscopic transtympanic Eustachian tube dilatation: an overview of evaluation methods and dilatation technique. World J Otorhinolaryngol Head Neck Surg 2019; 5 (03) 152-159
  • 20 Tarabichi M, Najmi M. Site of eustachian tube obstruction in chronic ear disease. Laryngoscope 2015; 125 (11) 2572-2575
  • 21 Tisch M, Störrle P, Danz B, Maier H. Zum Stellenwert der Bildgebung vor Tubendilation mit dem Bielefelder Tubenkatheter. HNO 2013; 61 (06) 488-491
  • 22 Swain SK, Janardan S, Mohanty JN. Endoscopy guided Eustachian tube balloon dilation: our experiences. Iran J Otorhinolaryngol 2020; 32 (112) 287-294
  • 23 Abdel-Aziz T, Schröder S, Lehmann M, Gehl HB, Ebmeyer J, Sudhoff H. Computed tomography before balloon Eustachian tuboplasty–a true necessity?. Otol Neurotol 2014; 35 (04) 635-638
  • 24 Lee S, Oh SJ, Choi SW. et al. The usefulness of Valsalva computed tomography as an assessment tool for the Eustachian tube. Am J Otolaryngol 2020; 41 (04) 102499
  • 25 El-Anwar MW, Eldib DB, Nofal AAF, Khazbak AO. Eustachian tube: computed tomography analysis. J Craniofac Surg 2020; 31 (06) 1763-1765
  • 26 Falkenberg-Jensen B, Hopp E, Jablonski GE, Pripp AH, Silvola JT. The cartilaginous Eustachian tube: reliable CT measurement and impact of the length. Am J Otolaryngol 2018; 39 (04) 436-440
  • 27 Grimmer JF, Poe DS. Update on eustachian tube dysfunction and the patulous eustachian tube. Curr Opin Otolaryngol Head Neck Surg 2005; 13 (05) 277-282
  • 28 Aydın N, Saylısoy S, Adapınar B, Arslantas D. A comparative evaluation of the Eustachian tube cartilage between healthy and diseased ears using a 3 Tesla MRI. Pol J Radiol 2020; 85 (01) e581-e585
  • 29 Lükens A, Dimartino E, Günther RW, Krombach GA. Functional MR imaging of the eustachian tube in patients with clinically proven dysfunction: correlation with lesions detected on MR images. Eur Radiol 2012; 22 (03) 533-538
  • 30 Gürkov R, Jerin C, Flatz W, Maxwell R. Clinical manifestations of hydropic ear disease (Menière's). Eur Arch Otorhinolaryngol 2019; 276 (01) 27-40
  • 31 Levo H, Kentala E, Rasku J, Pyykkö I. Aural fullness in Ménière's disease. Audiol Neurotol 2014; 19 (06) 395-399
  • 32 Bächinger D, Eckhard AH, Röösli C, Veraguth D, Huber A, Dalbert A. Endolymphatic hydrops mimicking obstructive Eustachian tube dysfunction: preliminary experience and literature review. Eur Arch Otorhinolaryngol 2021; 278 (02) 561-565

Address for correspondence

Maria Borshchenko
Bachelor of Medicine, Department of Otorhinolaryngology, First Moscow State Medical University named after I.M. Sechenov (Sechenov University); 8, Bldg. 2, Trubetskaya Street, Moscow 119991
Russia   

Publication History

Article published online:
01 June 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Holger Sudhoff Dienstort med, Bielefeld Hals-Nasen-Ohren Klinik K, Ockermann T. Die Ballondilatation der Eustachischen Röhre zur Behandlung der obstruktiven Tubendysfunktion; 2010
  • 2 Kivekäs I, Chao WC, Faquin W. et al. Histopathology of balloon-dilation Eustachian tuboplasty. Laryngoscope 2015; 125 (02) 436-441
  • 3 Smith ME, Weir AE, Prior DCC, Cope W, Tysome JR, Sutcliffe M. The mechanism of balloon Eustachian tuboplasty: a biomechanical study. Med Biol Eng Comput 2020; 58 (04) 689-699
  • 4 Llewellyn A, Norman G, Harden M. et al. Interventions for adult Eustachian tube dysfunction: a systematic review. Health Technol Assess 2014; 18 (46) 1-180 , v–vi
  • 5 Formánek M, Formánková D, Školoudík L, Zeleník K, Chrobok V, Komínek P. Effect of balloon Eustachian tuboplasty in adults that only have symptoms of chronic eustachian tube dysfunction, with a 1-year follow-up: prospective clinical trial. Ear Nose Throat J 2020; x: 145561320980199
  • 6 Alper CM, Teixeira MS, Rath TJ, Hall-Burton D, Swarts JD. Change in Eustachian tube function with balloon dilation in adults with ventilation tubes. Otol Neurotol 2020; 41 (04) 482-488
  • 7 Jansen S, Peters N, Hinkelbein J, Klußmann JP, Beutner D, Meyer MF. Subjective and objective effectiveness of eustachian tube balloon dilatation for patients with Eustachian tube dysfunction-evaluation in a pressure chamber. Otol Neurotol 2020; 41 (06) 795-801
  • 8 Froehlich MH, Le PT, Nguyen SA, McRackan TR, Rizk HG, Meyer TA. Eustachian tube balloon dilation: a systematic review and meta-analysis of treatment outcomes. Otolaryngol Head Neck Surg 2020; 163 (05) 870-882
  • 9 Utz ER, LaBanc AJ, Nelson MJ, Gaudreau PA, Wise SR. Balloon dilation of the eustachian tube for baro-challenge-induced otologic symptoms in military divers and aviators: a retrospective analysis. Ear Nose Throat J 2020. Doi: 145561320938156
  • 10 Anand V, Poe D, Dean M. et al. Balloon dilation of the Eustachian tube: 12-month follow-up of the randomized controlled trial treatment group. Otolaryngol Head Neck Surg 2019; 160 (04) 687-694
  • 11 Meyer TA, O'Malley EM, Schlosser RJ. et al. A randomized controlled trial of balloon dilation as a treatment for persistent Eustachian tube dysfunction with 1-year follow-up. Otol Neurotol 2018; 39 (07) 894-902
  • 12 Cutler JL, Meyer TA, Nguyen SA, O'Malley EM, Thackeray L, Slater PW. Long-term outcomes of balloon dilation for persistent Eustachian tube dysfunction. Otol Neurotol 2019; 40 (10) 1322-1325
  • 13 Luukkainen V, Vnencak M, Aarnisalo AA, Jero J, Sinkkonen ST. Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging. Acta Otolaryngol 2018; 138 (02) 122-127
  • 14 Choi SW, Oh SJ, Kim Y. et al. A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty. Sci Rep 2021; 11 (01) 23296
  • 15 Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification. Neurosurgery 1996; 38 (03) 425-432 , discussion 432–433
  • 16 Jufas N, Treble A, Newey A, Patel N. Endoscopically guided transtympanic balloon catheter dilatation of the Eustachian tube: a cadaveric pilot study. Otol Neurotol 2016; 37 (04) 350-355
  • 17 Kepchar J, Acevedo J, Schroeder J, Littlefield P. Transtympanic balloon dilatation of eustachian tube: a human cadaver pilot study. J Laryngol Otol 2012; 126 (11) 1102-1107
  • 18 Kapadia M, Tarabichi M, Najmi M, Hamza M. Safety of carotid canal during transtympanic dilatation of the Eustachian tube: a cadaver pilot study. Indian J Otolaryngol Head Neck Surg 2018; 70 (02) 211-217
  • 19 Kapadia M, Arsiwala Z, Tarabichi M. Endoscopic transtympanic Eustachian tube dilatation: an overview of evaluation methods and dilatation technique. World J Otorhinolaryngol Head Neck Surg 2019; 5 (03) 152-159
  • 20 Tarabichi M, Najmi M. Site of eustachian tube obstruction in chronic ear disease. Laryngoscope 2015; 125 (11) 2572-2575
  • 21 Tisch M, Störrle P, Danz B, Maier H. Zum Stellenwert der Bildgebung vor Tubendilation mit dem Bielefelder Tubenkatheter. HNO 2013; 61 (06) 488-491
  • 22 Swain SK, Janardan S, Mohanty JN. Endoscopy guided Eustachian tube balloon dilation: our experiences. Iran J Otorhinolaryngol 2020; 32 (112) 287-294
  • 23 Abdel-Aziz T, Schröder S, Lehmann M, Gehl HB, Ebmeyer J, Sudhoff H. Computed tomography before balloon Eustachian tuboplasty–a true necessity?. Otol Neurotol 2014; 35 (04) 635-638
  • 24 Lee S, Oh SJ, Choi SW. et al. The usefulness of Valsalva computed tomography as an assessment tool for the Eustachian tube. Am J Otolaryngol 2020; 41 (04) 102499
  • 25 El-Anwar MW, Eldib DB, Nofal AAF, Khazbak AO. Eustachian tube: computed tomography analysis. J Craniofac Surg 2020; 31 (06) 1763-1765
  • 26 Falkenberg-Jensen B, Hopp E, Jablonski GE, Pripp AH, Silvola JT. The cartilaginous Eustachian tube: reliable CT measurement and impact of the length. Am J Otolaryngol 2018; 39 (04) 436-440
  • 27 Grimmer JF, Poe DS. Update on eustachian tube dysfunction and the patulous eustachian tube. Curr Opin Otolaryngol Head Neck Surg 2005; 13 (05) 277-282
  • 28 Aydın N, Saylısoy S, Adapınar B, Arslantas D. A comparative evaluation of the Eustachian tube cartilage between healthy and diseased ears using a 3 Tesla MRI. Pol J Radiol 2020; 85 (01) e581-e585
  • 29 Lükens A, Dimartino E, Günther RW, Krombach GA. Functional MR imaging of the eustachian tube in patients with clinically proven dysfunction: correlation with lesions detected on MR images. Eur Radiol 2012; 22 (03) 533-538
  • 30 Gürkov R, Jerin C, Flatz W, Maxwell R. Clinical manifestations of hydropic ear disease (Menière's). Eur Arch Otorhinolaryngol 2019; 276 (01) 27-40
  • 31 Levo H, Kentala E, Rasku J, Pyykkö I. Aural fullness in Ménière's disease. Audiol Neurotol 2014; 19 (06) 395-399
  • 32 Bächinger D, Eckhard AH, Röösli C, Veraguth D, Huber A, Dalbert A. Endolymphatic hydrops mimicking obstructive Eustachian tube dysfunction: preliminary experience and literature review. Eur Arch Otorhinolaryngol 2021; 278 (02) 561-565