Balloon Dilation of the Eustachian Tube

The Eustachian tube is a channel of bone and cartilage. It connects the middle ear, the air-filled space behind the eardrum, to the nasopharynx at the very back of the nose. At rest the tube stays closed, so that neither air nor fluid passes. When you swallow, the muscles around it contract and open it, and air passes between the middle ear and the back of the nose.

The tube does three things. It balances the pressure in the middle ear against the pressure outside. It drains the secretions that collect in the middle ear. It protects the middle ear from the infection and the secretions that come from the back of the nose.

What blocks it

The tube blocks after upper airway infections that involve the back of the nose, with allergic reactions, with sinus infections, after surgical injury, and because of tumours and masses in that area. It also happens with no cause at all, because of the shape of the tube itself.

What blockage causes

When the pressure in the middle ear cannot be equalised, negative pressure builds up. Early on this causes a feeling of fullness in the ear, ringing, blockage and a sense that hearing has dropped.

If the pressure stays unequal for a long time, fluid collects in the middle ear. The eardrum is pulled inwards, sticks to the structures of the middle ear and forms pockets. Serious long-standing middle ear infection follows.

Patients with milder blockage notice nothing most of the time. Their complaints appear during infections and allergic reactions that swell the lining of the tube, or when the outside pressure changes quickly, as on a flight or during a dive.

Treatment

When the blockage develops quickly, after an infection or an allergic reaction, medicines and nasal sprays that reduce the swelling of the lining usually help. When the problem is long-standing, medical treatment usually fails.

Balloon dilation of the Eustachian tube came into use recently and gives very good results in patients with long-standing blockage. The surgeon passes a special catheter into the mouth of the tube at the back of the nose, guided by an endoscope through the nose. The balloon on the catheter is inflated inside the cartilage part of the tube. The tube widens, and its function improves for a long time.

The procedure is very safe in suitable patients. It is usually done under general anaesthesia, and both sides together take about 15 to 20 minutes.

Who it suits

• Patients whose long-standing tube problem has caused fluid in the middle ear, a collapsed eardrum, pockets in the eardrum, or an eardrum stuck to the middle ear structures
• Patients who cannot equalise middle ear pressure on flights or while diving even with medicines, and who get fluid, infection, bleeding or severe pain as a result