One Thousand and One Balloon Dilations of the Eustachian Tube In-Office: Protocol, Outcomes, and Pitfalls.

Abstract

Balloon dilation of the eustachian tube has gained ground in the treatment of chronic dysfunction ranging from severe otitis media with effusion (COME) to the milder barochallenge. Together with concomitant procedures such as balloon sinuplasty or middle ear surgery, the procedure has become increasingly popular as more physicians look for options in-office. This is a retrospective study of the performance of a single surgeon through 7 years, the evolution of the anesthetic protocol, pitfalls, outcomes, and complications in 1001 procedures in-office using local anesthetics. Balloon dilation was performed under local anesthesia since 2017 using first only nasal cottonoids soaked in 2% tetracaine/phenylephrine combined with xylocaine nasal spray, since modified with lidocaine/prilocaine gel and a mild oral sedative and currently finally modified using injections of the sphenopalatine ganglion. The effect was evaluated by otomicroscopy, tympanometry, audiometry, ETDQ-7, and a VAS score with 1 year follow-up. One thousand and one balloon dilations were performed in 511 participants. The results from the ETDQ-7 questionnaires, VAS scores, tympanometry, and audiometry showed a significant improvement after eustachian tube balloon dilation (p < 0.01). Pain scores during procedures in local anesthesia ranged from 7 on a scale from 1 to 10 using the first version of the protocol to 1-2 (only mild discomfort) using injections. Eustachian tube balloon dilation significantly reduced symptoms of eustachian tube dysfunction. Additionally, we found that the procedure using an evolved protocol is well-suited for private practice in-office, using local anesthetics and a mild sedative.