Middle Ear Pressure Changes during Balloon Eustachian Tuboplasty

Abstract

Objective Balloon eustachian tuboplasty (BET) has entered clinical use as a treatment for eustachian tube dysfunction. Some surgeons perform myringotomy prior to BET due to concerns that the increase in middle ear (ME) pressure caused by BET may cause otic barotrauma. We investigated the ME pressure changes occurring during BET in cadavers. Study design Human cadaver investigation of a surgical technique Setting Laboratory study at a tertiary referral center. Subjects and Methods ME pressures were recorded from fresh-frozen cadavers, and BET was performed with the Bielefeld balloon catheter inflated to 10 bar. Peak ME pressures were recorded during catheter insertion, inflation, deflation, and removal. A second pressure measurement was taken 15 seconds after each stage to assess the residual pressures. All BET procedures were repeated at least once. Where transmastoid recordings were made, BET was repeated, measuring pressure via a myringotomy to ensure equivalence. Results Data from 25 procedures in 13 ears (9 heads) were analyzed. A consistent pattern of ME pressure change was observed in all cases. Positive pressures occurred on insertion (maximum, 26 daPa) and inflation (maximum, 99 daPa) and negative pressures on deflation (maximum, –46 daPa) and removal (maximum, –42 daPa). There were no significant pressure differences between first and second procedures, except at 15 seconds after insertion ( P = .04). Conclusion In adult cadaveric specimens, BET induces ME pressures within the normal physiologic range. On this basis, routine myringotomy prior to BET in adults is not necessary.