What is Eustachian Tube Balloon Dilation?
The Eustachian tubes are the narrow tubes that connect the middle ear (the space behind the eardrum) with the back of the nose. The 3 main functions of the Eustachian tubes are to ventilate the middle ear, protect the middle ear from disease, and help drain secretions away from the middle ear.
The Eustachian tubes are normally closed, but open when we yawn, swallow, or chew, which allows air to flow into the middle ear and mucus to flow out. This equalizes air pressure on either side of the eardrum and keeps the middle ear free of mucus. It also helps the eardrum vibrate, which is necessary for us to hear.
Eustachian tube dysfunction (ETD) can cause symptoms such as fullness in the ear, ear pain, and muffle hearing. In more severe cases, it can lead to a "sucked in" eardrum (tympanic membrane retraction), persistent fluid behind the eardrum, or recurrent infections (recurrent otitis media). Until recently, the treatment for chronic ETD consisted medications or the placement of ear tubes. Eustachian tube balloon dilation (ETBD) is a simple, quick, low-risk procedure that can be performed under a short general anesthetic.
What to do BEFORE surgery
Here are a few things you can do before surgery to help things go more smoothly:
- Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon. Please see this list--Medications to Avoid Prior to Surgery
- Stop smoking at least 3 weeks before your surgery date.
- If you get a chest cold or fever during the 5 days before the surgery, please notify us. A cold may increase the risk from anesthesia.
- Sometimes blood counts and clotting is checked before surgery to make sure you are not at risk of increased bleeding. Labs need to be drawn the week prior to surgery. Your insurance carrier may dictate the lab where the blood is drawn.
- No food 8 hours prior to surgery. No liquids for 4 hours prior to surgery.
- Arrange for a ride home after the procedure
What to Expect During Surgery
Surgery is performed under general anesthesia. With general anesthesia, you will be asleep for the entire surgery. Surgery typically lasts less than 1 hour.
During surgery, a small lighted tube called an endoscope is passed through the nose to the opening of the Eustachian tube. A small catheter is then passed through the nose to where the Eustachian tubes drain. A small balloon is passed through the catheter. The balloon is then gently inserted into the opening of the Eustachian tube and then inflated for two minutes. It is then deflated and removed. Depending on the side of the symptoms, either one or both tubes can be dilated. Often patients with Eustachian tube dysfunction will have nasal inflammation that blocks the Eustachian tubes. This can be addressed at the same time (see Turbinate Reduction). When your surgery is over you will spend some time in the recovery area and then go home.
What to expect AFTER surgery
- Do not try to pop your ears for 1 week following the Eustachian tube balloon dilation.
- Discomfort is typically minimal after the procedure, so if you experience excessive pain please contact us.
- A small amount of nose bleeding may occur
- A sore throat might be expected for a few days.
- Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
- Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain.
What are the risks of Surgery?
As with any surgical procedure, Eustachian Tube Balloon Dilation has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
Bleeding: A slight nosebleed is not uncommon after surgery. Exceedingly rare is the risk of injury to the carotid artery which could cause substantial and possibly life-threatening bleeding.
Infection: It is unusual to have an ear infection after surgery.
Trauma to the Eustachian tube: Minor trauma to the mucosa may occur. Significant injury that causes scarring is unlikely but could block the Eustachian tube which would require tube placement. Very rarely is air introduced into the tissues around the Eustachian tube. In the small number of cases where this has occurred, it settled spontaneously, and did not cause any problems.
Overcorrection of the ETD: This could lead to a chronically open ET (patulous ET) which could cause a troublesome sound in the ear with breathing and possibly and echoing of one’s voice.
Failure to improve: This would either need revision surgery or tube placement.