In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Seilesh Babu discuss Eustachian tube dysfunction and balloon dilation as a therapeutic option.

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Acclarent

https://www.jnjmedtech.com/en-US/companies/acclarent

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SHOW NOTES

First, Dr. Babu provides background on Eustachian tube dysfunction. In kids and adults, Eustachian tube dysfunction can present as a sensation of “ear fullness”, recurrent fluid in the ear, or discomfort with pressure challenges, such as flying or scuba diving. Medical management involves nasal steroids, allergy medications, anti-reflux medications, avoidance of allergens, and doing a modified Valsalva maneuver at home. Additionally, ear tubes and balloon dilation are procedural options.

Next, Dr. Babu explains his workup for Eustachian tube dysfunction patients. He takes a thorough patient history and examines the patient’s tympanic membrane, nasopharynx, and serous outflow using a flexible scope. He orders an audiogram for all of his patients but notes that tympanograms are not as critical. For patients with discomfort during pressure challenges, he will consider doing a balloon dilation or placing an ear tube. For patients presenting with “ear fullness”, a more in-depth examination must be done through a trial tympanostomy tube or a myringotomy.

He also looks for red flags, which indicate Eustachian tube dysfunction may not be the correct etiology for their ear symptoms. These red flags include: aggravation of symptoms upon tube insertion, symptoms of dizziness and vertigo, autophony, and pulsatile tinnitus. Although it is rare, a diagnosis of Patulous Eustachian tube dysfunction must be considered. If the patient does not have these red flags and has had multiple ear tubes without symptom relief, they may be a good candidate for balloon dilation.

Dr. Babu then delineates his procedure for a Eustachian tube balloon dilation. He performs this procedure in the OR using the Acclarent AERA Eustachian tube dilation system. He inflates the balloon to achieve a pressure of 12 atm, keeps it dilated for 2 minutes, then removes the instrument. Some procedural pearls he shares are: putting the scope and balloon in at the same time to minimize bleeding in the nasopharynx and guiding the instruments in a lateral direction towards the external ear canal. He usually waits 2-3 weeks before reassessing the patient for recurrent symptoms. Upon discharge, he encourages patients to avoid nose blowing and Valsalva maneuvers, as these actions can cause a pneumothorax or pneumomediastinum. Common postoperative symptoms include minor nose bleeds and the sensation of a sore throat. Dr. Babu usually performs the balloon dilation in conjunction with other OR procedures, such as myringotomies and tympanoplasties, for efficacy.

Finally, the doctors discuss the specifics of billing for the Eustachian tube dilation procedure. In recent years, a specific billing code has been assigned for balloon dilation, and insurance companies are beginning to authorize this procedure for a variety of patients.

Devices discussed in this podcast are currently available in the US only.

Acclarent, Inc. 223616-220810

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RESOURCES

Acclarent:

https://www.jnjmedtech.com/en-US/companies/acclarent

AERA® Esutachian Tube Balloon Dilation System:

https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system

Howard, A., Babu, S., Haupert, M., & Thottam, P. J. (2021). Balloon Eustachian Tuboplasty in Pediatric Patients: Is it Safe?. The Laryngoscope, 131(7), 1657–1662. https://doi.org/10.1002/lary.29241