Endoscopic Balloon Dilatation Of The Eustachian Tube Performed 1st Time

The function of the Eustachian tube is to ventilate and regulate middle ear pressure, thus helping in sound conduction. In conditions like upper respiratory tract infection, nasal allergy, chronic sinusitis, nasal polyp, deviated nasal septum, hypertrophic adenoids, nasopharyngeal tumour, congenital conditions like cleft palate, submucosal cleft palate, Down’s syndrome, the Eustachian tube can be malfunctioning. Patients with Eustachian tube dysfunction usually complain of pain in the ear, difficulty in hearing, popping sensation, ringing sound in the ear, and disturbance in balance. Prolong Eustachian tube dysfunctioning can cause retracted TM, redness of the ear drum and even transudate in the middle ear cavity (fluid behind the eardrum).

An 11-year-old boy came with imapired hearing and blocked sensation of the right ear for six months. On clinical examination, there was fluid in the right middle ear cavity (serous otitis media). He was treated with systemic decongested and mucolytic agent, along with topical steroid nasal spray for one month but did not respond well to the treatment. He then underwent myringotomy and grommet insertion. Following the procedure, he was symptom-free for 17 months. After that, he started having hard time hearing and heaviness in his right ear again. On examination the grommet was already extruded. There was a retraction of the eardrum with fluid in the middle ear cavity. An impedance audiogram and pure tone audiogram were done, which was s/o of type B tympanogram on the right ear with mild conductive hearing loss, respectively. After discussing with the parents, the decision was taken for endoscopic balloon dilatation of the right eustachian tube under GA. The patient was positioned with a 15-degree head turned to the right side with a 15-degree reverse Trendelenburg position. The right nasal cavity was decongested with merocel sponges soaked in 1:1000 adrenaline. The desired decongestion was achieved. The 60-degree ET catheter, along with the balloon inside it, inserted into the right ET. The balloon advanced into the ET and inflated at a pressure of 10 mm H 2 O and kept inside the ET for 2 minutes. After 2 minutes, the balloon deflated. The balloon, along with the catheter withdrawn from the ET. The patient was extubated, and the procedure was completed without any difficulty.

The patient was discharged from the hospital the next day. The patient was reviewed at ENT OPD after 15 days. On revisit in the OPD, according to the patient, there was improvement in all symptoms along with improvement in hearing. A repeat impedance audiogram and pure tone audiogram were done, which suggested a tympanogram on both ears with a pure tone average of 10 dB in both ears. The patient came for a second follow-up one month after the first follow-up, completely symptom-free.

ET dysfunction is a very common health problem in India among children and even adults due to the high incidence of nasal allergy and frequent upper respiratory tract infections. Myringotomy, with grommet insertion, is an old conventional method along with conservative treatment.

Endoscopic balloon dilatation of ET is a newer method of treatment of chronic ET dysfunction, becoming very popular in western countries. With reported 7000 cases performed per year in Germany, it is unfortunately still in the budding stage in India due to its cost. Though showing very promising results in the initial stage, more and more long-term studies are required to accept the procedure nationwide, comparing the cost.