Emerging treatments
Tuboplasty
It has been suggested that, in the presence of Eustachian tube dysfunction (ETD) secondary to edema of the mucous membranes, surgical tuboplasty may be indicated.[36][37] The treatment is designed to allow for greater opening of the Eustachian tube orifice, through removal of mucosal volume at the orifice and submucosal scarring at the posterior aspect of the orifice. The treatment may be given at any time, but to date has been reserved for patients refractory to therapy for allergy and sinonasal complaints and are diagnosed with edema of the Eustachian tube orifice. Laser Eustachian tuboplasty or microdebrider Eustachian tuboplasty may be used. In the literature, reports of these procedures have found no significant adverse effects.[38][36]
Transnasal endoscopic balloon dilation
Transnasal endoscopic balloon dilation of the Eustachian tube (BDET) involves placing a sinus balloon catheter transnasally in the proximal Eustachian tube to dilate the cartilaginous part. One study reports benefit for up to 3 years, while another reports postoperative improvement in tympanometry and otoscopic appearance.[39][40] One systematic review of observational studies has demonstrated safety and efficacy among adults with chronic ETD.[41] One randomized controlled trial of adults undergoing BDET plus corticosteroid spray compared with corticosteroid spray alone demonstrated superiority in normalizing tympanometry (51.8% vs 13.9%) and Eustachian Tube Dysfunction Questionnaire-7 Symptom scores (56.2% vs 8.5%) at 6 weeks after the procedure.[42] In 2019 US and UK guidance was published to help clinicians considering this procedure.[43][44]
Use of this content is subject to our disclaimer