Balloon Eustachian Tubuloplasty (BETP) was approved by the U.S. Food and Drug Administration (FDA) on September 16th, 2016 to treat patients with Eustachian tube dysfunction (ETD). ETD is estimated to occur as a chronic condition in about 4% of adults worldwide, but it is an intermittent problem in an unknown higher percentage. ETD is commonly caused by a cold, the flu, a sinus infection, or allergies. Dr. Dennis Poe, an Associate Professor in the Department of Otology and Laryngology at Harvard Medical School and a full-time faculty member of the Department of Otolaryngology and Communications Enhancement at Boston Children’s Hospital, is the one to credit for developing this procedure.
What exactly is Eustachian tube dysfunction?
The Eustachian tube connects the middle of the ear to the back of the throat. Generally it is filled with air and helps to maintain an equal pressure inside the ear by opening and closing, similar to a valve. This valve opens during yawning or chewing and can allow for a release of pressure when in an airplane or driving in a car. Eustachian tube dysfuntion occurs when this tube becomes blocked symptoms manifest. Generally, treating the underlying cause is suggested, but for patients who have chronic ETD, additional interventions might be needed. With the recent FDA approval of the Eustachian Tube Balloon Dilation System, patients who have recurrent ETD can be treated with a simple 10-minute procedure.
What are symptoms of Eustachian tube dysfunction?
Common symptoms of ETD include:
- Feeling that your ears are plugged or full
- Sounds may seem muffled
- A popping or clicking sensation (children may say their ear “tickles”)
- Pain in one or both ears
- A ringing noise in your ear called tinnitus
- Trouble keeping your balance
If you experience any of these symptoms on a regular basis, don’t hesitate to contact South Florida ENT Specialist, Dr. Octavio “Gus” Carreño and his ENT Miami staff. Individuals who suffer from chronic Eustachian tube dysfunction should talk with an ENT doctor like Dr. Carreño to see if treatment is necessary.
Who does Eustachian tube dysfunction occur in most?
ETD occurs most often in:
- Children: due to their shorter and straighter Eustachian tubes, children are more prone to ear infections because germs and fluids can more easily become trapped in their ear. Children’s immune systems aren’t fully developed, further making them more susceptible to ETD.
- People who smoke: because smoking damages the cilia (the tiny hairs that sweep mucus from the middle ear to the back of the nose) it causes mucus to gather in the tubes.
- People who are overweight: fatty deposits around the tubes can lead to ETD.
What does the procedure entail?
The Balloon Eustachian Tubuloplasty (BETP) procedure is performed by a doctor who uses a small catheter to insert a small balloon through the patient’s nose and into the Eustachian tube. The balloon is then inflated, opening up a pathway for mucus and air to flow through the otherwise clogged Eustachian tube, helping to restore it to normal functions.
Clinical trials using the Eustachian Tube Balloon Dilation System showed that 52% of patients (299 total in this study) had normal tympanogram results six weeks after the procedure. Comparatively, only 14% of patients who were treated only with a conventional medical management (nasal spray) had normal tympanogram results. Another study of 100 Eustachian tube dilations with follow-ups over two years showed a 70% success rate and a 15% recurrence rate. Repeat dilations can be effective as well.
How does BETP compare to other treatment options?
- Other treatment options include:
- Using a decongestant to reduce the swelling of the lining of the tubes.
- Taking an antihistamine or using a steroid nasal spray to reduce any allergic response.
- Making a tiny incision in the eardrum and suctioning out the fluid in the middle ear. This gives the Eustachian tube lining time to shrink while the eardrum is healing (usually 1 to 3 days).
- Implanting small tubes in the eardrums. These let built-up fluid drain out of the middle ear. Children who get a lot of ear infections sometimes get tubes in their ears. They stay in for up to 18 months and fall out on their own.
BETP is thought to be more effective than initial treatments that target potential causes for mucosal inflammation. No initial treatment, such as steroids or allergy medications, have proven reliably effective according to Dr. Edward McCoul, the director of rhinology and sinus surgery at Ochsner Clinic and Health System. Making an incision in the eardrum is an invasive procedure that has the potential side effects including tympanic membrane perforation, scarring, and hearing loss. Thus far, the BETP appears to be the safest, most effective, and lowest risk procedure for ETD. It is also a benefit to patients as it can be repeated multiple times. The most common adverse events associated with the Eustachian Tube Balloon Dilation System were small tears in the lining of the Eustachian tube, minor bleeding and worsening of ETD.
Who should you see?
If you live in the South Florida area, please reach out to Dr. Carreño and his ENT Miami staff for questions about the procedure or other ENT questions. Dr. Carreño is board certified by the American Board of Otolaryngology and has been a Staff Otolaryngologist in the South Florida area since 2011. He and his ENT staff are happy to care for you and address any questions you might have or to discuss if you would be a good candidate for this or other ENT procedures.