Clin Exp Otorhinolaryngol.  2020 Nov;13(4):389-395. 10.21053/ceo.2019.01305.

Navigation-Assisted Balloon Eustachian Tuboplasty for Eustachian Tube Dilatory Dysfunction

• Choi SW
• Lee SH
• Oh SJ
• Kong SK

• KMID: 2508515
• DOI: http://doi.org/10.21053/ceo.2019.01305

Abstract

Objectives
. Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD.
Methods
. Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients’ symptoms preoperatively and at the postoperative follow-up.
Results
. Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient’s final visit at 6 months post-procedure.
Conclusion
. Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.

Keyword

Eustachian Tube; Dilatation; Dysfunction; Trauma; Navigation system

Figure

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  Fig. 1. (A) Photographs of the balloon catheter (arrow), guide catheter (arrowhead), and inflation device (asterisk). (B) Distal end of the balloon catheter, comprising an electromagnetic navigation sensor (arrow), a balloon (16 mm in length and 6 mm in diameter at 12 atm; arrowhead), and a black proximal balloon marker (asterisk). (C) Cross-sectional view of the balloon catheter consisting of an electromagnetic sensor part (0.9 mm in diameter; asterisk), inner tube (1.2 mm in diameter; arrow) and outer tube (1.6 mm in diameter; arrowhead). (D) Flexibility of the guide catheter. Neutral position (asterisks), right- and left-sided bending (arrows), and upward and downward bending (arrowheads).

• 

  Fig. 2. (A) Intraoperative view showing the insertion depth of the catheter tip as confirmed during a balloon Eustachian tuboplasty procedure. The catheter tip was advanced until its tip reached the isthmus. The on-screen crosshair provided real-time localization in three dimensions. Intraoperative view showing the internal carotid artery (asterisks). (B) Endoscopic photograph of catheter tip insertion over a black proximal endoscopic marker (denoting canalization of the cartilaginous segment of the Eustachian tube).

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  Fig. 3. Total 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores preoperatively, and at 1 month and 6 months post-procedure.

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  Fig. 4. (A) Preoperative computed tomography (CT) scans during the Valsalva maneuver, showing the nasopharyngeal end of the Eustachian tube (arrowheads). (B) Six-month postoperative CT scans during the Valsalva maneuver, showing patency of the cartilaginous Eustachian tube (arrows). (C) Six-month postoperative CT scans without the Valsalva maneuver. No micro-fracture was found along the bony canal of the internal carotid artery (asterisks).

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