Balloon dilatation of the Eustachian tube: an evidence-based review of case series for those considering its use

Background: Eustachian tube dysfunction is common and implicated in persistent middle ear disease. Recent studies suggest the promise of balloon dilatation of the Eustachian tube to modify local anatomy and physiology, restoring normal function.

Objectives: A literature review of the outcomes of balloon dilatation of the Eustachian tube was conducted, assessing four criteria (tympanometry, otoscopy findings, Valsalva and subjective symptoms). Outcomes were divided into short term (≤ 6 months) and long term (>6 months). Rates and severity of complications were documented. We also assessed cost, learning curve and requisite training.

Search strategy: Medline via PubMed was consulted with the following search request: 'eustachian tube' OR 'auditory tube' AND 'balloon'. No restrictions were placed on study date, type or language. Non-clinical studies, published abstracts and very small studies (<10 procedures) were excluded.

Results: Our search yielded 24 results and six case series, five of which met the inclusion criteria. Balloon dilatation has been performed on 375 Eustachian tubes (235 patients) and demonstrates clear short-term (<6 month) benefits across all recorded outcome measures in a majority of cases. 69 of 89 (78%) tympanogram profiles recorded preoperatively as abnormal (Type B/C/open) resolved to type A profiles postoperatively. 40 of 46 (87%) otoscopy findings preoperatively reported as abnormal (tympanic membrane retraction, perforation or otitis media with effusion) normalised postoperatively. The ability to perform a consistently positive Valsalva manoeuvre improved from 15 of 139 (11%) to 89 of 139 (64%) cases following dilatation. The two largest studies reported on 210 and 100 procedures and described symptom improvement in 67% of cases at 2 months and 71% at 26.3 weeks, respectively. An overall complication rate of ≈ 3% was observed, and no major adverse events are reported (0%). Cost and learning curve of the procedure were both deemed to be acceptable.

Conclusion: Balloon dilatation of the Eustachian tube appears to be safe, effective and affordable. Like many newly introduced techniques, the evidence remains limited to non-controlled case series, with heterogeneous data collection methods and lacking long-term outcomes. However, short-term data provides promising, consistent results based on objective measures, and when used selectively in patients refractive to maximal existing therapy, balloon dilatation presents a potentially significant advance.