Balloon Dilation of the Eustachian Tube

[Seilesh Babu MD]
Let's even start back with like, when a patient does come in, like you're alluding to, what symptoms should we be looking for? So I think, certain subsets of patients come in with easy decision-making as to what do we do. A patient who has baro challenges. They go scuba diving, they fly in an airplane, and they have. And then when you see them in the office, of course, they're going to have more of a normal examination because they're not having that problems, but you can trust their history enough. And experience has taught us that I think those type of patients do well with this type of intervention. Whether it's a tube in the ear or a balloon dilation, they'll actually do well in that scenario. And then you have some patients that come in with multiple serous effusions and they've had multiple tubes in their ears. And I think that also is a good candidate for their hearing loss, their ear fullness, multiple tubes that have helped their symptoms. I think that's a good candidate also to be looking at next steps. And in the patients who come in with ear fullness, I think that becomes a harder challenge to delineate what therapy is going to help that patient with ear fullness and ear fullness is a tough one. I have found myself putting them in categories and trying to figure out is it eustachian tube related or not? Is it Meneire’s disease? Is it superior canal dehiscence? Is it maybe masseter or pterygoid muscle tension that may be causing some of this? Is it anxiety? Are there other factors that we have to take into account? I think one of my main things that I do is I try doing either a myringotomy or a tympanostomy tube in that scenario to see, does that give them relief? My opinion is if it does not give them relief, then I don't think eustachian tube dysfunction is their main issue. And therefore, I don't think a balloon dilation would be indicated in that scenario, but that's a long-winded sort of way of saying what do these patients present with?

But the next steps then we think about evaluation is I think we should do a good thorough examination of their ears. See if there's retraction of the tympanic memory and see if there's fluid in the middle ear space. I think all of these patients should have nasopharygoscopy, as we had talked about to really look at the nasal pharynx. See, is there adenoid tissue? Is there adenoid in the eustachian tube? Is there hypertrophy of the torus tubarius? Is there mucosal edema? Is there cobblestoning? What is the movement of the eustachian tube look like? Some of that over time will give you a sense of maybe this is a good one to intervene on. All of them will get audiograms. I don't always get tympanograms, but many times tympanograms will help decide. There was a time where insurance coverage was an issue. And so you'd have to get a tympanogram on everybody to show that it was a flat or poor, but that has changed a bit now. So it's not as critical to get that, but many places will still get it. It's a good way to follow objectively. What do they do afterwards if it became normal.