Balloon eustachian tuboplasty. Indications, technique and results. Literature review

Dysfunction of the Eustachian tube (ET) has an incidence 0.9-4,6% in adults and 6.1% in children. Balloon Eustachian tuboplasty (BET) is not the only one treatment for Eustachian tube dysfunction (ETD), but is relatively new. The experience accumulated in the world over 12 years of using BET and the results require a comprehensive assessment, which was objective of this literature review. In this review, ETD refers to its obstructive variant, as the most common, and the only one in which ETD indicated. The article contains actual preoperative diagnostic studies for BET based on international and local clinical guidelines, which contains otomicroscopy, tympanometry, tuning fork tests, tone audiometry, nasopharyngoscopy, functional tests, ETDQ-7 (Eustachian Tube Dysfunction Questionnaire); indications and contraindications for BET are also presented. The options for access to ET, the technical features for performing BET and its modification in terms of the balloon inflation algorithm, exposure time, pressure inside the balloon and the frequency of the procedure are described. At the same time, in studies conducted under the conditions of BET simulation, it was proved that most of the plastic deformation occurs at low inflation pressure, below 5 bar, tissue deformation continues even when the pressure rises to 10 bar, but it is elastic, not plastic in nature. Plastic deformation was observed only during the first inflation, thus, multiple repeated inflations proposed by a number of authors do not increase the clinical efficacy of BET and increase the risk of complications. The article contains possible and documented complications of BET and the frequency of their occurrence, while no study reported serious negative consequences. The effectiveness of BET in the treatment of persistent ETD, in the early and in the long-term periods, more than 50% of any study population. However, it is difficult to assess the results of BET, since the design of studies varies: the differences begin with the definition of BET, the sample of patients and examination methods, and end with different criteria for evaluating the effectiveness of the technique. Further development of appropriate clinical guidelines will allow the maximum standardization of clinical trial planning and simplify the comparison of results and meta-analysis of data. The effect of BET requires further clinical studies in patients with secretory otitis media with respiratory allergies, patients with chronic suppurative otitis media and ETD, patients after ineffective primary BET. Key words: Eustachian tube, balloon Eustachian tuboplasty, Eustachian tube dysfunction, secretory otitis media, chronic suppurative otitis media Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study